Why HIV Risk Is Higher Among Men Who Have Sex with Men

In 2019, nearly 1.2 million people in the United States were living with HIV, with approximately 13% unaware of their status, according to the Centers for Disease Control and Prevention (CDC).

HIV prevalence is notably higher among men who have sex with men (MSM). That year, MSM accounted for 65% of new HIV diagnoses, highlighting a significant public health concern.

This article delves into why MSM face a greater risk of HIV infection and outlines key prevention methods to combat transmission.

Understanding the Elevated HIV Risk Among MSM

Globally, MSM are 25 times more likely to contract HIV than the general population, based on UNAIDS data.

In the U.S., MSM—including gay, bisexual, and other men who have sex with men—represent the majority of new HIV cases.

The higher prevalence within this group means MSM are more likely to engage in sexual activity with partners who carry the virus.

Additional factors further increase transmission risk among MSM.

Modes of HIV Transmission

HIV spreads through contact with certain bodily fluids, including:

• Blood
• Semen (including pre-ejaculate fluids)
• Vaginal fluids
• Breast milk containing the virus

Unprotected sexual intercourse is a common transmission route, but sharing needles or syringes for drug use also poses significant risk.

Mother-to-child transmission can occur during pregnancy, childbirth, or breastfeeding.

While rare today, HIV transmission via blood transfusions or organ transplants was more common before rigorous screening began in 1985.

Social Factors Influencing HIV Risk

HIV disproportionately affects specific MSM subpopulations.

Black and Hispanic MSM face higher infection rates compared to non-Hispanic white MSM, as reported by the CDC.

Contributing factors include lower uptake of preventive medications, stigma surrounding same-sex relationships, systemic racism, and healthcare disparities.

In some regions, especially parts of Africa, Russia, and the Middle East, laws criminalizing same-sex sexual activity hinder access to HIV prevention and care.

Impact of Stigma on HIV Prevention and Treatment

Stigma remains a major barrier despite advances in HIV prevention and treatment.

Fear of discrimination can cause MSM to conceal their sexual orientation from healthcare providers, limiting testing and preventive care.

HIV-related stigma also discourages those diagnosed from maintaining treatment, which is crucial for viral suppression and reducing transmission risk.

Consequently, stigma perpetuates ongoing HIV transmission within MSM communities.

Risks Associated with Unprotected Anal Sex

Unprotected anal intercourse carries a higher HIV transmission risk than unprotected vaginal sex due to the delicate nature of anal tissues, which are prone to microtears.

Individuals in the receptive role during anal sex face greater susceptibility to HIV infection.

Challenges in HIV Testing and Treatment Among MSM

Early diagnosis and antiretroviral therapy (ART) are vital to prevent progression to AIDS and reduce viral loads to undetectable levels, effectively eliminating transmission risk.

The CDC advises MSM to undergo HIV testing at least annually, with more frequent testing (every 3 to 6 months) recommended for those at higher risk.

However, many MSM do not adhere to these guidelines, resulting in undiagnosed infections and delayed treatment.

In 2018, about one in six MSM with HIV in the U.S. were unaware of their status, and only 65% received any HIV care.

Stigma and fear of discrimination contribute to these gaps in testing and treatment.

Underutilization of PrEP and PEP Among MSM

Preventive medications such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) significantly lower HIV acquisition risk.

Daily PrEP use is highly effective for HIV-negative individuals at increased risk, while PEP should be initiated within 72 hours after potential exposure and continued for 28 days.

Despite their availability, PrEP and PEP usage remains limited among MSM, particularly within Black and Hispanic communities.

In 2017, PrEP uptake was reported as follows:

• 19% among Black MSM
• 21% among Hispanic MSM
• 31% among non-Hispanic White MSM

Barriers include limited healthcare access and provider discomfort in prescribing these medications.

Effective HIV Prevention Strategies

1. Consistent Use of Protection During Sexual Activity

Condoms and other barrier methods provide strong protection against HIV and other sexually transmitted infections (STIs).

Individuals with HIV or other STIs should adhere to treatment and use protection every time they have sex to reduce transmission risk.

Proper condom selection and correct usage are essential for maximum effectiveness.

2. Opt for Lower-Risk Sexual Practices

Engaging in sexual activities with lower HIV transmission risk, such as oral sex or non-contact activities, can decrease exposure.

3. Limit Number of Sexual Partners

Reducing the number of sexual partners lowers the overall risk of encountering an HIV-positive individual.

4. Regular HIV Testing and Prompt Treatment

MSM should get tested for HIV at least annually, with more frequent testing for those with multiple partners or unknown partner statuses.

Early initiation of ART upon diagnosis helps maintain health and prevents further HIV spread.

Open communication with partners about testing history and HIV status is also important.

5. Consider PrEP and PEP Usage

HIV-negative individuals at risk should consult healthcare providers about starting PrEP.

PEP is critical for potential exposures and must be taken promptly within 72 hours.

People living with HIV should encourage their partners to explore these preventive options.

Summary

New HIV infections continue to occur annually, disproportionately affecting MSM.

Using condoms or other barrier methods consistently, undergoing regular HIV testing, and discussing HIV status with partners are key to reducing transmission.

Antiretroviral therapies not only manage HIV effectively but also help prevent its spread.

Preventive medications like PrEP and PEP provide additional protection for those at risk.

Stay informed and proactive to safeguard your health and the health of your community.

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