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In these countries, the researchers calculated a transmission risk of 0.19% when the male partner was HIV-positive, and 0.87% when the female partner had HIV.

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Two studies provided data on the circumcision status of male partners who were at risk of HIV infection.

In both cases, the transmission risk was higher for men who were not circumcised, especially if they also had genital ulcer disease.

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They speculate that the overall higher apparent risk could be driven by higher rates of sexually transmitted infections or higher viral load levels.

Nonetheless, they point out that the figures from low-income settings suggest that there is a greater risk of transmission from women to men than the other way round, which is the inverse of the high-income country findings and is generally considered less biologically plausible.

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More than half were conducted in the USA or western Europe, with most of the others carried out in Africa, and a handful conducted in Thailand and Haiti.

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