On this page
- The Bottom Line
- Key Facts
- Straight Does Not Mean Risk-Free
- The Conversation Is Missing in Routine Care
- How PrEP Became Branded as “Not for Me”
- Black Women Are Being Lost Between Referral and Prescription
- Why LGBTQIA+ and Sexual-Health Clinics Often Do This Better
- What Every Healthcare Practice Can Do
- What Patients Can Ask
- Sexual Health Is Primary Care
- When to Seek Medical Care
- Research & references
The Bottom Line
Picture your last routine medical appointment.
Someone probably checked your blood pressure. They may have asked whether you smoke, exercise, sleep well, or wear a seat belt. If you have the right—or wrong—birthday coming up, they may have reminded you about a colonoscopy before you even sat down.
But did anyone ask about your sexual health?
Not simply whether you needed birth control or had symptoms of a sexually transmitted infection. Did anyone ask what kind of sex you have, whether you know your partner's HIV status, when you were last tested, whether sex is comfortable and pleasurable, or whether pre-exposure prophylaxis—better known as PrEP—might be useful to you?
For many patients, the answer is no.
That silence matters because HIV prevention is still too often treated as specialty care for gay and bisexual men instead of an ordinary part of healthcare for every sexually active person. LGBTQIA+-focused and dedicated sexual-health clinics did not create this problem by talking about HIV too much. They developed expertise because their communities fought for informed, affirming care during an epidemic that was too often met with neglect.
The problem is that the rest of healthcare has not fully carried those lessons into every exam room.
Key Facts
- In 2022, heterosexual contact accounted for 22% of new HIV diagnoses in the United States and six territories—8,495 diagnoses.
- Among women diagnosed with HIV in 2022, approximately 83% of diagnoses were attributed to heterosexual contact.
- In 2024, Black females accounted for 52% of HIV diagnoses among females while representing only 13% of the female population.
- Only 42.4% of more than 53,000 patients across 13 federally qualified health-center sites had any documented sexual-history screening.
- When taken as prescribed, PrEP reduces the risk of acquiring HIV from sex by about 99%.
- CDC guidance says any licensed prescriber can prescribe PrEP—specialization in HIV medicine is not required.
Straight Does Not Mean Risk-Free
Sexual identity is not a laboratory result, and it is not a complete risk assessment.
A patient may identify as heterosexual while having partners of more than one gender. A married patient may not know that a partner has other partners. Someone may know a partner's HIV status but not when that person was last tested. People can also underestimate risk because HIV has been portrayed for decades as something that happens primarily to “other people.”
The national data make clear that heterosexual communities cannot be left out of HIV prevention.
In 2022, heterosexual contact accounted for 22% of new HIV diagnoses in the United States and six territories—8,495 diagnoses. That included 2,660 diagnoses among men and 5,835 among women attributed to heterosexual contact. [1] Among women diagnosed with HIV that year, approximately 83% of diagnoses were attributed to heterosexual contact. [2]
The disparities are especially serious for Black women. In its most recent surveillance release, the Centers for Disease Control and Prevention reported 7,752 HIV diagnoses among females in the United States in 2024. Black females accounted for 52% of those diagnoses while representing only 13% of the female population. Their HIV diagnosis rate was 12 times the rate among White females. [3]
Those numbers do not mean Black women are inherently riskier. They reflect overlapping structural conditions, including unequal access to prevention, poverty, regional differences in healthcare availability, medical mistrust, stigma, inconsistent testing, and providers who may not initiate the conversation.
HIV does not check a sexual-orientation box before transmission. Prevention cannot depend on that box either.
The Conversation Is Missing in Routine Care
The gap begins before anyone even mentions PrEP. Clinicians cannot recommend appropriate testing or prevention if sexual health is never discussed.
A 2023 mixed-methods study reviewed records for more than 53,000 patients across 13 federally qualified health-center sites. Only 42.4% had any documented sexual-history screening. Gay and lesbian patients had greater odds of being screened, while older patients and patients whose primary language was not English were less likely to have screening documented. Clinic staff described discomfort discussing sexual health and assumptions about patients who were older, married, in long-term relationships, or from particular cultures. [4]
There it is: the assumption problem.
