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Nevertheless, there is evidence to suggest that anal intercourse is also widely practiced by women in the US 1 — 4. Given that anal intercourse is associated with higher rates of heterosexual HIV transmission than vaginal intercourse 10 — 13 , women who engage in unprotected anal intercourse with sexual partners of unknown or seropositive status may be at greater risk for acquiring HIV than women who do not practice anal intercourse or who use protection while doing so. Additionally, Halperin 1 found that women who engaged in anal intercourse were less likely to use condoms during anal intercourse than during vaginal intercourse. Most studies of heterosexual HIV transmission fail to distinguish between vaginal and anal intercourse in their assessments of coital acts, thus continuing to overlook anal intercourse as a potential source of HIV transmission.