Prevention Challenges

The high prevalence of HIV infection among MSM means they face a greater risk of being exposed to infection with each sexual encounter—especially as they get older

Sexual risk accounts for most HIV infections in MSM. These risks include unprotected sex and sexually transmitted diseases (STDs). The practice of not using a condom during anal sex with someone other than a primary, HIV-negative partner continues to pose a significant threat to the health of MSM.
Alcohol and illicit drug use contributes to increased risk for HIV infection and other STDs among MSM. The use of substances such as alcohol and other drugs can increase the likelihood of risky sexual behavior.

Many MSM with HIV are unaware of their HIV infection, especially MSM of color and young MSM. A recent CDC study found that among urban MSM in 21 cities in 2008 who were unaware of their HIV infection, 55% had not been tested in the previous 12 months. Low awareness of HIV status among young MSM likely reflects several factors: they may have been infected more recently, may underestimate their personal risk, may have had fewer opportunities to get tested, or may believe that HIV treatment minimize the threat of HIV. CDC recommends that all MSM get tested for HIV once a year— and more often if they are at higher risk. MSM at higher risk includes those who have multiple or anonymous sex partners or use drugs during sex.

Stigma and homophobia may have a profound impact on the lives of MSM, especially their mental and sexual health. Internalized homophobia may impact men’s ability to make healthy choices, including decisions around sex and substance use. Stigma and homophobia may limit the willingness of MSM to access HIV prevention and care, isolate them from family and community support, and create cultural barriers that inhibit integration into social networks.

Racism, poverty, and lack of access to health care are barriers to HIV prevention services, particularly for MSM from racial or ethnic minority communities. A recent CDC study found a strong link between socioeconomic status and HIV among MSM: prevalence increased as education and income decreased, and awareness of HIV status was higher among MSM with greater education and income.

Complacency about HIV may play a key role in HIV risk, particularly among young MSM. Since young MSM did not experience the severity of the early HIV epidemic, some may falsely believe that HIV is no longer a serious health threat because of treatment advances and decreased mortality. Additional challenges for many MSM include maintaining safe behaviors over time and underestimating personal risk.