CDC H IV/A IDS Fact Sheet

HIV/AIDS among

Men Who Have Sex

with Men

1-800-CDC-INFO (232-4636)

In English, en Español

24 Hours/Day

cdcinfo@cdc.gov

http://www.cdc.gov/hiv 

July 2005

In the United States, HIV and AIDS have had a 

tremendous effect on men who have sex with men 

(MSM). MSM accounted for approximately two 

thirds of all HIV infections among men in 2003, 

even though only about 5% to 7% of men in the 

United States identify themselves as MSM [1, 2]. 

The number of HIV diagnoses for MSM decreased 

during the 1980s and 1990s, but recent surveillance data show an increase in HIV diagnoses for 

this group [3]. Given the high prevalence of HIV 

infection in young MSM of minority races and 

ethnicities, there is a continued need for culturally 

diverse prevention and education services.

STATISTICS

Cumulative Effect of HIV Infection 

and AIDS (through 2003)

An estimated 503,305 MSM (440,887 MSM and 

62,418 MSM who inject drugs) had received a 

diagnosis of AIDS, accounting for 67% of all 

men and 54% of all people who received a 

diagnosis of AIDS [1].

An estimated 295,981 MSM (257,898 MSM and 

38,083 MSM who inject drugs) with AIDS had 

died, accounting for 68% of all men and 56% of 

all people with AIDS who died [1].

At the end of 2003, an estimated 207,323 MSM 

(182,989 MSM and 24,334 MSM who inject 

drugs) were living with AIDS, representing 66% 

of all men and 51% of all people living with 

AIDS [1].

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AIDS in 2003

An estimated 19,846 MSM (17,969 MSM 

and 1,877 MSM who inject drugs) received 

a diagnosis of AIDS, accounting for 63% of 

all men and 46% of all people who received a 

diagnosis of AIDS [1].

An estimated 7,248 MSM (6,015 MSM and 

1,233 MSM who inject drugs) with AIDS died, 

accounting for 55% of all men and 40% of all 

people with AIDS who died [1].

•

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Transmission categories of male 

adolescents and adults given a diagnosis 

of AIDS, through 2003

Note. Based on data from 50 states, the District of Columbia, 

and US dependencies, possessions, and associated nations.


H IV/A IDS among Men Who Have Sex w ith Men

HIV/AIDS in 2003

In the 33 areas with long-term, confidential namebased reporting, an estimated 15,756 MSM 

(14,532 MSM and 1,224 MSM who inject drugs) 

received a diagnosis of HIV/AIDS, accounting for 

68% of all men and 49% of all people receiving an 

HIV/AIDS diagnosis that year [1].

RISK Factors AND BARRIERS 

TO PREVENTION

Sexual Risk Factors

Sexual risk factors account for most HIV infections in MSM. These factors include unprotected 

sex and sexually transmitted diseases (STDs).

Not using a condom during anal sex with 

someone other than a primary partner 

of known HIV status continues to be a 

significant threat to the health of MSM [4]. 

Not all the reasons for an apparent increase 

in unprotected anal intercourse are known, 

but research points to the following factors: 

improvements in HIV treatment, substance use, 

complex sexual decision making, seeking sex 

partners on the Internet, and failure to maintain 

prevention practices [5].

STDs, which increase the risk for HIV 

infection, remain an issue for MSM. According 

to the Gonococcal Isolate Surveillance Project, 

the proportion of positive test results for 

gonorrhea among MSM increased from 4% in 

1988 to 19.6% in 2003 [6]. Rates of syphilis 

among MSM have increased in some urban 

areas, including San Francisco, Chicago, 

New York, and Seattle [7–9]. In the 9 US 

•

•

Transmission categories of male adults 

and adolescents living with AIDS, 2003

Note. Based on data from 50 states, the District of Columbia, 

and US dependencies, possessions, and associated nations.

Race/ethnicity of MSM living with HIV/AIDS 

at the end of 2003 (total no. = 181,206)

A. MSM

Note. Based on 33 areas with long-term, confidential namebased reporting.

B. MSM who inject drugs


H IV/A IDS among Men Who Have Sex w ith Men

cities participating in the MSM Prevalence 

Monitoring Project, STDs and HIV positivity 

varied by race and ethnicity but tended to 

be highest among African American MSM 

[6]. In addition to increasing susceptibility to 

HIV, STDs are markers for high-risk sexual 

practices that can transmit HIV, making 

increases in STD rates a cause for 

concern [10].

Substance Use

The use of alcohol and illegal drugs continues 

to be prevalent among some MSM and is linked 

to HIV and STD risk [11]. Substance use can 

increase the risk of HIV transmission through the 

tendency toward risky sexual behaviors while 

under the influence and through sharing needles 

or other injection equipment. Reports of increased 

use of the stimulant drug methamphetamine 

across the country have raised public health 

concerns because methamphetamine use has been 

associated both with sexual risk behaviors for HIV 

and STDs and sharing injection equipment when 

the drug is injected [12]. Methamphetamine and 

other “party” drugs (such as ecstasy, ketamine, 

and GHP [gamma hydroxybutyrate]) may be 

used to decrease social inhibitions and enhance 

sexual experiences [13]. These drugs, along with 

alcohol and nitrate inhalants (“poppers”), have 

been associated with risky sexual practices among 

MSM [14].

Complacency about Risk

Almost 25 years into the HIV epidemic, there 

is evidence of an underestimation of risk, of 

difficulty in maintaining safer sexual practices, 

and of a need to sustain prevention efforts for each 

generation of young gay and bisexual men.

The success of highly active antiretroviral 

therapy (HAART) may have had the 

unintended consequence of increasing some 

MSM’s risk behaviors. Some research 

suggests that the negative aspects of HIV 

infection have been minimized since the 

introduction of HAART, which has led to a 

•

false understanding of what living with HIV 

means and thus can lead to increased risk 

behaviors [15, 16]. For example, some MSM 

may mistakenly believe that they or their 

partners are not infectious when they take 

medication or have low or undetectable viral 

loads [17]. Even though surveys suggest that 

optimism about HIV treatments is associated 

with a greater willingness to have unprotected 

anal intercourse [18, 19], a recent review found 

that the prevalence of unprotected sexual 

intercourse was not significantly higher among 

HIV-positive persons who were receiving 

HAART or who had an undetectable viral load. 

However, this review did find that unprotected 

sex was associated with beliefs about HAART 

and viral load [20].

Long-term efforts to maintain safer sexual 

practices present a significant challenge. A 

4-city study indicates that years of exposure 

to prevention messages and long-term efforts 

to maintain safer sexual practices may play 

a role in the decision of HIV-positive MSM 

to engage in unprotected anal intercourse 

[16, 21].

The rates of risky behaviors are higher among 

young MSM than among older MSM [21, 22]. 

Not having seen firsthand the toll of AIDS, 

young MSM may be less motivated to practice 

safer sex.

Unknown HIV Status

Approximately 25% of people in the United States 

who are infected with HIV do not know they are 

infected [23]. According to a recent study of young 

MSM, 77% of those who tested HIV-positive 

incorrectly believed that they were not infected 

[24]. Young African American MSM in this study 

were especially likely to be unaware of their 

infection―approximately 9 of 10 young African 

American MSM compared with 6 of 10 young 

white MSM. Of the men who tested positive, most 

(74%) had previously tested negative for HIV 

infection, and 59% believed that they were at low 

or very low risk. 

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H IV/A IDS among Men Who Have Sex w ith Men

Research has shown that many people who know 

they are infected alter their behaviors to reduce 

their risk of transmitting the virus [25, 26]. 

Therefore, increasing the proportion of people 

who know their HIV status can help decrease 

HIV transmission.

MSM Who Are HIV-positive

HAART has enabled MSM who are infected 

with HIV to live longer—an undeniably positive 

outcome of new treatments. However, HAART’s 

success means there are more MSM living with 

HIV who can potentially transmit the virus to their 

sex partners. This emphasizes the importance of 

prevention efforts focused on those who are living 

with HIV.

Although many MSM reduce risk behaviors after 

learning that they have HIV, most remain sexually 

active. Most MSM with HIV believe that they 

have a personal responsibility to protect others 

from HIV, but some engage in high-risk sexual 

practices that may result in others’ contracting HIV 

[27–29]. Some interventions for persons living 

with HIV have been shown to be effective. More 

prevention efforts need to be directed to this group.

The Internet

During the past decade, the Internet has created 

new opportunities for MSM to meet sex partners 

[30]. Internet users can anonymously find 

partners with similar sexual interests without 

having to leave their residence or having to 

risk face-to-face rejection if the behaviors they 

seek are not consistent with safer sex [31]. 

The Internet may also normalize certain risky 

behaviors by making others aware of these 

behaviors and creating new connections between 

the men who engage in them. In contrast, the 

Internet is a potentially powerful tool for use with 

interventions.

Social Discrimination and Cultural 

Issues

MSM are members of all communities, all races 

and ethnicities, and all strata of society. To reduce 

the rate of HIV infection, prevention efforts must 

be designed with respect for the many differences 

among MSM and with recognition of the 

discrimination against MSM and persons infected 

with HIV in many parts of the country.

Social and economic factors, including racism, 

homophobia, poverty, and lack of access to 

health care, are barriers to receiving HIV 

prevention services, particularly for MSM of 

minority races or ethnicities. Indeed, African 

American and Hispanic men are more likely 

than white men to be given a diagnosis of HIV 

infection in the late stages of infection, often 

when they already have AIDS [32].

Stigma associated with homosexuality 

may inhibit some men from identifying 

themselves as gay or bisexual, despite having 

sex with other men [33, 34]. These men may 

miss prevention and health messages directed 

to openly gay men. 

African American and Hispanic MSM are 

less likely than white MSM to live in gay 

neighborhoods [35]. Therefore, prevention 

programs directed to gay neighborhoods may 

not reach these MSM.

For Hispanic MSM, unique cultural 

factors may discourage openness about 

homosexuality: machismo, the high value 

placed on masculinity; simpatia, the 

importance of smooth, nonconfrontational 

relationships; and familismo, the importance of 

a close relationship with one’s family [36, 37].

Although Asians/Pacific Islanders and 

American Indians/Alaska Natives accounted 

for less than 2% of the AIDS cases in MSM 

reported nationally between 1989 and 1998, 

these groups accounted for noteworthy 

proportions of cases in certain metropolitan 

areas [33]. Also, HIV among American 

Indians/Alaska Natives may be underestimated 

because of the underrecognition of American 

Indians/Alaska Natives as a race/ethnicity in 

surveillance systems [38].

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H IV/A IDS among Men Who Have Sex w ith Men

Lack of Communication and Risk 

Assessment

Open and honest communication about sexual 

issues is vital to avoiding false assumptions about 

a partner’s HIV status. For example, an HIVinfected man may assume that his partner must 

be infected or he would insist on using a condom; 

a man who is not infected may assume that his 

partner also is not infected or he would use a 

condom [39]. Additionally, because many young 

MSM with HIV are unaware of their infection, 

relying on partners to disclose HIV-positive status 

is often insufficient [24].

Concurrent Psychosocial Problems

Depression, childhood sexual abuse, using more 

than 1 drug, and partner violence have been shown 

to increase high-risk sexual behaviors. Further 

research has shown that the combined effects 

of these problems may be greater than their 

individual effects [40]. Therefore, MSM with more 

than 1 of these problems may be at higher risk 

for HIV infection. The emergence of this type of 

research, which shows the interaction and additive 

effect of various psychosocial problems, will result 

in more refined prevention efforts.

Prevention

Among all people in the United States, the annual 

number of new HIV infections declined from a 

peak of more than 150,000 in the mid-1980s and 

stabilized at approximately 40,000 after the late 

1990s. Persons of racial and ethnic minorities are 

disproportionately affected by the HIV epidemic. 

To reduce further the incidence of HIV, CDC 

announced a new initiative, Advancing HIV 

Prevention (http://www.cdc.gov/hiv/partners/

AHP.htm), in 2003. This initiative comprises 

4 strategies: making HIV testing a routine part 

of medical care, implementing new models 

for diagnosing HIV infections outside medical 

settings, preventing new infections by working 

with HIV-infected persons and their partners, and 

further decreasing perinatal HIV transmission.

MSM as a group continue to be most affected 

by HIV and AIDS. Research shows that HIV 

prevention efforts can reduce sexual risk: one 

review found that among men who received an 

HIV prevention intervention, the proportion who 

engaged in unprotected sex decreased, on average, 

26% [41].

CDC offers effective interventions for MSM. 

Examples include

Many Men, Many Voices, which is a group 

STD/HIV prevention intervention for gay 

men of color and men who have sex with 

other men but do not identify themselves as 

gay or bisexual

Mpowerment, which comprises HIV 

prevention, safer sex, and risk-reduction 

messages in a community-building format for 

young MSM

Popular Opinion Leader, which involves 

identifying, enlisting, and training key 

opinion leaders to encourage safer sexual 

norms and behaviors within the social 

networks of MSM

Healthy Relationships, which helps develop 

the skills and self-efficacy of people living 

with HIV/AIDS

Peers Reaching Out and Modeling Intervention Strategies (PROMISE), which uses 

peer advocates (including men who do not 

identify themseves as gay) to help people 

adopt practices to reduce or eliminate risk for 

HIV infection

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H IV/A IDS among Men Who Have Sex w ith Men

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AIDS surveillance: Through a uniform system, 

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adjusted for reporting delays and for the redistribution

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tested late in the course of HIV infection, who have limited 

access to care, or in whom treatment has failed.

HIV surveillance: Monitoring trends in the HIV epidemic

today requires collecting information on HIV cases that 

have not progressed to AIDS. Areas with confidential

name-based HIV infection reporting requirements use 

the same uniform system for data collection on HIV 

cases as for AIDS cases. A total of 33 areas­—the US 

Virgin Islands and 32 states (Alabama, Alaska, Arizona, 

Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, 

Kansas, Louisiana, Michigan, Minnesota, Mississippi, 

Missouri, Nebraska, Nevada, New Jersey, New Mexico, 

North Carolina, North Dakota, Ohio, Oklahoma, South 

Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, 

West Virginia, Wisconsin, and Wyoming)—have collected 

these data for at least 5 years, providing sufficient data 

to monitor HIV trends and to estimate risk behaviors for 

HIV infection. Recently, 9 additional areas have begun 

confidential name-based HIV surveillance, and data from 

these areas will be included in coming years.

HIV/AIDS: This term includes persons with a diagnosis 

of HIV infection (not AIDS), a diagnosis of HIV infection 

and a later diagnosis of AIDS, or concurrent diagnoses of 

HIV infection and AIDS.


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For more information . . . 

CDC Division of HIV/AIDS Prevention

http://www.cdc.gov/hiv

CDC HIV/AIDS prevention resources

CDC-INFO

1-800-232-4636

Information about personal risk and where to 

get an HIV test

CDC National HIV Testing Resources

http://www.hivtest.org

Location of HIV testing sites

CDC National Prevention Information 

Network (NPIN)

1-800-458-5231

http://www.cdcnpin.org

CDC resources, technical assistance, and 

publications

AIDSinfo

1-800-448-0440

http://www.aidsinfo.nih.gov

Resources on HIV/AIDS treatment and clinical 

trials