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HIV and men who have sex with men

  • Men who have sex with men are 25 times more likely to have HIV than heterosexual men.  
  • Of all new HIV infections in 2020, 23% were among men who have sex with men. 
  • It is illegal to have sex with someone of the same sex in many countries which makes this group much more vulnerable to HIV. 

In this page we refer to men who have sex with men (sometimes abbreviated to MSM). This includes men who have sex with men and identify as gay, as well as men who do not identify as gay.  

Men who have sex with men have an increased risk of HIV. There are biological reasons for this, because anal sex has a higher risk of HIV than vaginal sex. 

But, other factors such as punitive laws, stigma and discrimination make it hard for men who have sex with men to access health services which increases HIV risk. 

Why are men who have sex with men at higher risk of HIV?

Anal sex has a higher risk of HIV than vaginal sex

This is because the walls of the anus are thin and more easily torn, creating an entry point for HIV into the bloodstream. Condoms and lubricant reduce the risk of HIV from anal sex. 

Lack of sex education for men who have sex with men

Not enough places in the world provide good sex education (if at all), but sex education that includes sex between men is even rarer. This leaves men who have sex with men without the sexual health knowledge to protect themselves from HIV. 

Low HIV testing rates

Men who have sex with men are much less likely to know their HIV status than other adult men because of low testing rates. This means having sex within this group is more likely to lead to HIV transmission because people aren’t aware they have HIV and could be passing it on. 

Having an STI

Having a sexually transmitted infection (STI) also makes someone more at risk of HIV. STI rates among men who have sex with men are higher than the general population. 

Having multiple partners

Having multiple sexual partners is common among men who have sex with men, yet many men engaging in casual sex do not use condoms consistently. 

Chemsex

Chemsex is when someone has sex while being on drugs. It is more common among men who have sex with men and can lead to higher risk sexual activity that could increase HIV risk. 

Having sex with someone of the same sex is a crime in some countries

Some countries criminalise same-sex sexual activity, with the death penalty in some of them. This makes men who have sex with men too afraid to access HIV services and sexual health services for fear of being arrested. 

Homophobia, stigma, discrimination and negative attitudes

This can lead to men who have sex with men wanting to hide their sexual orientation and therefore they are less likely to access HIV and other health services or report crimes to the police. 

How can HIV services meet the needs of men who have sex with men?

Involve men who have sex with men

Involve men who have sex with men in the design and delivery of HIV services. This way the service is more likely to meet their needs.  

Staff services with men who have sex with men

This is likely to increase trust between men who have sex with men and the service, lowering the fear of stigma and making the service more accessible. 

Home based HIV testing

Because HIV testing rates are low among men who have sex with men, home testing is a good way to encourage testing uptake, as it doesn’t require going to a clinic and disclosing your sexuality. 

Provide PrEP and PEP

HIV can be avoided if men who have sex with men can take PrEP (pre-exposure prophylaxis) before exposure to HIV, or PEP (post-exposure prophylaxis) after exposure to HIV. 

Make condoms and lubricants available

Because of the fear of attending a health service, it is important to make condoms available to men who have sex with men at other places where they might meet up or via peer educators in the community. 

Address negative attitudes

Provide education and sensitisation training for healthcare staff to reduce negative attitudes towards men who have sex with men, so that they are more likely to come back again, test for HIV and access treatment. 

Collect data on men who have sex with men

Data on how HIV affects men who have sex with men is still extremely scarce in many countries making it harder to improve their situation as a group. Collecting and recording data from men who have sex with men as a separate and distinct group is important. 

What systemic changes could reduce the risk of HIV for MSM?

Remove laws that criminalise men who have sex with men

Men who have sex with men would be more likely to access HIV and police services if there wasn’t a constant threat of being criminalised. This would also protect men who have sex with men from violence and abuse. 

Stop police harassment

Law enforcement officers need to be educated and sensitised about the rights of men who have sex with men. By respecting their rights, police officers could help rather than punish men who have sex with men. 

End stigma and discrimination

Education is needed to change harmful societal attitudes and norms about sexual orientation. Ending stigma would help reduce men who have sex with men’s risk of HIV. 

Make violence against men who have sex with men illegal

No-one should experience violence because of their sexual orientation. Laws that protect men who have sex with men from violence would enable them to access HIV, health and police services. 

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