Meng, X., Zou, H., Fan, S., et al. AIDS and Behavior (May 2015), Vol. 19, Issue 5, pp. 882–889.
The authors of this review examined global data on the relative HIV risk of different modes of anal sex among men who have sex with men (MSM). They analyzed 21 papers published before September 2013 and conducted a meta-analysis of HIV prevalence and relative risk for HIV infection for two time periods: 1981–1985 and 1986–2010. Their analysis showed that men engaging in receptive anal intercourse only (MRAI) were 6.9 and 1.8 times more likely to be HIV-positive in 1981–1985 and 1986–2010, respectively; and 6.2 times more likely to develop incident HIV infection overall, compared to men engaging in insertive anal intercourse only (MIAI) during those time periods. Overall, MRAI and men engaging in both insertive and receptive anal sex were 6.2 and 6.6 times more likely to develop incident HIV infection compared to MIAI. This study is the first to provide concrete data evidence that sexual positioning is significantly associated with HIV transmission among MSM. The authors concluded that despite relatively lower prevalence and incidence of HIV in men engaging in insertive anal sex only, the prevalence and incidence of HIV were invariably high among men engaging in any variation of anal sex.