Providers may assume a married woman is monogamous, an older adult is not sexually active, a heterosexual man does not need an HIV conversation, or a patient will raise the subject if something is wrong. Meanwhile, patients frequently wait for the clinician to ask because they are embarrassed, uncertain, or unaware that preventive options exist.
Everybody waits. Nobody talks. The blood pressure gets documented beautifully, though.
How PrEP Became Branded as “Not for Me”
PrEP is medication used by people without HIV to reduce their chance of acquiring it. When taken as prescribed, PrEP reduces the risk of acquiring HIV from sex by about 99%. [5]
Nevertheless, many heterosexual patients have never been told that PrEP could be an option for them.
In a 2026 qualitative study of 50 heterosexually active adults in New York City, approximately two-thirds had heard of PrEP, but none had used it. Most participants had never discussed PrEP or received information about it in a healthcare setting, even when they had recently undergone HIV testing. Many associated PrEP primarily with gay and bisexual men or transgender people because that was how they had encountered it through advertising and social networks. [6]
A 2025 study examining PrEP integration in an OB/GYN practice found similar barriers. Patients and staff reported limited PrEP knowledge, inadequate time during routine appointments, billing concerns, and varying comfort with sexual-health conversations. Some believed PrEP was only intended for gay men. [7]
That perception has consequences. If a woman believes PrEP is “a gay men's medication,” she is unlikely to ask about it. If her clinician makes the same assumption, the conversation may never happen.
Black Women Are Being Lost Between Referral and Prescription
Awareness is only the beginning. Patients must also move successfully from screening to referral, connection with a prescriber, and receipt of medication.
A 2024 analysis of a large HIV-prevention demonstration program showed just how badly that continuum can break down. Among Black women in the program, 2,805 were identified as eligible for PrEP, but only 270 were linked with a PrEP clinician and only 190—6.8%—were prescribed PrEP. [8]
Within the same program, 37% of eligible Black and Hispanic men who have sex with men and 45% of eligible transgender women received prescriptions. The answer is not to provide those groups with less support. It is to build equally intentional pathways for women and heterosexual patients.
In other words, handing someone a referral and wishing them luck is not a prevention program. It is paperwork wearing a name badge.
Why LGBTQIA+ and Sexual-Health Clinics Often Do This Better
Specialized clinics frequently have systems specifically designed for sexual healthcare. Staff are trained to use direct, nonjudgmental language. HIV and STI testing may be routine. PrEP education, laboratory monitoring, insurance navigation, and follow-up are built into the workflow. Patients are less likely to shock the room by mentioning anal sex, multiple partners, a partner of the same gender, or a question about pleasure.
Mainstream medical practices often operate differently. Sexual health competes with diabetes, hypertension, medication refills, acute complaints, preventive screenings, and a clock that seems to sprint once the clinician enters the room. Some clinicians received limited training in taking an inclusive sexual history. Others know about PrEP but are not comfortable prescribing it, mistakenly believing it belongs exclusively to infectious-disease specialists.
Current CDC guidance says otherwise. Clinicians should inform all sexually active adults and adolescents about PrEP, including people who do not report specific HIV risk factors. The CDC also states that any licensed prescriber can prescribe PrEP; specialization in HIV medicine is not required. [5]
The standard is no longer “wait until someone looks high-risk.” The standard is to provide information broadly enough for patients to make informed decisions.
What Every Healthcare Practice Can Do
Improving these conversations does not require turning every annual physical into an interrogation. It requires making sexual health routine, respectful, confidential, and clinically useful.
1. Ask Everyone, Not Only Patients Who “Look” at Risk
Clinicians can explain that they ask all patients the same questions regardless of age, gender, relationship status, or sexual orientation. Normalization reduces embarrassment and signals that honest answers will not be punished.
The CDC's “Five Ps” framework provides a practical structure: partners, practices, protection from STIs, past history of STIs, and pregnancy intention. [9] Questions should address behavior rather than rely on labels.
2. Make HIV Testing and PrEP Education Routine
Patients should not need to arrive already knowing the name of a medication before a clinician tells them it exists. HIV testing, PrEP, condoms, vaccines, post-exposure prophylaxis, and appropriate STI screening should be discussed as ordinary prevention options.
3. Build the Conversation Into the Workflow
Electronic health-record prompts, confidential previsit questionnaires, standing testing protocols, patient-education materials, and clear referral processes can prevent sexual health from disappearing when appointments become busy.
