Table of ContentsView AllTable of ContentsCurrent StatisticsBiological Risk FactorsSexual Risk FactorsSocial Risk FactorsStigma and RacismPrevention in MSM
Table of ContentsView All
View All
Table of Contents
Current Statistics
Biological Risk Factors
Sexual Risk Factors
Social Risk Factors
Stigma and Racism
Prevention in MSM
Gay men get human immunodeficiency virus (HIV) infections at higher rates than any other group in the United States, with 67% of new cases in 2022 occurring in men who have sex with men (MSM).Certain biological factors increase the risk. Social, cultural, and economic factors—such as stigma, racism, homophobia, and high rates of poverty—further compound the risk.
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A Note on Gender and Sex TerminologyVerywell Health acknowledges thatsex and gender are related concepts, but they are not the same.Sex refers to biology: chromosomal makeup, hormones, and anatomy. People are most often assigned male or female at birth based on their external anatomy; some people do not fit into that sex binary and are intersex.Gender describes a person’s internal sense of self as a woman, man, nonbinary person, or another gender, and the associated social and cultural ideas about roles, behaviors, expressions, and characteristics.Research studies sometimes don’t use the terminology in this way. For example, terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate.To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
A Note on Gender and Sex Terminology
Verywell Health acknowledges thatsex and gender are related concepts, but they are not the same.Sex refers to biology: chromosomal makeup, hormones, and anatomy. People are most often assigned male or female at birth based on their external anatomy; some people do not fit into that sex binary and are intersex.Gender describes a person’s internal sense of self as a woman, man, nonbinary person, or another gender, and the associated social and cultural ideas about roles, behaviors, expressions, and characteristics.Research studies sometimes don’t use the terminology in this way. For example, terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate.To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Verywell Health acknowledges thatsex and gender are related concepts, but they are not the same.
Research studies sometimes don’t use the terminology in this way. For example, terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate.
To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
HIV Statistics Among MSM
While calculation methods and research definitions vary, those used in a 2024 review suggest that among the general population, the definition of men who have sex with men (MSM) ranges from 3.3% who had sex in the past year to 6.2% across a lifetime.A broader definition that accounts for sexual identity and attraction as well as behavior suggests they make up 9.3% of the U.S. population.
What MSM MeansMSM focuses on behavior rather than self-identification. The term was created during the 1990s as a means to track the route of HIV transmission and the spread of infection through male-to-male sexual activity. Before this change, many infections were left unaccounted for.
What MSM Means
MSM focuses on behavior rather than self-identification. The term was created during the 1990s as a means to track the route of HIV transmission and the spread of infection through male-to-male sexual activity. Before this change, many infections were left unaccounted for.
Despite their smaller numbers, MSM account for about two-thirds of all infections. According to the Centers for Disease Control and Prevention (CDC), if the current trend continues, as many as one in six MSM will be infected with HIV in the course of their lifetime.
Black MSM are disproportionately affected, with Black males accounting for 49% of all HIV infections that occurred in people ages 13-24 in 2022.Recent trends have shown improvement, but the CDC warns of a50% lifetime riskof getting HIV, according to the CDC.
LGBT and HIVTransgender people account for 0.3% of the U.S. population but represent 2% of all new HIV diagnoses.Transwomen are especially vulnerable with one of every five having HIV.Lesbians have lower rates of HIV than heterosexual people or MSM. However, Women who have sex with women (WSW) have lower rates of HIV than heterosexual people or MSM but may also have risk factors such as injection drug use.Risk factors include healthcare access, lack of family support, higher rates of violence, alcohol or drug use, and survival sex work.
LGBT and HIV
Transgender people account for 0.3% of the U.S. population but represent 2% of all new HIV diagnoses.Transwomen are especially vulnerable with one of every five having HIV.Lesbians have lower rates of HIV than heterosexual people or MSM. However, Women who have sex with women (WSW) have lower rates of HIV than heterosexual people or MSM but may also have risk factors such as injection drug use.Risk factors include healthcare access, lack of family support, higher rates of violence, alcohol or drug use, and survival sex work.
Transgender people account for 0.3% of the U.S. population but represent 2% of all new HIV diagnoses.Transwomen are especially vulnerable with one of every five having HIV.
