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It’s either needle sharing or gay anal sex that infects the man. Africa is different, because of the prevalence of other STDs.

That isn't quite correct. First of all, you are right in that insertive penile intercourse (be it vaginal or anal) is about 10 times less risky than receptive intercourse and that additional STDs facilitate transmission. However, that pales in comparison to another factor: most infections are due to high viral loads, be it either from full blown AIDS or in the course of the primary infection (first few weeks). The reason why there are so many cases in Africa is because many patients go undiagnosed for long times and because of a "web" of concurrent sexual affairs (e.g. husband has 6 women on the side, wife has 4 affairs) in some African cultures. It's the concurrence, i.e. simultaneous occurrence, that is the problem: This way one primary infection is spread among the group which is linked to the next group and so forth.

That way the HIV pandemic in Africa is sustained. Because of diffent cultural standards, such a spread would be unthinkable in most parts of the US. But that doesn't mean that individual heterosexuals are "safe". STDs are rampant among promiscuous Americans, too, and men can get HIV from a woman with a sufficiently high viral, it's just less likely. Statistically speaking that would be the difference between a limited local(ly sustainable) epidemic and a pandemic.

That isn’t quite correct. First of all, you are right in that insertive penile intercourse (be it vaginal or anal) is about 10 times less risky than receptive intercourse and that additional STDs facilitate transmission. However, that pales in comparison to another factor: most infections are due to high viral loads, be it either from full blown AIDS or in the course of the primary infection (first few weeks). The reason why there are so many cases in Africa is because many patients go undiagnosed for long times and because of a “web” of concurrent sexual affairs (e.g. husband has 6 women on the side, wife has 4 affairs) in some African cultures. It’s the concurrence, i.e. simultaneous occurrence, that is the problem: This way one primary infection is spread among the group which is linked to the next group and so forth.

A simpler way to look at this is that when African husbands and wives have open running genital sores due to STDs being commonplace, the HIV can easily be transmitted either way, unlike among typical US populations.