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With regard to unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high-income countries. [56] In low-income countries, the risk of female-to-male transmission is estimated as 0. 38% per act, and of male-to-female transmission as 0. 30% per act; the equivalent estimates for high-income countries are 0. 04% per act for female-to-male transmission, and 0. 08% per act for male-to-female transmission. [56] The risk of transmission from anal intercourse is especially high, estimated as 1. 4–1. 7% per act in both heterosexual and homosexual contacts. [56][57] While the risk of transmission from oral sex is relatively low, it is still present. [58] The risk from receiving oral sex has been described as "nearly nil";[59] however, a few cases have been reported. [60] The per-act risk is estimated at 0–0. 04% for receptive oral intercourse. [61] In settings involving prostitution in low-income countries, risk of female-to-male transmission has been estimated as 2. 4% per act, and of male-to-female transmission as 0. 05% per act. [56]

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