Lesbians have lower rates of HIV than heterosexual people or MSM. However, Women who have sex with women (WSW) have lower rates of HIV than heterosexual people or MSM but may also have risk factors such as injection drug use.Risk factors include healthcare access, lack of family support, higher rates of violence, alcohol or drug use, and survival sex work.
MSM are at greater biological risk of HIV because ofanal sex. Simply put, a person is more likely to get HIV from anal sex thanvaginal sex. The risk may be as much as 18 times greater than that of vaginal sex.
There are several explanations for this:
Because of these and other factors, HIV infection can occur quickly.
Sexual behaviors also add to the risk of HIV in MSM. This includes having multiple sex partners or using online hookup sites. While these factors are not exclusive to MSM, they can amplify the risk in certain groups.
Studies have shown that MSM, as a group, are at greater risk because:
In some communities of color, MSM tend to face more stigma.The sexual networks tend to be smaller and this can increase the likelihood of exposure to the virus.
Condomless Sex
Condomless anal sex further compounds the risk of getting HIV.
While the risk is greater for the receptive (“bottom”) partner, the insertive (“top”) partner is also at significant risk. This is because rectal fluids contain a high concentration of HIV—in some cases as much as five to 25 times higher than in blood or semen.
According to a 2022 study from the CDC, the rate of condomless sex among HIV-positive MSM has increased from 46.0% in 2012 to 70.5% in 2017. If the rate continues to increase, it may hinder progress toward ending the HIV/AIDS epidemic.
Socioeconomic Risk Factors
Certain groups are at greater risk of HIV, most especiallyBlackandLatinxMSM.Contributing socioeconomic factors include:
In 2023, the poverty rate among Black and Latinx people in the United States was 17.8% and 16.6% respectively, compared to 9.7% among White people.Not surprisingly, this translates to higher rates of HIV in communities of color, particularly Black and Latinx MSM.
Stigma, Homophobia, and Racism
Rather than subject themselves to shame or discrimination, some men may avoidHIV testingandtreatmentuntil the disease is advanced and harder to manage. Testing positive may also force them to come out about how they got infected, which they may not be ready to do because of cultural stigma, homophobia, and racism.
Among those who test positive, isolation and a lack of social support can contribute to depression, alcohol or drug abuse, sexual risk-taking, and inconsistent medical care. Many who start treatment for HIV do not continue.
A 2021 study from the Rutgers School of Public Health found that HIV stigma, both perceived and real, affected MSM in several ways:
Prevention
As dire as the statistics may seem, there are effective ways to reduce the risk of HIV on an individual basis. This includes limiting your number of sexual partners and engaging in sexual practices (such as mutual masturbation ororal sex) that pose less risk of HIV transmission.
Central to the prevention of HIV are two important tools:
By maintaining an undetectable viral load, you cannot pass HIV to others—a strategy popularly referred to as U=U (Undetectable = Untransmittable).
Summary
Numerous factors place men who have sex with men (MSM) at a high risk of HIV. These include biological vulnerabilities, sexual practices, andsocial and economic disparitiesthat can affect how a person accesses HIV prevention, testing, or treatment.
Black and Latinx MSM are disproportionately affected due to the intersection of these and other risk factors, including racism and homophobia.
