Rate of HIV Infection Increasing Among Gays

Around the world, the incidence of HIV in gay men is increasing consistently, growing at 2-5 percent annually. Although the U.S. transmission rate declined in the early years of the American epidemic, when activists were promoting condoms and HIV was constantly in the news, in recent years rates have begun to creep up again, especially after the lesbians, gays, bisexuals and transgender step up their campaign.

The sexual HIV transmission rate in men who have sex with men (MSM) is substantially higher than the rate seen in heterosexuals.

This is due to a number of biological, behavioral, and social factors.

• The average HIV transmission rate during anal sex is estimated to be 18 times higher than the rate during vaginal intercourse. The risk of acquiring HIV during an act of unprotected anal intercourse is estimated to be 1.4 percent.
• The role variability of gay men increases transmission risk. Men who practice receptive, unprotected anal intercourse are at higher risk of contracting HIV. Men who practice insertive, unprotected anal intercourse are more likely to transmit HIV to their partners. This combination optimizes the spread of HIV between gay men in a way not seen in heterosexual couples.

In addition, certain groups of gay men are at particularly high risk for not only the above reasons but also because a large percentage of their potential partners are infected with the virus. This issue is particularly problematic for Black MSM. They often date within very small, high-risk communities. As such, their HIV risk is often higher than that of other MSM, even when their behavioral and lifestyle choices are safer.

For example, Black MSM in the United States are three times as likely to have HIV as other MSM even though, on average, they are less likely to engage in risky behaviors-- such as using drugs during sex. However, it's not just the higher risk of their partner pool that causes this disparity. Black MSM with HIV are also less likely to have health insurance, be on successful cART regimens, or have a high CD4 count than other HIV positive MSM. This reflects systemic healthcare inequities related to race, whose effects are not limited to Black MSM.