We examined the relation between recent cocaine use and heterosexual exposure to human immunodeficiency virus (HIV). Five hundred nineteen heterosexually active participants in the New England Behavioral Health Study, an HIV testing and counseling program, provided information for this study. The outcome measure included behaviors that increased the risk for exposure to HIV via contact with infected genital secretions. Nearly one-third (31.8%) of participants reported use of cocaine during the year before study entry. These individuals were 1.3 times [90% confidence interval (CI) = 1.1–1.7] more likely to risk HIV exposure than people not using cocaine during this period, with evidence of a dose-dependent relation among HIV-positive cocaine users. HIV-positive crack users were at 1.9 times greater risk (90% CI = 1.2–2.9) for HIV risk-taking behavior than those who did not use crack. The effect of cocaine was present even among those individuals without other injection drug use.