EPIDEMIOLOGY OF ORAL HIV 1 & 2 INFECTION IN HIGH RISK WO

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DESCRIPTION: (Adapted from Applicant's Abstract) Transmission of HIV via oral-genital contact has now been convincingly documented. Risk of HIV transmission during unprotected oral-genital sex appears to be low compared to that encountered during unprotected vaginal sex. However, the true risk of oral HIV transmission has been difficult to assess as relatively few individuals engage exclusively in oral sexual contact. Attempting to estimate this risk using HIV seroconversion as an endpoint would be prohibitively expensive and present ethical problems. Other approaches are needed to assess aspects of oral HIV transmission. Development of HIV education and risk reduction programs related to oral HIV transmission are currently important since recent data suggest that in some high risk groups, attempts to decrease high risk behaviors (such as unprotected anal or vaginal sex) have made unprotected oral sex exceedingly common, perhaps increasing the proportion of HIV infections in these populations attributable to orogenital sexual contact. Development of educational programs concerning risk of oral HIV transmission is urgently needed in Africa where the majority of HIV infections have occurred, and where commercial sex workers (CSWs) have been integral to the spread of HIV-1 and HIV-2. Little is known about the frequency and determinants of fellation and its relationship to risk of HIV infection. However, a survey the investigators undertook during the emergence of the HIV-1 epidemic in Senegal revealed that most CSMs frequently engaged in both vaginal sex and fellatio. Some CSWs in Senegal have enrolled in HIV testing and counseling programs and it is possible that such programs have stressed fellatio in lieu of vaginal sex. The investigators are proposing a study among CSWs in Senegal to examine the role of fellatio in the spread of HIV-1 and HIV-2. Specifically, they propose to (1) describe the frequency and determinants of the practice of fellatio among CSWs, and among CSWs who have not been previously tested for HIV or been enrolled in HIV risk reduction programs, to determine the associations between HIV serologic status and fellatio and other sexual practices, (2) provide insights into risk of transmission of HIV from infected CSWs to uninfected male partners during fellatio by describing the determinants of the frequency and quantity with which HIV is shed into oral secretions, and (3) undertake a small pilot study to attempt to decrease the frequency and level of HIV in oral secretions by using low cost topical treatments for lesions known to be associated with inflammation.