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HIV in Men Who Have Sex With Men: What to Know

Medically Reviewed by Melinda Ratini, DO, MS on April 13, 2022

If you are a man who has sex with men, you might be at greater risk forgetting HIV, the virus causes AIDS. It’s important to know your risk factors and how you can avoid infection.

If you already are HIV-positive, there are steps you can take to prevent your partner or partners from becoming infected and reduce your chances of getting sick.

HIV Risk Factors for Men Who Have Sex With Men

About 1.2 million people in the U.S. are estimated to have HIV. Of these, about 13% don’t know they have it. That means they could spread the virus to others without knowing it.

Men who have sex with men (MSM) are the largest group of people with HIV. About 70% of the estimated 34,800 new HIV infections in 2019 involved men who have sex with men. The CDC also tracks the number of people diagnosed with HIV each year (since people can live for years without knowing they have it). In 2019, there were 36,801 new HIV diagnoses. Gay and bisexual men made up 69% of those.

If you are an American male having sex with other men, you have about a 1 in 6 chance of getting HIV at some point in your life (compared to a 1 in 524 chance for men who don’t have sex with men).

HIV risk is even greater for certain racial and ethnic groups. Black MSM have a 1 in 2 lifetime risk for HIV. Hispanic or Latino MSM have a 1 in 4 risk. In 2019, 37% of diagnosed infections in the U.S. among men who have sex with men were among Black men; 32% were among Hispanic or Latino men.

Other HIV risk factors include:

  • Having sex without using a condom
  • Having unprotected anal sex, especially if you are the receptive (bottom) partner, which is 10 to 15 times more likely to lead to HIV than being the insertive (top) partner
  • Having more than one partner or anonymous partners
  • Using illegal drugs (especially needle-sharing IV drug use) or drinking a lot of alcohol, which can affect your judgment and make you more likely to have unsafe sex

Having an STD is another risk factor. You can get STDs from the same behaviors that can raise your risk of getting HIV. Also, having an STD may create open sores or inflammation, allowing the HIV virus to penetrate your skin. Syphilis is especially prevalent among men who have sex with men and can put you at high risk for HIV in the future.

You May Be Able to Prevent HIV With a Pill or Shot

Preventive medications, known as “pre-exposure prophylaxis” or PrEP for short, cut your risk of getting HIV from sex by about 99% when taken properly. PrEP can lower the risk of getting HIV from IV drug use by at least 74%.

Two prescription medications are available in daily pill form: Truvada, introduced in 2012, and Descovy , available since 2019. The FDA approved a new injectable medication, Apretude, in December 2021. Once you get started on Apretude, you only need to get a shot once every 2 months to stay protected against HIV. That could be more convenient than taking pills every day. But you have to visit a health care facility to get the shots.

PrEP isn’t for all MSM. Health care experts say it should be given to people with risk factors for HIV exposure. This includes men who have sex with men, are sexually active, and have additional risks, including:

  • A sex partner with HIV
  • Not regularly using condoms during anal sex
  • An STD (syphilis, gonorrhea, or chlamydia) within the past 6 months
  • Sharing injection drug syringes

If you are a man in a mutually monogamous relationship with a male partner who has recently tested negative for HIV, you likely don’t need PrEP. But your doctor or an HIV counselor who knows your entire risk profile can tell you whether PrEP is for you.

Not all doctors are equally educated about PrEP. And PrEP may not be available in clinics near you. For example, about one-fourth of clinics in the South have this medication, though the region has more than half of all new HIV cases, a recent study reported. The CDC provides a locator list for PrEP providers so you can find one near you.

You also may be worried about PrEP’s cost. Financial help is available if you can’t afford PrEP.

Stigma is another barrier. Some people say they are not comfortable seeing doctors and talking about their sexual behaviors, or having others know they are taking PrEP. They say they’ve experienced “PrEP shaming” and homophobia. Finding an informed health care professional or support group can help get rid of these fears.

Other Steps You Can Take to Avoid HIV

Besides PrEP, you can do other things to keep from getting infected with HIV, including:

  • Get tested for HIV: At least annually, the CDC suggests. HIV.gov says if you have risk factors, test every 3-6 months.
  • Get tested for other STDs: The CDC says sexually active MSM should be tested “at least annually” for syphilis, gonorrhea, and chlamydia. If you have multiple or anonymous sex partners, get tested every 3-6 months.
  • Use condoms (even if you take PrEP) since they prevent STDs. Avoid oil-based lubricants, which can cause condoms to break.
  • Avoid illegal drugs and don’t drink too much alcohol.

If you are exposed to HIV, emergency treatment is available if given within 72 hours. This "post-exposure prophylaxis" (or PEP) can prevent the virus from taking hold. It is more effective the quicker you are treated after being exposed.

Medication is also available if you do get HIV. It’s called antiretroviral therapy, or ART. These medications can help reduce the amount of HIV virus in your body to extremely low levels. When this happens, it’s almost impossible to transmit HIV sexually. Your health care provider can help figure out your best HIV treatment plan.

Whether you have HIV or are trying to avoid getting it, it’s important to learn your risks and find ways to provide a safer future for yourself and others.

Show Sources

SOURCES:

CDC.gov: “HIV and Gay and Bisexual Men,” “Men Who Have Sex With Men (MSM),” “HIV and Gay and Bisexual Men: HIV Risk Behaviors,” “Ways HIV Can Be Transmitted,” “STDs and HIV – CDC Fact Sheet,” “Pre-Exposure Prophylaxis (PrEP),” “PrEP Effectiveness,” “Which STD Tests Should I Get?”

Cleveland Clinic: “Should You Be on PrEP?”

FDA: “Truvada for PrEP Fact Sheet: Ensuring Safe and Proper Use,” “FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic,” “FDA Approves First Injectable Treatment for HIV Pre-Exposure Prevention”

HIV.gov: “Fast Facts,” “PrEP for HIV Prevention.”

HIVinfo.NIH.gov: “HIV Treatment: The Basics”

Mayo Clinic: “Health issues for gay men and men who have sex with men”

Journal of the American Medical Association: “Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement.”

Advances in Therapy: “Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review.”

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