HIV Among Gay, Bisexual, and Other Men Who Have Sex With Men
Gay, bisexual, and other men who have sex with men (MSM))a represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young MSM (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all MSM. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were MSM or MSM-IDU.
New HIV Infectionsb
- In 2010, MSM accounted for 63% of estimated new HIV infections in the United States and 78% of infections among all newly infected men. From 2008 to 2010, new HIV infections increased 22% among young (aged 13-24) MSM and 12% among MSM overall.
- Among all MSM, white MSM accounted for 11,400 (38%) estimated new HIV infections in 2010. The largest number of new infections among white MSM (3,300; 29%) occurred in those aged 25 to 34.
- Among all MSM, black/African American MSM accounted for 10,600 (36%) estimated new HIV infections in 2010. The largest number of new infections among black/African American MSM (4,800; 45%) occurred in those aged 13 to 24. From 2008 to 2010 new infections increased 20% among young black/African American MSM aged 13 to 24.
- Among all MSM, Hispanic/Latino MSM accounted for 6,700 (22%) estimated new HIV infections in 2010. The largest number of new infections among Hispanic/Latino MSM (3,300; 39%) occurred in those aged 25 to 34.
Estimates of New HIV Infections in the United States for the Most-Affected Subpopulations, 2010
Source: CDC. Estimated HIV incidence among adults and adolescents in the United States, 2007–2010. HIV Surveillance Supplemental Report 2012;17(4). Subpopulations representing 2% or less of the overall US epidemic are not reflected in this chart. Abbreviations: MSM, men who have sex with men; IDU, injection drug user.
HIV and AIDS Diagnosesc and Deaths
- In 2011, in the United States, MSM accounted for 79% of 38,825 estimated HIV diagnoses among all males aged 13 years and older and 62% of 49,273 estimated diagnoses among all persons receiving an HIV diagnosis that year.
- At the end of 2010, of the estimated 872,990 persons living with an HIV diagnosis, 440,408 (50%) were MSM. Forty-seven percent of MSM living with an HIV diagnosis were white, 31% were black/African American, and 19% were Hispanic/Latino.
- In 2011, MSM accounted for 52% of estimated AIDS diagnoses among all adults and adolescents in the United States. Of the estimated 16,694 AIDS diagnoses among MSM, 39% were in blacks/African Americans; 34% were in whites; and 23% were in Hispanics/Latinos.
- By the end of 2010, an estimated 302,148 MSM with an AIDS diagnosis had died in the United States since the beginning of the epidemic, representing 48% of all deaths of persons with an AIDS diagnosis.
The large number of MSM living with HIV means that, as a group, gay, bisexual, and other MSM have an increased chance of being exposed to HIV. Results of HIV testing conducted in 20 cities as part of the National HIV Behavioral Surveillance System indicated that 18% of MSM tested in 2011 were HIV-positive and that HIV prevalence increased with increasing age.
In this study, the overall percent of gay and bisexual men with HIV who knew of their HIV infection increased from 56% in 2008 to 66% in 2011. Among those infected, 49% of young MSM aged 18 to 24 years knew of their infection, whereas 76% of those aged 40 and over were aware of their HIV infection. Fifty- four percent of black/African American MSM knew of their infection, compared with 63% of Hispanic/Latino MSM and 86% of white MSM. Persons who don’t know they have HIV don’t get medical care and can unknowingly infect others. The Centers for Disease Control and Prevention (CDC) recommends that all MSM get tested for HIV at least once a year. Sexually active MSM might benefit from more frequent testing (e.g., every 3 to 6 months).
Sexual risk behaviors account for most HIV infections in MSM. Anal sex without a condom (unprotected anal sex) has the highest risk for passing HIV during sex. It is also possible to become infected with HIV through oral sex, though the risk is significantly less than for anal or vaginal sex. For sexually active MSM, the most effective ways to prevent HIV are to limit or avoid anal sex, or for MSM who do have anal sex, to correctly use a condom every time. Gay men are at increased risk for sexually transmitted infections (STIs), like syphilis, gonorrhea, and chlamydia, and CDC recommends that all sexually active MSM be tested annually for these infections.
