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Sexual transmission through genital and rectal mucosa accounts for the vast majority of HIV- 1 infections worldwide. The viral invasion in women occurs mostly through the non-keratinized squamous epithelium of the vagina and ectocervix, and also through the single-layer columnar epithelium of the endocervix figure 2A. Sexual transmission in men most frequently takes place through the inner foreskin and the penile urethra as a consequence of penile—vaginal or penile—anal intercourse figure 2B. Therefore, HIV sexual transmission mechanisms in female genital mucosa are reviewed below in more detail. Human vagina and ectocervix are covered by non-keratinized squamous epithelium, which can be abraded by shearing during sexual intercourse. There are several pathways for HIV virions, either free or infected donor cell-associated, to traverse the surface of female genital mucosa.

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Another study conducted by the University of Indiana asked questions on heterosexual anal sex and found that the percentage having anal intercourse within the past year demonstrated a similar age breakdown as that of the NSFG. Adolescents are also practicing heterosexual anal sex; and again, the prevalence increases with age. Are there health concerns regarding heterosexual anal intercourse? Of course — as with all types of sexual activity — there are both emotional and physical pitfalls.
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