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Safe, safer, safest: the hierarchy of sexual risk behaviors for HIV.

HIV prevention providers have sought to facilitate risk reduction by formulating a hierarchical ranking of behaviors, ranging from those involving the greatest risk of HIV transmission to those involving the least risk. While broad comparisons between some behaviors—for example, mutual masturbation versus unprotected anal intercourse—are fairly straightforward, the degree of risk involved with other behav­ iors, such as oral sex, is far more debatable. This article provides a brief overview of the concept of risk and its use in epidemio­ logical research as well as a discussion of how and why HIV risk varies across indi­ viduals. It also summarizes key research findings on the risk associated with vari­ ous sexual behaviors including why the risk associated with some behaviors is so difficult to estimate. It concludes with gen­ eral recommendations for HIV prevention providers about advising clients on how best to manage their risk of HIV infection.