Alcohol and illegal drug use increases risk for HIV and other STIs. Using substances such as alcohol and methamphetamines can impair judgment and increase risky sexual behavior.
Homophobia, stigma, and discrimination may place gay men at risk for multiple physical and mental health problems and affect whether they seek and are able to obtain high-quality health services.
What CDC Is Doing
Guided by the National HIV/AIDS Strategy for the United States, CDC and its partners are pursuing a high-impact prevention approach to reducing new HIV infections by using combinations of scientifically proven, cost-effective, and scalable interventions directed to the most vulnerable populations in the geographic areas where HIV prevalence is highest.
As part of high-impact prevention, CDC is aligning surveillance and program activities more closely. For example, while linkage to care soon after HIV diagnosis is relatively high, more people living with HIV should receive continuous care and antiretroviral treatment, and a greater proportion of persons infected with HIV should have a suppressed HIV viral load—the most important goal for maximizing a person’s health as well as reducing the risk of transmission. By increasing the reporting of CD4 and viral load data across the country, CDC will aid health departments and clinicians in monitoring treatment progress toward viral load suppression. Currently, CDC estimates that only 25% of the 1.1 million individuals with HIV have their viral loads adequately suppressed.
CDC is also encouraging MSM and their healthcare providers to take advantage of biomedical approaches to HIV prevention. Pre-exposure prophylaxis (PrEP), which involves taking antiretroviral medications prior to becoming exposed to HIV, can reduce the risk of HIV infection in individuals at very high risk of infection. Post-exposure prophylaxis, which involves taking antiretrovial medications soon after possible exposure to HIV, also plays a role in HIV prevention, but should be not be considered a primary means of HIV prevention. Also, while HIV treatments can dramatically improve the health of HIV-positive persons who are treated, they also have prevention benefits: individuals whose HIV viral loads are suppressed have a greatly reduced chance of transmitting the virus to their partners (Treatment as Prevention).
CDC continues to focus on HIV testing. To expand HIV prevention services for young gay and bisexual men of color, transgender youth of color, and their partners, CDC awarded $55 million over 5 years to 34 community-based organizations with strong links to these populations. This funding will be used to provide HIV testing to more than 90,000 young gay and bisexual men and transgender youth of color, with a goal of identifying more than 3,500 previously unrecognized HIV infections and linking those who are HIV-infected to care and prevention services. Additionally, CDC’s MSM Testing Initiative seeks to identify at least 3,000 MSM with HIV who were previously unaware of their infection and link at least 85% to care.
Through its Act Against AIDS campaigns and other collaborative activities, CDC aims to provide MSM with effective and culturally appropriate messages about HIV prevention. The REASONS/RAZONES testing campaign features Latino gay and bisexual men sharing their reasons for getting an HIV test, while Testing Makes Us Stronger campaign encourages black gay and bisexual men to get tested for HIV. Let’s Stop HIV Together focuses on raising awareness of HIV and AIDS and simultaneously combatting complacency and stigma by increasing support for people living with the disease.
CDC also funds state and local health departments and community-based organizations to support HIV prevention services for MSM. Through the Diffusion of Effective Behavioral Interventions (DEBI) project, CDC supports various behavioral interventions and other high-impact prevention strategies.
Read more about CDC activities to reduce HIV risk and improve the health of MSM.
For more background information view the bibliography and other references used in this factsheet.
a The term men who have sex with men (MSM) is used in CDC surveillance systems. It indicates the behaviors that transmit HIV infection, rather than how individuals self-identify in terms of their sexuality.
b New HIV infections refer to HIV incidence, or the estimated number of people who are newly infected with HIV each year.
c HIV and AIDS diagnoses are the number of persons diagnosed with HIV infection and the number of persons diagnosed with AIDS, respectively, during a given time period. The terms do not indicate when the persons were infected.