About 22% of new HIV infections in the United States are among straight people, based on 2022 estimates. That translates to roughly 7,000 of the 31,800 new infections that year. While gay and bisexual men account for the majority of new cases (66% of diagnoses in 2023), heterosexual transmission remains a significant route of infection, particularly for women.
The U.S. Numbers by Gender
Among straight people newly infected with HIV, women outnumber men by more than two to one. Of the estimated 7,000 heterosexual infections in 2022, about 4,900 (15% of all new infections) were among women, while 2,100 (6%) were among men. In 2023, women overall represented 19% of all HIV diagnoses in the U.S., and the vast majority of those were through heterosexual contact.
This gender gap exists largely because receptive vaginal sex carries a higher per-act risk of HIV transmission than insertive vaginal sex. Biological factors like a larger surface area of exposed tissue make women more vulnerable during intercourse with an infected male partner.
Racial and Geographic Disparities
The 22% figure is a national average, and it masks enormous variation by race and geography. Black women are disproportionately affected by heterosexual HIV transmission. They account for a far larger share of new heterosexual diagnoses than white or Hispanic women relative to their population size. Poverty, limited access to healthcare, and higher background prevalence of HIV in certain communities all contribute to this disparity. In the U.S. South, where healthcare access gaps are widest, heterosexual transmission rates tend to be higher than in other regions.
Straight People Are More Likely to Be Diagnosed Late
One of the most concerning patterns in heterosexual HIV is how late people tend to find out. A Dutch study analyzing over 1,600 heterosexual HIV diagnoses between 2012 and 2022 found that 57% were classified as late-stage disease, meaning the immune system had already sustained significant damage by the time of diagnosis. In 2023, that number was 58% for heterosexuals, compared to 30% for gay and bisexual men and transgender individuals. Across Europe, the pattern is similar: about 55% of heterosexual diagnoses in 2022 were late-stage versus 41% among men who have sex with men.
Late diagnosis matters because it means years of untreated infection during which a person can unknowingly pass the virus to partners. It also means worse health outcomes. People diagnosed late start treatment with a weaker immune system and face higher risks of serious illness.
Why Straight People Get Tested Less
The main reason for late diagnosis is simple: straight people are far less likely to get tested. Many don’t perceive themselves as being at risk, and their doctors often don’t bring it up. A CDC study of heterosexual adults at increased risk for HIV found that 58% had never been offered an HIV test by a healthcare provider. Among that group, 37% had never been tested at all. When providers did offer a test, 96% of patients accepted, suggesting the barrier isn’t reluctance but the fact that the conversation never happens.
The CDC has recommended routine HIV screening at least once for all adults aged 13 to 64 since 2006, regardless of perceived risk. Yet many providers still treat HIV testing as something to offer only to patients they consider high-risk, which often means they skip straight patients entirely.
Global Context
The U.S. picture is unusual compared to the rest of the world. Globally, heterosexual contact is the dominant mode of HIV transmission. In sub-Saharan Africa, which carries the heaviest burden of HIV worldwide, the epidemic is driven primarily by heterosexual sex, and women make up the majority of people living with the virus. The relatively low percentage of heterosexual cases in the U.S. reflects the specific epidemiological pattern in this country, not a biological rule about who can contract HIV.
In Western Europe, heterosexual transmission accounts for a larger share of new diagnoses than in the U.S., often ranging from 25% to over 40% depending on the country. Immigration from regions with high HIV prevalence contributes to some of these numbers, as people may have acquired the virus through heterosexual contact before arriving in Europe.
What This Means for Risk
The 22% figure sometimes leads people to conclude that straight sex is low-risk for HIV. That’s a misreading of the data. The percentage reflects how many people in each group are getting infected relative to the total, not how risky any individual encounter is. Unprotected vaginal sex with an HIV-positive partner who isn’t on treatment carries real transmission risk, estimated at roughly 1 in 1,000 per act for men and closer to 1 in 500 for women. Those odds increase substantially with concurrent sexually transmitted infections, which cause inflammation and make transmission easier.
Pre-exposure prophylaxis (PrEP), a daily or on-demand medication that prevents HIV infection, is highly effective for straight people but dramatically underused. Uptake among heterosexual women in particular remains very low compared to gay and bisexual men, despite the fact that women represent the majority of straight people diagnosed each year. If you’re sexually active with partners whose HIV status you don’t know, PrEP and regular testing are the most reliable ways to stay protected.