Soon after the Acquired Immunodeficiency Syndrome (AIDS) was initially described, the epidemiology of the syndrome suggested that a blood-borne, sexually transmitted agent was an important factor in the development of the syndrome. The identification and isolation of the human immunodeficiency virus (HIV) as the etiologic agent of AIDS, followed by the development of sensitive and specific assays for the detection of antibodies to its viral proteins, facilitated the study of specific forms of transmission of the virus as well as the natural history of HIV infections. In this paper, the current evidence is reviewed regarding the modes of sexual transmission of HIV in homosexuals and heterosexuals. Several well designed studies support the efficient transmission of HIV via receptive and insertive anal intercourse and by vaginal intercourse. There is no current evidence, despite detailed study, to suggest that kissing, oral-genital, or oral-anal sexual contact provides an efficient means of viral transmission. Activities which promote or result in anorectal or vaginal mucosal injury appear to facilitate infection with this virus.
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