If you are a man who has sex with men, you might have a higher risk of getting HIV, the virus that causes AIDS. It's important to know your risk factors and how you can prevent infection. There are more options to treat HIV and lower your viral count to undetectable.
That means you likely wont pass HIV to your partner. And there are HIV medications your partner can take to stay protected, too.
If you're already HIV positive, you can prevent your partner or partners from becoming infected and lower your chances of getting sick. It's called antiretroviral therapy (ART), which lowers your risk of infecting partners almost completely.
If you're partner doesn't have HIV, they can take pre-exposure prophylaxis (PrEP) to prevent HIV infection. Find out about HIV risk factors for men who have sex with men, how HIV medications work, who can get them, and steps you can take to lower your risk of HIV.
HIV Risk Factors for Men Who Have Sex With Men
About 1.2 million people in the U.S. have HIV, but about 13% of them don't know they have it. That means they could spread HIV to others without knowing it.
Men who have sex with men (MSM) are the largest group of people with HIV. About 67% of the estimated 31,800 new HIV infections in 2022 involved men who have sex with men. The CDC also tracks the number of people diagnosed with HIV each year (since people can live for years without knowing they have it).
If you're a man who has sex with other men in the U.S., you have about a 1 in 6 chance of getting HIV at some point in your life (compared to a 1 in 524 chance for men who don’t have sex with men).
Risk factors for HIV
HIV risk is even higher for certain racial and ethnic groups. Black MSM have a 1 in 2 lifetime risk of HIV. Hispanic or Latino MSM have a 1 in 4 risk. In 2022, 39% of diagnosed infections in the U.S. among men who have sex with men were among Black men; 33% were among Hispanic or Latino men.
Other HIV risk factors include:
- Having sex without using a condom
- Having unprotected anal sex, especially if you are the receptive (bottom) partner, which is 10 to 15 times more likely to lead to HIV than being the insertive (top) partner
- Having more than one partner or anonymous partners
- Using illegal drugs (especially needle-sharing IV drug use) or drinking a lot of alcohol, which can affect your judgment and make you more likely to have unsafe sex
Having a sexually transmitted disease (STD) is another risk factor. You can get STDs from the same behaviors that can raise your risk of getting HIV.
Also, having an STD may create open sores or inflammation, allowing HIV to get through your skin. Syphilis is especially common among men who have sex with men and can put you at high risk of HIV in the future.
You May Be Able to Prevent HIV With a Pill or Shot
Preventive medications, known as "pre-exposure prophylaxis," or PrEP for short, cut your risk of getting HIV from sex by about 99% when taken properly. PrEP can lower the risk of getting HIV from injection drug use by at least 74%.
Two prescriptions are available in pill form:
The injections for PrEP include:
- Apretude, once you start, you'll get a shot once every two months.
- Yeztugo, after you start, you'll only need a shot twice a year.
The shots may be easier than taking pills every day, but you'll need to visit a health care facility to keep up with your follow-up tests.
Who can get PrEP?
PrEP isn't for all MSM. Health care experts say it should be given to HIV-negative people with risk factors for HIV exposure. This includes men who have sex with men, are sexually active, and have other risks, including:
- A sex partner with HIV
- Not regularly using condoms during anal sex
- An STD (syphilis, gonorrhea, or chlamydia) within the past six months
- Sharing injection drug syringes
- Having multiple sex partners whose HIV status is unknown
If you are an HIV-negative man in a mutually monogamous relationship with a male partner who has recently tested negative for HIV, you likely don't need PrEP. But your doctor or an HIV counselor who knows your entire risk profile can tell you whether PrEP is for you.
Where can I find PrEP?
Not all doctors are equally educated about PrEP. And PrEP may not be available at clinics near you. For example, about one-fourth of clinics in the South have this medication, though the region has more than half of all new HIV cases, a recent study reported. The CDC provides a locator list for PrEP providers so you can find one near you.
PrEP barriers
You also may be worried about PrEP's cost. Financial help is available if you can't afford PrEP.
Stigma is another barrier. Some people say they are not comfortable seeing doctors and talking about their sexual behaviors, or having others know they are taking PrEP. They say they've had to deal with "PrEP shaming" and homophobia.
Finding an informed health care professional or support group can help get rid of these fears.
Other Steps You Can Take to Lower Your Risk for HIV
Besides PrEP, you can do other things to keep from getting infected with HIV.
Get tested for HIV
At least annually, the CDC suggests. HIV.gov says if you have risk factors, test every three to six months.
Get tested for other STDs
The CDC says sexually active MSM should be tested "at least annually" for syphilis, gonorrhea, and chlamydia. If you have multiple or anonymous sex partners, get tested every three to six months.
Use condoms
Even if you take PrEP, use a condom because condoms prevent STDs. Use water-based lubricants instead of oil-based ones, which can cause condoms to break.
Get help for illegal drug use
If you drink too much alcohol or use illegal drugs, there are many programs that can help you quit. You may find a 12-step program or a 28-day inpatient treatment center helpful. There are many options to help you get the support you need to get healthy again.
What is PEP?
If you are exposed to HIV, emergency treatment is available if given within 72 hours. This "post-exposure prophylaxis" (or PEP) can prevent the virus from taking hold. The quicker you are treated after being exposed, the better PEP works.
Whether you have HIV or are trying to avoid getting it, it's important to learn your risks and find ways to provide a safer future for yourself and others.
