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.
HIV and men who have sex with men
- Men who have sex with men are 28 times more likely to have HIV than heterosexual men.
- Of all new HIV infections in 2021, 21% 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 it harder for this group to access HIV services.
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?
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.
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 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 sexual partners is common among men who have sex with men, yet many men engaging in casual sex do not use condoms consistently.
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.
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.
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 in the design and delivery of HIV services. This way the service is more likely to meet their needs.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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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