Key takeaways

  • Men who have sex with men (MSM) make up most new HIV diagnoses in the United States, with 67% of new cases in 2022. Stigma, homophobia, and limited access to care can increase risk.
  • HIV transmission risk is higher during anal sex without a condom or other barrier method, especially for the receptive partner. Regular HIV testing and treatment can lower viral load and prevent transmission.
  • Prevention options include using condoms, limiting sexual partners, and taking preexposure prophylaxis (PrEP), and postexposure prophylaxis (PEP). PEP must start within 72 hours and be taken for 28 days.

About 1.2 million people in the United States are living with HIV as of 2022, according to the Centers for Disease Control and Prevention (CDC). About 13% of them didn’t know.

HIV is more common than average in men who have sex with men (MSM). In 2022, 67% of new HIV diagnoses were in gay men, bisexual men, or other MSM.

Here’s a look at why MSM have a higher risk of contracting HIV, as well as steps to prevent transmission.

Because HIV is more common among MSM, these individuals are more likely to have sex with someone who has the virus. Several other factors also raise the risk of transmission across MSM.

Stigma plays a significant role in HIV transmission, despite advances in prevention and treatment.

Even in areas where same-sex activity is legal, the fear of stigma, homophobia, and discrimination can drive people to hide their sexual identity from healthcare professionals. This creates a barrier to testing and preventive treatment.

The stigma attached to HIV may also prevent people aware of their HIV-positive status from accessing and maintaining treatment to suppress their viral load and help stop the spread. Someone with HIV may also be afraid of being refused treatment or being treated differently.

As a result, stigma can further drive HIV transmission.

HIV can be transmitted through sex without a condom or other barrier method.

However, the risk of transmission is higher during anal sex without a condom or other barrier method than vaginal sex without a condom or other barrier method.

This is because the skin around the anus is thinner than the skin around the vagina, so small tears are more likely to occur during anal sex.

Someone without HIV is more likely to contract the virus during anal sex if they are the receptive partner — the partner whose anus is being penetrated by the penis.

Early diagnosis and treatment for HIV are important. Treatment with antiretroviral therapy prevents progression to stage 3 HIV, which is also called AIDS. It can also reduce the virus to undetectable levels, at which point it can’t be transmitted to others.

The CDC recommends that MSM get tested for HIV at least once per year. People at higher risk of HIV may benefit from more frequent testing, such as every 3 to 6 months.

Not all MSM follow these recommendations. As a result, some may have HIV without realizing it. This can lead to delays in treatment and increase the risk of transmission.

As of 2022, approximately 14 out of 100 MSM with HIV in the United States didn’t know they had the virus, reports the CDC. In that same year, per the CDC, only 78 out of 100 gay and bisexual men with HIV in the United States received some HIV care.

Medications are available to reduce your likelihood of acquiring HIV. These include preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP).

If someone without HIV is at a higher risk of contracting the virus, taking PrEP daily significantly lowers that risk.

If an individual without HIV has a possible exposure to the virus, they can take PEP within 72 hours. This greatly reduces the risk of transmission.

Despite the availability of these medications, medical care can be limited for some people, as not everyone has access to stable and consistent healthcare. And for those who do, medical professionals in certain regions or countries may be another barrier to getting care, as not all care providers are comfortable prescribing these medications.

HIV also disproportionately affects certain MSM populations.

Among MSM, Black and Hispanic or Latino men are at higher risk than white men of contracting the virus.

There are a number of reasons this may be, including the fact that, in addition to homophobia, Black and Hispanic men also have to contend with the stress of racism, which can also affect the healthcare that they receive.

Also, HIV tends to affect people in under-resourced communities with less access to preventive HIV care. And today, while many nations have more progressive policies, some areas across Africa, Russia, and the Middle East continue to enforce laws against same-sex activity. This cuts off access to preventive HIV care for these individuals.

This can also be seen in the disparities in PrEP awareness in the United States.

In 2017, the CDC reported that the percentages of gay and bisexual men who were aware of PrEP were:

  • 78% of Black or African American MSM
  • 81% of Hispanic or Latino MSM
  • 91% of white MSM

By 2023, these numbers had risen to:

  • 90% of Black or African American MSM
  • 92% of Hispanic or Latino MSM
  • 96% of white MSM

However, there are still differences in rates of HIV care and suppressed viral load, which is one of the key ways to reduce HIV transmission.

Of gay and bisexual men who were diagnosed with HIV, 62% of Black men, 67% of Hispanic men, and 73% of white men were virally suppressed.

There are several ways to reduce the risk of HIV transmission.

1. Use a barrier method during sex

Condoms and other barrier methods can protect against HIV and other sexually transmitted infections (STIs).

If you have HIV or another STI, getting treatment and using a condom or other barrier method every time you have sex can reduce the risk of transmission.

If you don’t have an STI, you can protect yourself from acquiring an STI by using a condom or other barrier method every time you have sex.

Also, it’s important to buy the right size condom for you and to use it properly.

2. Choose alternative sexual activities

Some activities carry a higher risk of HIV transmission than others. The risk of transmission is high during anal sex without a condom or other barrier method.

The risk of transmission is lower during oral sex or activities that don’t involve contact with bodily fluids.

3. Limit your number of sexual partners

The risk of HIV transmission increases with the number of sexual partners a person has. The more partners you have, the more likely you are to have a partner with issues managing HIV or another STI, which can also increase the risk of transmission.

4. Get testing and treatment, if needed

If you’re an MSM, consider getting tested at least annually for HIV. People who have sex with multiple partners or partners of unknown HIV status should consider getting tested more frequently, such as every 3 to 6 months.

Those who test positive for HIV need to follow their doctor’s recommended treatment plan. Taking antiretroviral medication will lower the risk of complications and help prevent HIV transmission.

It also helps to ask your sexual partners about their testing history and status.

5. Take PrEP or PEP

If you don’t have HIV, ask a doctor whether you should take PrEP to lower your risk of contracting the virus.

If you have sex without a condom or other barrier method with someone who has HIV or someone who might have HIV, ask a doctor about PEP. You must take PEP within 72 hours of possible exposure and continue taking it for 28 days.

People who have HIV need to encourage their partners to speak with a doctor about PrEP and PEP.

New HIV infections occur each year, with a large number affecting men who have sex with men (MSM).

Reduce your risk of contracting or transmitting the virus by using a condom or other barrier method during sex. Get regularly tested for HIV and talk with sexual partners about their HIV status.

Antiretroviral medications are available to treat HIV. They help prevent transmission and lower the risk of complications from HIV.

Medications are also available to reduce the chances that someone without HIV will contract the virus after exposure.