The majority of women who develop Acquired Immunodeficiency Syndrome (AIDS) are poor inner-city Blacks. While Blacks comprise about one-eighth of the American population, they account for about half of all women with AIDS. This chapter describes the links between low levels of condom use and inner-city women’s experiences and understandings of heterosexual relationships. It examines the causes, contexts, and mechanisms of Human Immunodeficiency Virus (HIV)/AIDS-risk denial, which enables and necessitates unsafe sex. The chapter focuses on the relationship between women’s conjugal and extraconjugal relationships and the unsafe sex that HIV/AIDS-risk denial entails. The findings come from a study conducted in 1991–1993 that attempted to identify and explore barriers to safer sex among clients of the Maternal and Infant Health Care Program in Cleveland, Ohio, with the aim of improving the efficacy of M&I HIV/AIDS education.