What makes MSM vulnerable to HIV?

What makes MSM vulnerable to HIV?

Biological factors

• It’s easier for HIV to be transmitted through unprotected anal sex than through unprotected vaginal sex.
• If a man has another sexually transmitted infection (STI), this can be an extra biological factor that increases his risk of becoming infected with HIV. STIs are relatively common in some communities of MSM, and because men do not always think – or are not always encouraged – to be tested for STIs that are present rectally, these infections often go undiagnosed and untreated. In many cases, fear of discrimination stops MSM from accessing testing services.

Behavioural factors

• Certain behaviours increase MSM’s risk of becoming infected with HIV, such as having multiple sex partners, not using condoms consistently, not learning about HIV or having a complacent or negative attitude towards safer sex.
• Alcohol and drugs are a common part of socialising in some communities of MSM. Drink and drugs can make it more likely that people will have unprotected sex and a higher number of sexual partners. In the U.S. for instance, a study in Los Angeles found that MSM who used the drug crystal meth were three times more likely than non-drug using MSM to be infected with HIV.⁴

Social/cultural factors

• Some governments and societies are in denial about the fact that sex between men happens, and it is a taboo subject in many cultures. As a result, HIV prevention campaigns often only talk about the risks of heterosexual sex, and there is little appropriate information available to MSM, which can give them the false impression that they are not at risk. There is evidence that this has happened in some Asian countries, for instance.⁵
• In countries where sex between men is criminalised, MSM are excluded from sexual health services and might find it hard to access condoms and lubricants to protect themselves from HIV.
• A certain proportion of sex between men in most countries is commercial. As with female sex workers, male or transgender sex workers may find it difficult to persuade their clients to use condoms, or may be offered more money to have unprotected sex, increasing the risk that they will become infected with HIV. In some countries there are HIV programmes aimed at female sex workers, but none targeting male sex workers.⁶
• In countries where antiretroviral drugs are widely available, a climate of optimism about the effectiveness of this treatment may lead some MSM to take more risks