Why Do Gay People Get HIV?

Why men who have sex with men have the highest risk for the virus

In the United States, gay men get human immunodeficiency virus (HIV) at higher rates than other groups for many reasons. It is easier to transmit the virus during anal sex than during vaginal sex, for example. Gay men, especially gay men of color, also have additional risk factors including poorer access to health care. 

There are many ways to reduce your risk of getting HIV, including correct condom use and HIV prevention medications.

This article takes a closer look at four key factors that place gay men and other men who have sex with men (MSM) at the highest risk of HIV compared to all other groups.

Two men in bed

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HIV Infections in Gay Men

According to the Centers for Disease Control and Prevention (CDC), 70% of all new HIV infections in 2019 were gay or bisexual men. Over one-third of these were Black men who are gay or bisexual.

In discussing HIV infections in gay men, though, it's important to remember that not all men who have sex with men are gay. MSM actually refers to any man who has sex with another man, whether he is gay, bisexual, heterosexual, or another sexuality.

Several risk factors unique to MSM can increase the odds of becoming infected, including:

  • Risks associated with anal sex
  • Social and economic risk factors
  • Stigma

HIV and Condomless Anal Sex

Unprotected anal sex, also known as condomless anal sex, is a major risk factor for passing the virus.

Not all gay men and other MSM engage in anal sex. However, condomless anal sex is one of the main ways MSM acquire HIV. In fact, condomless anal intercourse is even more likely to transmit HIV than condomless vaginal sex. This is true regardless of the sex of the receptive ("bottom") partner.

One of the main reasons for this is the structure of the rectum itself. Unlike the vagina, which is lined with a dense layer of cells that acts as a barrier, the rectum only has a single column of these cells.

  • Because rectal tissues are fragile, they are also prone to breakage, allowing the virus to slip past the thin cell layer.
  • Rectal tissues are also rich in immune cells called CD4 T cells. These are the very cells that HIV targets for infection.

Because of this, HIV can establish an infection quickly. Studies using animal models have shown that within an hour of rectal exposure, HIV can breach the body's frontline immune defenses. Within 24 hours, the virus can spread throughout the body.

Social and Economic Risk Factors

Certain groups of gay men and other men who have sex with men are at greater risk of getting HIV. This includes Black or Latinx MSM in particular.

Poverty, racism, high rates of unemployment, lack of government support, and poor access to health care all contribute to the high rates of HIV in people of color.

Stigma and Consequences of Testing Positive

Stigma can also play a role in HIV transmission. People with HIV are frequent targets of stigma—not just because of their HIV status, but sometimes also because of their sexual orientation and race. This can affect their health in a number of ways.

Some people wrongfully believe that the high rate of HIV among gay men and MSM confirms that gay and bisexual people are "promiscuous," "diseased," or "immoral." This attitude can send many MSM into hiding.

Rather than subject themselves to shame or discrimination, some men may avoid HIV testing and treatment until 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 want or be ready to do.

If they do get tested and have HIV, isolation and a lack of support can contribute to depression, alcohol or drug abuse, sexual risk-taking, and inconsistent treatment and care.

Many who begin medical treatment for HIV do not remain in care.

Preventing HIV

Choosing not to have sex is obviously the best way to prevent HIV infection, but that is not desirable or reasonable for most people.

HIV prevention, then, comes down to personal choices.

One of the most effective ways to reduce your risk of getting HIV is by using a condom every time you have sex. Be sure to choose one that fits correctly and put it on properly.

The use of condoms approved for vaginal sex has long been recommended for people who have anal sex as well. And while you can use those, there is now a condom that is formally approved by the Food and Drug Administration (FDA) for anal sex. ONE condoms got this marketing authorization in March 202.

Limiting the number of sexual partners you have and/or engaging in other types of sexual activity, such as oral sex, are also good ways to reduce your risk.

HIV Testing for Gay Men and MSM

Frequent testing is important if you are an MSM. Get tested at least once a year. If you have multiple partners and you don't know their HIV status, consider getting tested every three to six months.

Not everyone experiences symptoms during the early stage of HIV. This is why it's important to get tested if you think you've been exposed to the virus.

If you test positive, inform your sexual partner(s) and get treatment. Treatment can help protect your health and reduce your risk of passing the virus to others.

What Is PrEP?

Pre-exposure prophylaxis (PrEP) is a medication that is highly effective at reducing HIV transmission. However, due to a lack of awareness and access, only about one-third of MSM reported using PrEP in 2017.

Risk of Other STIs

There is also a high rate of sexually transmitted infections (STIs) among MSM. Having an STI can increase the odds of getting HIV. Some infections, like syphilis, increase the risk by as much as 500%.

Many STIs lead to changes in the infected tissue, and also alter the type and number of immune cells in the infected area. These effects can make the area more susceptible to the HIV virus.

Among the reasons for the high rate of STIs:

  • MSM are more likely to have multiple sex partners (of either sex) compared to those who exclusively have sex with women.
  • MSM between the ages of 18 and 24 are more likely to have sex with a partner five or more years older than them. This matters in terms of their risk because the older someone is, the more sexual encounters they are likely to have had.

Summary

There are numerous factors that place gay and bisexual men at a high risk of becoming infected with the HIV virus, including physiological vulnerabilities, sexual practices, social and economic inequities, and cultural stigma.

Black and Latinx MSM are especially impacted due to the intersection of these and other risk factors, including racism and homophobia.

Frequently Asked Questions

  • What are the early symptoms of HIV?

    Symptoms of early HIV infection can be similar to influenza symptoms. These symptoms can include:

  • Is there a risk of HIV of a partner doesn't ejaculate?

    Yes. Pre-seminal fluid can still contain the virus.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Centers for Disease Control and Prevention. HIV and African American gay and bisexual men.

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  6. National Institutes of Health. To end HIV epidemic, we must address health disparities.

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  8. HIV.gov. Syphilis and HIV: a dangerous duo affecting gay and bisexual men.

  9. 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. Published 2016 Jul 7. doi:10.1186/s12889-016-3149-z

  10. Glick SN, Morris M, Foxman B, et al. A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women. J Acquir Immune Defic Syndr. 2012 May 1;60(1):83–90. doi:10.1097/QAI.0b013e318247925e

By Elizabeth Boskey, PhD
Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.