Applied & Preventive Psychology 3:75-90 (1994). CambridgeUniversityPress. Printed in the USA. Copyright © 1994AAAPP 0962-1849/94 $5.00 + .00 Heterosexual behaviors and risk of exposure to HIV: Current status and prospects for change PAUL J. POPPEN AND CAROL A. REISEN Department of Psychology, The George Washington University, Washington, D.C. Abstract Prevalence of HIV among heterosexuals is relatively low as compared to that of gay and bisexual males and intravenous drug users (IDUs). However, many heterosexuals engage in behavior that places them at risk for exposure to HIV. Changes in sexual behavior in response to HIV are reviewed for both high-prevalence groups such as gay and bisexual men and IDUs and lower prevalence heterosexual groups. Psychosocial factors contributing to behavior change are evaluated. The implications for future changes by heterosexuals, especially the adoption of self- protective behaviors such as condom use, are discussed. Key words: Heterosexual, HIV, Risk-taking, Sexual behavior Control of the spread of the AIDS epidemic through sexual contact will require changes in behaviors that place people at risk for HIV infection. While a major goal of the public health agenda has been to foster changes in sexual practices of gay and bisexual men, who are at high risk for HIV infection, changes must also occur for heterosexuals, who are at lower risk. While heterosexual contact is responsible for fewer than one-tenth of new cases of AIDS, this mode of transmission is the most rapidly increasing category (Cen- ters for Disease Control [CDC], 1993a). To prevent further spread of the epidemic, it is essential to affect behavior change among heterosexuals. This paper focuses on hetero- sexual behaviors relevant to exposure to HIV. The AIDS epidemic in the United States has dispropor- tionately affected the gay and bisexual male community, intravenous drug users (IDUs) and their sexual partners, hemophiliacs, and racial and ethnic minorities. Research and intervention efforts to control the spread of HIV have been aimed at all of these groups, but the vast bulk has targeted gay and bisexual men. Research on gay and bisex- ual men has allowed the identification of factors that facili- tate and impede change to lower risk sexual behavior and also provided documentation of reductions in unsafe sexual practices and in the rate of new HIV infections. The public health policy to target high-risk groups, such as gay and bisexual men, has been an appropriate response to the ur- gency of the problem. Lower risk groups such as heterosex- Send correspondence and reprint requests to Paul J. Poppen, Depart- ment of Psychology, The GeorgeWashingtonUniversity,Washington,DC 20052. uals have been the object of far less attention. Currently there is very little research in the United States on sexual practices of the general heterosexual population that place them at risk for HIV infection. This article reviews the available literature on heterosex- ual risk-taking and compares it to the more extensive litera- ture on higher risk groups in order to identify social and psychological factors that might be significant in influenc- ing heterosexual behavior change. Attention will be paid to the general adult population as well as to subgroups among heterosexuals (adolescents, high risk adolescents, racial and ethnic minorities, and women) to identify unique circum- stances within these groups that create opportunities for and barriers to change. A brief epidemiological overview of AIDS will be provided, with a concentration on modes of transmission and populations most affected. The conclusion of the article discusses prospects for change in the hetero- sexual population and problems that need to be addressed to accomplish this change. 75 Epidemiology The spread of AIDS within the United States continues at a somber pace. The first case of AIDS was reported in June 1981. Within 78 months, 50,000 cases were reported. In only 20 more months, the next 50,000 cases were reported, and 14 months after that, the next 100,000 (CDC, 1992b). By the end of 1992, more than 250,000 cases of AIDS had been reported to the CDC, with over 160,000 of these result- ing in death (CDC, 1993a). Blood-screening studies per-