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.CDC Publishes New HIV Surveillance Reports.Batchelder AW, Foley JD, Kim J, Thiim A, Kelly J, Mayer K,et al.Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances.Soc Sci Med. 2021 Apr;275:113824. doi:10.1016/j.socscimed.2021.113824Hoover KW, Wiener J, Purcell DW, Sullivan PS.Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys.JMIR Public Health Surveill. 2024 Jun 11;10:e56643. doi:10.2196/56643Centers for Disease Control and Prevention.Lifetime risk of HIV diagnosis in the United States.Centers for Disease Control and Prevention.Estimated HIV Incidence and Prevalence in the United States, 2018–2022.Centers for Disease Control and Prevention.Fast facts: HIV and transgender people.Human Right Campaign.Transgender people and HIV: what we know.Centers for Disease Control and Prevention.HIV risk in lesbians, bisexuals, and other women who have sex with women.Kelley CF, Pollack I, Yacoub R, Zhu Z, Van Doren VE, Gumber S,et al.Condomless receptive anal intercourse is associated with markers of mucosal inflammation in a cohort of men who have sex with men in Atlanta, Georgia.J Int AIDS Soc. 2021 Dec;24(12):e25859. doi:10.1002/jia2.25859Anderson JL, Khoury G, Fromentin R, et al.Human immunodeficiency virus (HIV)–infected CCR6+ Rectal CD4+ T cells and HIV persistence on antiretroviral therapy.J Infect Dis.2020:221(5):744-55. doi:10.1093/infdis/jiz509Centers for Disease Control and Prevention.Men who have sex with men (MSM).Mercer CH, Prah P, Field N, et al.The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).BMC Public Health. 2016;16:525. doi:10.1186/s12889-016-3149-zLe Vu S, Ratmann O, Delpech V, et al.HIV-1 transmission patterns in men who have sex with men: insights from genetic source attribution analysis.AIDS Res Hum Retroviruses. 2019;35(9):805-813. doi:10.1089/AID.2018.0236Babel RA, Wang P, Alessi EJ, Raymond HF, Wei C.Stigma, HIV risk, and access to HIV prevention and treatment services among men who have sex with men (MSM) in the United States: a scoping review.AIDS Behav. 2021;25(11):3574-3604. doi:10.1007/s10461-021-03262-4Public Health Agency of Canada.Getting to the bottom of it: anal sex, rectal fluid, and HIV transmission.Kudon HZ, Mulatu MS, Song W, Heitgerd J, Rao S.Trends in condomless sex among MSM who participated in CDC-funded HIV risk-reduction interventions in the United States, 2012-2017.J Public Health Manag Pract. 2022;28(2):170-3. doi:10.1097/PHH.0000000000001143National Institutes of Health.To end HIV epidemic, we must address health disparities.U.S. Census Bureau.Poverty in the United States: 2023.Brewer R, Hood KB, Moore M, et al.An exploratory study of resilience, HIV-related stigma, and HIV care outcomes among men who have sex with men (MSM) living with HIV in Louisiana.AIDS Behav. 2020;24(7):2119-2129. doi:10.1007/s10461-020-02778-5National Institutes of Health Office of AIDS Research.HIV and sexually transmitted diseases (STDs).Cohen MS, Council OD, Chen JS.Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.J Int AIDS Soc. 2019;22(Suppl 6):e25355. doi:10.1002/jia2.25355Centers for Disease Control and Prevention.Preventing HIV with PrEP.Rodger A, Cambiano V, Bruun T, et al.Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.JAMA.2016;316(2):171-81. doi:10.1001/jama.2016.5148.
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.CDC Publishes New HIV Surveillance Reports.Batchelder AW, Foley JD, Kim J, Thiim A, Kelly J, Mayer K,et al.Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances.Soc Sci Med. 2021 Apr;275:113824. doi:10.1016/j.socscimed.2021.113824Hoover KW, Wiener J, Purcell DW, Sullivan PS.Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys.JMIR Public Health Surveill. 2024 Jun 11;10:e56643. doi:10.2196/56643Centers for Disease Control and Prevention.Lifetime risk of HIV diagnosis in the United States.Centers for Disease Control and Prevention.Estimated HIV Incidence and Prevalence in the United States, 2018–2022.Centers for Disease Control and Prevention.Fast facts: HIV and transgender people.Human Right Campaign.Transgender people and HIV: what we know.Centers for Disease Control and Prevention.HIV risk in lesbians, bisexuals, and other women who have sex with women.Kelley CF, Pollack I, Yacoub R, Zhu Z, Van Doren VE, Gumber S,et al.Condomless receptive anal intercourse is associated with markers of mucosal inflammation in a cohort of men who have sex with men in Atlanta, Georgia.J Int AIDS Soc. 2021 Dec;24(12):e25859. doi:10.1002/jia2.25859Anderson JL, Khoury G, Fromentin R, et al.Human immunodeficiency virus (HIV)–infected CCR6+ Rectal CD4+ T cells and HIV persistence on antiretroviral therapy.J Infect Dis.2020:221(5):744-55. doi:10.1093/infdis/jiz509Centers for Disease Control and Prevention.Men who have sex with men (MSM).Mercer CH, Prah P, Field N, et al.The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).BMC Public Health. 