Anal intercourse between men and women

  • Anal intercourse plays an important role in HIV transmission between heterosexuals.

Anal intercourse between men and women has generally not received as much attention as anal intercourse between men. However, there is evidence that anal sex is practised by large numbers of sexually active adults on a regular basis, and that anal intercourse plays an important role in HIV transmission amongst heterosexuals.

One quarter of heterosexual women in the United States have reported having anal intercourse occasionally, and 10% engage in it regularly. A 2004 telephone survey of heterosexuals under 35 conducted by the US Association for Social Health found that, of the approximately 7% of heterosexuals who said they had anal sex, 65% did not use condoms.

In the UK, 12.3% of male respondents and 11.3% of women who responded to the National Survey of Sexual Attitudes and Lifestyles (2000) reported anal intercourse with a partner of the opposite sex in the previous year.

In 1992 the European Study on Heterosexual Transmission of HIV highlighted anal intercourse as one of the factors which increased the likelihood of transmission amongst the couples in the study, and showed that amongst couples where the infected partner was still asymptomatic (and not likely to be highly infectious), the chance that infection was likely to have taken place through anal intercourse was five times greater than through vaginal intercourse. (Caution should be exercised when drawing conclusions from these findings, because of the small numbers involved.) Unprotected heterosexual anal sex has also been shown to be a significant route of HIV infection in Africa, especially in young men and women.1 2

The risk of infection for a woman from one act of anal intercourse has been reported as 2.3 times greater than that from vaginal intercourse.3


  1. Lane T et al. Anal sex as a risk factor for HIV infection among young people aged 15-24 in South Africa: data from a nationally representative household survey. XV International AIDS Conference, Bangkok, abstract LbOrC21, 2004
  2. Vandenhoudt H et al. First sexual intercourse and exposure to HIV infection among young women in a high HIV prevalence area in Western Kenya. XV International AIDS Conference, Bangkok, abstract LbOrC22, 2004
  3. Padian N et al. Female to male transmission of Human Immunodeficiency Virus. JAMA 266(12): 1664-1667, 1987
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap