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 

Revised June 2007

In the United States, HIV infection and AIDS have 

had a tremendous effect on men who have sex 

with men (MSM). MSM accounted for 71% of all 

HIV infections among male adults and adolescents 

in 2005 (based on data from 33 states with longterm, confidential name-based HIV reporting), 

even though only about 5% to 7% of male adults 

and adolescents 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, 4]. Additionally, racial 

disparities exist with regard to HIV diagnoses 

within the MSM population. A recent study, 

conducted in 5 large US cities, found that HIV 

prevalence among black MSM (46%) was more 

than twice that among white MSM (21%) [5].

The recent overall increase in HIV diagnoses for 

MSM, coupled with racial disparities, strongly 

points to a continued need for appropriate 

prevention and education services tailored for 

specific subgroups of MSM, especially those who 

are members of minority races/ethnicities.

STATISTICS

HIV/AIDS in 2005

(The following bullets refer to the 33 states with long-term, 

confidential name-based HIV reporting. See the box, before 

the References section, for a list of the 33 states.)

In the 33 states with long-term, confidential 

name-based HIV reporting, an estimated 

19,620 MSM (18,296 MSM and 1,324 MSM 

•

Transmission categories of male adults 

and adolescents with HIV/AIDS diagnosed 

during 2005

Note. Based on data from 33 states with long-term, 

confidential name-based HIV reporting. Because of rounding, 

percentages may not equal 100.

who inject drugs) received a diagnosis of HIV/

AIDS, accounting for 71% of male adults and 

adolescents and 53% of all people receiving an 

HIV/AIDS diagnosis that year [1].

The number of HIV/AIDS diagnoses among 

MSM (including MSM who inject drugs) 

increased 11% from 2001 through 2005 [1]. 

It is not known whether this increase is due to 

an increase in the testing of persons with risk 

factors, which results in more HIV diagnoses, or 

due to an increase in cases of HIV infection

An estimated 231,893 MSM (207,810 MSM and 

24,083 MSM who inject drugs) were living with 

HIV/AIDS [1].

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

AIDS in 2005

(See the box, before the References section, for AIDS 

definition. The following data are from 50 states and the 

District of Columbia.)

An estimated 19,248 MSM (17,230 MSM 

and 2,018 MSM who inject drugs) received a 

diagnosis of AIDS, accounting for 65% of male 

adults and adolescents and 47% of all people 

who received a diagnosis of AIDS [1].

An estimated 7,293 MSM (5,929 MSM and 

1,364 MSM who inject drugs) with AIDS died, 

accounting for 60% of all men and 45% of all 

people with AIDS who died [1].

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Since the beginning of the epidemic, an 

estimated 517,992 MSM (452,111 MSM and 

65,881 MSM who inject drugs) had received a 

diagnosis of AIDS, accounting for 68% of male 

adults and adolescents who received a diagnosis 

of AIDS and 54% of all people who received a 

diagnosis of AIDS [1].

Since the beginning of the epidemic, an 

estimated 300,669 MSM (260,749 MSM and 

39,920 MSM who inject drugs) with AIDS had 

died, accounting for 68% of male adults and 

adolescents with AIDS who had died and 57% of 

all people with AIDS who had died [1].

At the end of 2005, an estimated 217,323 MSM 

(191,362 MSM and 25,961 MSM who inject 

drugs) were living with AIDS, representing 67% 

of male adults and adolescents living with AIDS 

and 52% of all people living with AIDS [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).

Having anal sex without a condom continues 

to be a significant threat to the health of MSM 

[6]. Unprotected anal sex (barebacking) with 

casual partners is an increasing concern. 

Not all the reasons for an apparent increase 

in unprotected anal intercourse are known, 

but research points to the following factors: 

optimism about improved HIV treatment, 

substance use, complex sexual decision 

making, seeking sex partners on the Internet, 

and failure to practice safer sex [7]. Some of 

these men may be serosorting, or only having 

sex (or unprotected sex) with a partner whose 

HIV serostatus, they believe, is the same as 

their own. Although serosorting between 

MSM who have tested HIV-positive is likely 

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

Race/ethnicity of MSM living with 

HIV/AIDS, 2005 
H IV/A IDS among Men Who Have Sex w ith Men

to prevent new HIV transmission to persons 

who are not infected, the effectiveness of 

serosorting between men who have tested HIVnegative has not been established. Serosorting 

with condom use may further reduce the risk 

of HIV transmission. However, for men with 

casual partners, serosorting alone is likely to 

be less effective than always using condoms 

because some men do not know or disclose 

their HIV serostatus [8]. 

STDs, which increase the risk for HIV 

infection, remain an important health issue 

for MSM. According to the Gonococcal 

Isolate Surveillance Project, the proportion 

of gonorrhea-positive test results among 

MSM increased from 4% in 1988 to 20.2% 

in 2004 [9]. Rates of syphilis among MSM 

have increased in some urban areas, including 

Chicago, New York, San Francisco, and Seattle 

[10–12]. In the 9 US cities participating in the 

MSM Prevalence Monitoring Project, the rates 

of STDs and HIV positivity varied by race 

and ethnicity but tended to be highest among 

black and Hispanic MSM [9]. In addition to 

increasing susceptibility to HIV, STDs are 

markers for high-risk sexual practices, through 

which HIV infection can be transmitted [13].

Unknown HIV Serostatus

Approximately 25% of people in the United States 

who are infected with HIV do not know they are 

infected [14].

Through its National HIV Behavioral 

Surveillance system, CDC found that 25% of 

the MSM surveyed in 5 large US cities were 

infected with HIV and 48% of those infected 

were unaware of their infections [5].

In a recent CDC study of young MSM, 77% 

of those who tested HIV-positive mistakenly 

believed that they were not infected [15]. 

Young black MSM in this study were more 

likely to be unaware of their infection―

approximately 9 of 10 young black MSM 

compared with 6 of 10 young white MSM. Of 

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•

•

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.

Research has shown that many people who 

learn that they are infected with HIV alter their 

behaviors to reduce their risk of transmitting the 

virus [16, 17]. Therefore, increasing the proportion 

of people who know their HIV serostatus can help 

decrease HIV transmission.

Substance Use

The use of alcohol and illegal drugs continues 

to be prevalent among some MSM and is linked 

to risk factors for HIV infection and other STDs 

[18]. Substance use can increase the risk for 

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 are also a 

concern because methamphetamine use has been 

associated both with risky sexual behaviors for 

HIV infection and other STDs and with the sharing 

of injection equipment when the drug is injected 

[19]. Methamphetamine and other “party” drugs 

(such as ecstasy, ketamine, and GHB [gamma 

hydroxybutyrate]) may be used to decrease social 

inhibitions and enhance sexual experiences [20]. 

These drugs, along with alcohol and nitrate 

inhalants (“poppers”), have been strongly 

associated with risky sexual practices among 

MSM [21].

Complacency about Risk

More than 25 years into the HIV epidemic, there 

is evidence of an underestimation of risk, of 

difficulty in maintaining safer sex practices, and of 

a need to sustain prevention efforts for all gay and 

bisexual men.

The success of highly active antiretroviral 

therapy (HAART) may have had the 

unintended consequence of increasing the risk 

behaviors of some MSM.

•


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

Some research suggests that the perceptions 

of 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 to an increase in risky sexual 

behaviors [22, 23]. For example, some MSM 

may mistakenly believe that they or their 

partners are not infectious when they take 

antiretroviral medication or when they have 

low or undetectable viral loads [24].

Optimism about HIV treatments is 

associated with a greater willingness to have 

unprotected anal intercourse [25–27]. 