2016;16:525. doi:10.1186/s12889-016-3149-zLe Vu S, Ratmann O, Delpech V, et al.HIV-1 transmission patterns in men who have sex with men: insights from genetic source attribution analysis.AIDS Res Hum Retroviruses. 2019;35(9):805-813. doi:10.1089/AID.2018.0236Babel RA, Wang P, Alessi EJ, Raymond HF, Wei C.Stigma, HIV risk, and access to HIV prevention and treatment services among men who have sex with men (MSM) in the United States: a scoping review.AIDS Behav. 2021;25(11):3574-3604. doi:10.1007/s10461-021-03262-4Public Health Agency of Canada.Getting to the bottom of it: anal sex, rectal fluid, and HIV transmission.Kudon HZ, Mulatu MS, Song W, Heitgerd J, Rao S.Trends in condomless sex among MSM who participated in CDC-funded HIV risk-reduction interventions in the United States, 2012-2017.J Public Health Manag Pract. 2022;28(2):170-3. doi:10.1097/PHH.0000000000001143National Institutes of Health.To end HIV epidemic, we must address health disparities.U.S. Census Bureau.Poverty in the United States: 2023.Brewer R, Hood KB, Moore M, et al.An exploratory study of resilience, HIV-related stigma, and HIV care outcomes among men who have sex with men (MSM) living with HIV in Louisiana.AIDS Behav. 2020;24(7):2119-2129. doi:10.1007/s10461-020-02778-5National Institutes of Health Office of AIDS Research.HIV and sexually transmitted diseases (STDs).Cohen MS, Council OD, Chen JS.Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.J Int AIDS Soc. 2019;22(Suppl 6):e25355. doi:10.1002/jia2.25355Centers for Disease Control and Prevention.Preventing HIV with PrEP.Rodger A, Cambiano V, Bruun T, et al.Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.JAMA.2016;316(2):171-81. doi:10.1001/jama.2016.5148.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.CDC Publishes New HIV Surveillance Reports.Batchelder AW, Foley JD, Kim J, Thiim A, Kelly J, Mayer K,et al.Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances.Soc Sci Med. 2021 Apr;275:113824. doi:10.1016/j.socscimed.2021.113824Hoover KW, Wiener J, Purcell DW, Sullivan PS.Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys.JMIR Public Health Surveill. 2024 Jun 11;10:e56643. doi:10.2196/56643Centers for Disease Control and Prevention.Lifetime risk of HIV diagnosis in the United States.Centers for Disease Control and Prevention.Estimated HIV Incidence and Prevalence in the United States, 2018–2022.Centers for Disease Control and Prevention.Fast facts: HIV and transgender people.Human Right Campaign.Transgender people and HIV: what we know.Centers for Disease Control and Prevention.HIV risk in lesbians, bisexuals, and other women who have sex with women.Kelley CF, Pollack I, Yacoub R, Zhu Z, Van Doren VE, Gumber S,et al.Condomless receptive anal intercourse is associated with markers of mucosal inflammation in a cohort of men who have sex with men in Atlanta, Georgia.J Int AIDS Soc. 2021 Dec;24(12):e25859. doi:10.1002/jia2.25859Anderson JL, Khoury G, Fromentin R, et al.Human immunodeficiency virus (HIV)–infected CCR6+ Rectal CD4+ T cells and HIV persistence on antiretroviral therapy.J Infect Dis.2020:221(5):744-55. doi:10.1093/infdis/jiz509Centers for Disease Control and Prevention.Men who have sex with men (MSM).Mercer CH, Prah P, Field N, et al.The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).BMC Public Health. 2016;16:525. doi:10.1186/s12889-016-3149-zLe Vu S, Ratmann O, Delpech V, et al.HIV-1 transmission patterns in men who have sex with men: insights from genetic source attribution analysis.AIDS Res Hum Retroviruses. 2019;35(9):805-813. doi:10.1089/AID.2018.0236Babel RA, Wang P, Alessi EJ, Raymond HF, Wei C.Stigma, HIV risk, and access to HIV prevention and treatment services among men who have sex with men (MSM) in the United States: a scoping review.AIDS Behav. 2021;25(11):3574-3604. doi:10.1007/s10461-021-03262-4Public Health Agency of Canada.Getting to the bottom of it: anal sex, rectal fluid, and HIV transmission.Kudon HZ, Mulatu MS, Song W, Heitgerd J, Rao S.Trends in condomless sex among MSM who participated in CDC-funded HIV risk-reduction interventions in the United States, 2012-2017.J Public Health Manag Pract. 2022;28(2):170-3. doi:10.1097/PHH.0000000000001143National Institutes of Health.To end HIV epidemic, we must address health disparities.U.S. Census Bureau.Poverty in the United States: 2023.Brewer R, Hood KB, Moore M, et al.An exploratory study of resilience, HIV-related stigma, and HIV care outcomes among men who have sex with men (MSM) living with HIV in Louisiana.AIDS Behav. 2020;24(7):2119-2129. doi:10.1007/s10461-020-02778-5National Institutes of Health Office of AIDS Research.HIV and sexually transmitted diseases (STDs).Cohen MS, Council OD, Chen JS.Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.J Int AIDS Soc. 2019;22(Suppl 6):e25355. doi:10.1002/jia2.25355Centers for Disease Control and Prevention.Preventing HIV with PrEP.Rodger A, Cambiano V, Bruun T, et al.Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.JAMA.2016;316(2):171-81. doi:10.1001/jama.2016.5148.
