There are biological, behavioural and legal factors which put men who have sex with men 24 times more at risk of HIV compared with the general population. Many countries have made significant progress in recognising the rights of LGBTQ people, while in other countries punitive laws and homophobia create additional barriers for men who have sex with men from accessing HIV prevention, testing and treatment services.
Globally, more funding is required to support targeted HIV prevention, testing and treatment programmes for men who have sex with men. Explore this page to find out more about what factors put men who have sex with men at risk of HIV , HIV prevention programmes , HIV testing initiatives , using technology , access to antiretroviral treatment , barriers to prevention and the way forward for men who have sex with men.
Globally, men who have sex with men sometimes referred to as MSM are 24 times more likely to be living with HIV than the general population.
What factors put men who have sex with men at risk of HIV? The fact that HIV prevalence among men who have sex with men is so high in many countries means that members of this group have an increased chance of being exposed to the virus, due to mainly having sex within this group.
Biological factors One major reason for high vulnerability to HIV among this group is that unprotected anal sex carries a higher risk of transmission 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.
Alcohol and drugs are a common part of socialising in some communities of men who have sex with men. Whenever drink and drugs are taken, it can make it more likely that people will have unprotected sex and a higher number of sexual partners, increasing the risk of HIV transmission. The drugs of interest - namely GHB gamma-hydoxybutyrate , methamphetamine and methedrone - are used to facilitate sexual sessions lasting many hours or even days with multiple partners.
It was recently estimated that 3 in 10 gay men in the UK had engaged in chemsex in the last year. In cases where sexual activity is prolonged there is also a concern that participants living with HIV may forget to take ART medication, or that those who are HIV negative will miss the hour window to be eligible for receiving post-exposure prophylaxis PEP after suspected exposure to HIV.
Estimates suggest that 4. This is more common in countries where HIV prevalence among the whole men who have sex with men population is quite high. In 13 countries including Iran, Sudan, Saudi Arabia, Yemen and parts of Nigeria and Somalia, homosexuality is punishable by the death penalty.
In 17 countries 'homosexual propaganda' is banned or 'morality laws' actively target public promotion or expression of same-sex and trans realities. Such laws have been introduced in recent years in countries including Russia, Lithuania and Nigeria. This drives men who have sex with men to hide their identity and sexual orientation.
Many fear a negative reaction from healthcare workers. As a result, men who have sex with men are less likely to access HIV services.
This can make it harder to cope with aspects of HIV such as adherence to medication. However, access varies greatly between regions and within countries. For example, men who have sex with men on a higher income are more likely to be able to afford, and therefore access prevention initiatives, than those on a low income.
It is important that a combination of prevention programmes are available. In recognition of this, in , a group of international agencies and non-governmental organisations NGOs released a tool for use by public health officials, HIV and STI programmes officials, NGOs both international and community-based and health workers.
Condoms and lubricants One of the most important prevention responses is to make high-quality condoms, along with water-based lubricants, available and accessible to men who have sex with men. In some countries, gay bars and other known meeting places for men who have sex with men, such as bathhouses, provide and promote condoms and lubricants.
The Blue Sky Club is a civil society group in Vietnam that provides 'edutainment' events in local bars and clubs, combining HIV education and condom distribution with entertainment, which are well received by local men who have sex with men.
In sub-Saharan Africa, studies have shown how HIV services that are targeted at, and run by men who have sex with men, have seen the greatest response and uptake. This prevention strategy works on the basis that there is an elevated sense of trust between members of the men who have sex with men population, whereby fear of stigma is eradicated. Peer training in the Philippines In the Philippines, one initiative attempted to help civil society engage with local government in the HIV response.
Eighteen community-based groups were set up and men who have sex with men and transgender people were trained in sexual health and rights.
After three years, community leadership led to dialogue with local government officials on HIV, gender and human rights issues. One outcome of this process was an anti-discrimination ordinance in the city of Cebu in which prohibits discrimination on the basis of sexual orientation, gender identity and health status including HIV.
Home-based testing has the benefit of the user being able to avoid identification by healthcare workers.