Long-term efforts to practice safer sex present 

a significant challenge. A 4-city study indicates 

that years of exposure to prevention messages 

and long-term efforts to practice safer sex 

may play a role in the decision of HIVpositive MSM to engage in unprotected anal 

intercourse [23, 28].

The rates of risky behaviors are higher among 

young MSM than among older MSM [28, 29]. 

Not having seen firsthand the toll of AIDS in 

the early years of the epidemic, young MSM 

may be less motivated to practice safer sex.

MSM Who Are HIV-positive

HAART has enabled HIV-infected MSM to live 

longer. However, HAART’s success means there 

are more MSM living with HIV who have the 

potential to transmit the virus to their sex partners. 

This emphasizes the importance of focusing 

prevention efforts on those who are living 

with HIV.

Although many MSM reduce their risk behaviors 

after learning that they have HIV, most remain 

sexually active [17]. Most HIV-infected MSM 

believe that they have a personal responsibility 

to protect others from HIV, but some engage in 

risky sexual behaviors that may result in others’ 

contracting HIV [30–32]. Interventions to reduce 

the risk for transmission, some of which were 

tested with MSM, are available for persons living 

with HIV [33, 34].

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The Internet

During the past decade, the Internet has created 

new opportunities for MSM to meet sex partners 

[35]. Internet users can anonymously find partners 

with similar sexual interests without having to 

leave their residence or having to risk face-toface rejection if the behaviors they seek are not 

consistent with safer sex [36]. The Internet may 

also normalize certain risky behaviors by making 

others aware of these behaviors and creating new 

connections between those who engage in them. 

At the same time, however, the Internet has the 

potential to be a powerful tool for use with HIV 

prevention 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 other 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 HIV prevention 

services, particularly for MSM of minority races 

or ethnicities. Black 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, suggesting 

that they are not accessing testing or health care 

services through which HIV infection could be 

diagnosed at an earlier stage [37].

The stigma associated with homosexuality may 

inhibit some men from identifying themselves 

as gay or bisexual, even though they have 

sex with other men [38, 39]. Some men who 

have sex with men and with women don’t 

identify themselves as gay or bisexual [40]. 

Research among black men has shown that 

even if these men do not identify themselves 

as gay or bisexual, they do not engage in risky 

behavior more often than the men who do 

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

identify themselves as gay or bisexual [41]. This 

research suggests that elevated rates of STDs 

and undetected or late diagnosis of HIV infection 

may contribute to higher rates of HIV infection 

among black MSM.

Black and Hispanic MSM are less likely 

than white MSM to live in gay-identified 

neighborhoods [42]. Therefore, prevention 

programs directed to gay-identified 

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 [43, 44].

Although Asians/Pacific Islanders and American 

Indians/Alaska Natives accounted for less 

than 2% of the AIDS cases in MSM reported 

nationally during 1989–1998, these groups 

accounted for noteworthy proportions of cases 

in certain metropolitan areas [38]. Also, HIV 

infection among American Indians and Alaska 

Natives may be underestimated because not all 

surveillance systems recognize American Indian 

or Alaska Native as a race/ethnicity [45].

Combinations of Risk Factors

There is growing recognition that combinations 

of individual, sociocultural, and biomedical 

factors affect HIV risk behavior among MSM 

[46]. Childhood sexual abuse, substance use, 

depression, and partner violence have been shown 

to increase the practice of risky sexual behaviors. 

Further research has shown that the combined 

effects of these problems may be greater than their 

individual effects [47]. Therefore, MSM with more 

than 1 of these problems may have additional 

risk factors for HIV infection. The expansion and 

wider awareness of this type of research, which 

shows the additive effect of various psychosocial 

problems, will result in more precise 

prevention efforts.

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Differences within the MSM 

Population

Even though MSM constitute a group at risk for 

HIV, not all MSM are at risk for HIV. Analyzing 

the context within which individuals of the larger 

MSM community live and socialize may be a 

promising method for developing and focusing 

HIV interventions. A recent large-scale HIV 

vaccine efficacy trial looked at combinations of 

demographic characteristics and risk behaviors to 

help identify MSM at greatest risk [48]. This study 

of more than 5,000 HIV-negative MSM found 

that older men with large numbers of sex partners, 

young men who used “party” drugs, and older 

men who used nitrate inhalants were most likely to 

contract HIV.