4. Prepare Primary Care, Men's Health, and OB/GYN Clinicians to Prescribe
PrEP can be managed in routine care. Practices that do not prescribe it should establish a dependable referral pathway that confirms whether the patient was actually connected—not merely whether a fax was sent into the wilderness.
5. Discuss Wellness, Not Only Infection
Sexual healthcare also includes consent, pleasure, pain, erectile concerns, vaginal and anal health, fertility goals, medication side effects, relationship safety, and sexual functioning. Patients are more likely to engage when the conversation is about helping them have healthier lives—not merely cataloging risky behavior.
What Patients Can Ask
Until routine care catches up, patients may need to begin the conversation themselves.
A clinician who responds professionally will not be shocked by these questions. A clinician who is uncomfortable may still need to hear them.
Sexual Health Is Primary Care
LGBTQIA+ clinics have demonstrated what happens when sexual health is treated as real healthcare: conversations become easier, testing becomes routine, and prevention tools become visible.
That approach should not remain behind the doors of specialty clinics.
Primary care should ask. Men's health should ask. OB/GYN clinicians should ask. Nurses should ask. Patients should be able to discuss HIV prevention without first proving that they belong to a particular community or meet someone else's idea of risk.
Sexual health belongs beside every other part of preventive care—without assumptions, shame, or whispered questions at the end of the appointment.
Because HIV prevention is not gay healthcare or straight healthcare.
It is healthcare.
When to Seek Medical Care
Contact a healthcare professional promptly if any of the following apply:
- You think you may have been exposed to HIV within the past 72 hours — post-exposure prophylaxis (PEP) is time-sensitive.
- You have never been tested for HIV, or you do not know when your last test was.
- You have new or unexplained genital, anal, or oral symptoms such as sores, discharge, burning, or pain.
- A partner tells you they have HIV or another sexually transmitted infection.
- You want to start PrEP, restart it, or discuss whether it fits your life.
If a clinician will not discuss sexual health with you, that is a reason to seek another clinician — not a reason to stop asking.
Frequently Asked Questions
Scholarly Sources & References
- 1.Centers for Disease Control and Prevention. “Fast Facts: HIV in the United States.” https://www.cdc.gov/hiv/data-research/facts-stats/index.html
- 2.HIV.gov. “U.S. Statistics.” Updated February 25, 2026. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
- 3.Centers for Disease Control and Prevention. “HIV Diagnoses, Deaths, and Prevalence—2024 Data Release.” May 18, 2026. https://www.cdc.gov/hiv-data/nhss/hiv-diagnoses-deaths-prevalence.html
- 4.Gagnon KW, Coulter RWS, Egan JE, Ho K, Hawk M. “Patient and Clinician Sociodemographics and Sexual History Screening at a Multisite Federally Qualified Health Center: A Mixed Methods Study.” Annals of Family Medicine. 2023;21(5):395–402. doi:10.1370/afm.3012
- 5.Centers for Disease Control and Prevention. “Clinical Guidance for PrEP.” Updated April 30, 2026. https://www.cdc.gov/hivnexus/hcp/prep/index.html
- 6.Meunier É, Ávila A, Kobrak P. “Considerations of HIV PrEP Among Heterosexually Active Women and Men: Results From a Qualitative Study in New York City.” Archives of Sexual Behavior. 2026;55:977–989. doi:10.1007/s10508-025-03303-2
- 7.Khosropour CM, Healy E, Murphy EM, et al. “‘I Honestly Didn't Know It Was for Women Too…’: Acceptability and Feasibility of Integrating PrEP Services Into OB/GYN Practices.” Frontiers in Health Services. 2025;5:1567688. doi:10.3389/frhs.2025.1567688
- 8.Townes A, Tanner MR, Yu L, et al. “Inequities Along the HIV Pre-Exposure Prophylaxis Services Continuum for Black Women in the United States, 2015–2020.” Obstetrics & Gynecology. 2024;143(2):294–301. doi:10.1097/AOG.0000000000005451
- 9.Centers for Disease Control and Prevention. “Guide to Taking a Sexual History.” Updated June 26, 2024. https://www.cdc.gov/sti/hcp/clinical-guidance/taking-a-sexual-history.html