Centers for Disease Control and Prevention.CDC Publishes New HIV Surveillance Reports.
Batchelder AW, Foley JD, Kim J, Thiim A, Kelly J, Mayer K,et al.Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances.Soc Sci Med. 2021 Apr;275:113824. doi:10.1016/j.socscimed.2021.113824
Hoover KW, Wiener J, Purcell DW, Sullivan PS.Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys.JMIR Public Health Surveill. 2024 Jun 11;10:e56643. doi:10.2196/56643
Centers for Disease Control and Prevention.Lifetime risk of HIV diagnosis in the United States.
Centers for Disease Control and Prevention.Estimated HIV Incidence and Prevalence in the United States, 2018–2022.
Centers for Disease Control and Prevention.Fast facts: HIV and transgender people.
Human Right Campaign.Transgender people and HIV: what we know.
Centers for Disease Control and Prevention.HIV risk in lesbians, bisexuals, and other women who have sex with women.
Kelley CF, Pollack I, Yacoub R, Zhu Z, Van Doren VE, Gumber S,et al.Condomless receptive anal intercourse is associated with markers of mucosal inflammation in a cohort of men who have sex with men in Atlanta, Georgia.J Int AIDS Soc. 2021 Dec;24(12):e25859. doi:10.1002/jia2.25859
Anderson JL, Khoury G, Fromentin R, et al.Human immunodeficiency virus (HIV)–infected CCR6+ Rectal CD4+ T cells and HIV persistence on antiretroviral therapy.J Infect Dis.2020:221(5):744-55. doi:10.1093/infdis/jiz509
Centers for Disease Control and Prevention.Men who have sex with men (MSM).
Mercer CH, Prah P, Field N, et al.The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).BMC Public Health. 2016;16:525. doi:10.1186/s12889-016-3149-z
Le Vu S, Ratmann O, Delpech V, et al.HIV-1 transmission patterns in men who have sex with men: insights from genetic source attribution analysis.AIDS Res Hum Retroviruses. 2019;35(9):805-813. doi:10.1089/AID.2018.0236
Babel RA, Wang P, Alessi EJ, Raymond HF, Wei C.Stigma, HIV risk, and access to HIV prevention and treatment services among men who have sex with men (MSM) in the United States: a scoping review.AIDS Behav. 2021;25(11):3574-3604. doi:10.1007/s10461-021-03262-4
Public Health Agency of Canada.Getting to the bottom of it: anal sex, rectal fluid, and HIV transmission.
Kudon HZ, Mulatu MS, Song W, Heitgerd J, Rao S.Trends in condomless sex among MSM who participated in CDC-funded HIV risk-reduction interventions in the United States, 2012-2017.J Public Health Manag Pract. 2022;28(2):170-3. doi:10.1097/PHH.0000000000001143
National Institutes of Health.To end HIV epidemic, we must address health disparities.
U.S. Census Bureau.Poverty in the United States: 2023.
Brewer R, Hood KB, Moore M, et al.An exploratory study of resilience, HIV-related stigma, and HIV care outcomes among men who have sex with men (MSM) living with HIV in Louisiana.AIDS Behav. 2020;24(7):2119-2129. doi:10.1007/s10461-020-02778-5
National Institutes of Health Office of AIDS Research.HIV and sexually transmitted diseases (STDs).
Cohen MS, Council OD, Chen JS.Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.J Int AIDS Soc. 2019;22(Suppl 6):e25355. doi:10.1002/jia2.25355
Centers for Disease Control and Prevention.Preventing HIV with PrEP.
Rodger A, Cambiano V, Bruun T, et al.Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.JAMA.2016;316(2):171-81. doi:10.1001/jama.2016.5148.
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