The appreciation of differences within the MSM 

community will aid in the development of 

successful HIV prevention interventions.

Prevention

To reduce the incidence of HIV, CDC released 

the Revised Recommendations for HIV Testing 

of Adults, Adolescents, and Pregnant Women in 

Health-Care Settings (http://www.cdc.gov/mmwr/

preview/mmwrhtml/rr5514a1.htm) in 2006. 

These recommendations include the routine HIV 

screening of adults, adolescents, and pregnant 

women in health care settings in the United 

States. They also include reducing barriers to HIV 

testing. In 2003, CDC announced Advancing HIV 

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

prev_prog/AHP). 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.

Given that a large number of HIV-infected MSM 

are unaware of their infection, HIV testing is an 

important strategy for this population. Many of 


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

these men have previously tested HIV-negative, so 

CDC recommends that all sexually active MSM be 

tested for HIV at least once a year [49]. MSM who 

engage in high-risk behaviors (e.g., unprotected 

anal sex with casual partners) should be tested 

more frequently.

MSM as a group continues to be the population 

most affected by HIV infection and AIDS. 

However, research shows that HIV prevention 

efforts can reduce sexual risk factors: one review 

found that among men who received an HIV 

prevention intervention, the proportion who 

engaged in unprotected sex decreased, on average, 

26% [50].

CDC offers effective interventions for MSM 

(http://www.effectiveinterventions.org). These 

interventions can be tailored to various audiences, 

such as African American or Hispanic MSM. For 

example,

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 sex as the norm in 

the social networks of MSM

Healthy Relationships, which helps develop 

the skills and self-efficacy of MSM and other 

people living with HIV/AIDS

Peers Reaching Out and Modeling Intervention 

Strategies (PROMISE), which uses peer 

advocates (including men who do not identify 

themselves as gay) to help people adopt 

practices to reduce or eliminate risk factors for 

HIV infection

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In 2006, CDC provided 54 awards to communitybased organizations that focus primarily on 

MSM. CDC also provides funding through state, 

territorial, and local health departments. Of these 

54 awards, 63% focus on African Americans, 43% 

on Hispanics, 13% on Asians and Pacific Islanders, 

and 20% on whites (the percentages do not add to 

100% because some of the organizations focus on 

more than one racial/ethnic group). For example,

An organization in Jefferson County, Alabama, 

that provides a range of services, including 

individual counseling, community and street 

outreach, and interventions for African 

American men and Spanish-speaking men

An organization in New York City that 

provides HIV/AIDS–related services, 

education, and research to Asian and Pacific 

Islander communities

An organization offering HIV/AIDS services 

throughout Los Angeles and San Bernadino 

counties and San Diego that is committed to 

enhancing the health and well-being of the 

Latino community and other underserved 

communities through community education, 

prevention, mobilization, advocacy, and direct 

social services.

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

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

For more information . . . 

CDC HIV/AIDS

http://www.cdc.gov/hiv

CDC HIV/AIDS 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

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have sex with men―United States, 1989–1998. MMWR 

2000;49:4–11.

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and non-student men who have sex with men―North 

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“down low”: bisexual black men, HIV risk and 

heterosexual transmission. Journal of the National 

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Millet GA, Peterson JL, Wolitski RJ, Stall R. Greater 

risk for HIV infection of black men who have sex with 

men: a critical literature review. American Journal of 

Public Health 2006;96:1007–1019.

Mills TC, Stall R, Pollack L, et al. Health-related 

characteristics of men who have sex with men: a 

comparison of those living in “gay ghettos” with those 

living elsewhere. American Journal of Public Health

2001;91:980–983.

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