HIV Epidemiology and Risk Behavior Among Men Who Have Sex with Men

The global burden of HIV among men who have sex with men (MSM) remains disproportionately high, with incidence and prevalence rates exceeding those of the general population across diverse regions. Recent decades have seen rising HIV prevalence among MSM in many urban centres, driven by a confluence of individual, interpersonal and structural factors. Individual behaviours such as condomless anal intercourse, multiple concurrent partnerships and engagement in transactional sex elevate exposure risk, while co-occurring sexually transmitted infections and syndemic conditions compound vulnerability. At the interpersonal level, social and sexual networks, online partner-seeking platforms and venue-based interactions shape patterns of transmission. Structural determinants—including stigma, criminalisation, uneven access to testing and prevention services, and migration dynamics—further influence epidemic trajectories. Biomedical interventions such as pre-exposure prophylaxis and early antiretroviral treatment have demonstrated efficacy in reducing new infections, yet uptake remains uneven, particularly in resource-limited settings. Integrative approaches that address multi-level drivers through community engagement, expanded testing, tailored behaviour-change strategies and structural reform are central to curbing HIV spread among MSM and to achieving global targets for epidemic control.

Research from Nature Portfolio

A large serial cross-sectional study spanning 2009–2013 among Chinese MSM demonstrated contrasting trends in sexual health indicators. Condom use during both recent and commercial anal sex rose steadily, and prevalence of syphilis and hepatitis C declined over the study period. Despite these positive shifts, HIV prevalence continued to climb, revealing a persistent expansion of the epidemic. A positive ecological correlation between HIV and syphilis prevalence underscored the interplay of co-infections. The findings point to the need for deeper investigations into behavioural, biological and service-delivery gaps that allow HIV transmission to persist even as some risk behaviours recede.

HIV Epidemiology and Risk Behavior Among Men Who Have Sex with Men publication trend

The graph below shows the total number of articles in hiv epidemiology and risk behavior among men who have sex with men across all publications each year (not limited to Nature Index journals).

Technical terms

Incidence: The rate at which new HIV infections occur in a population over a specified period.

Prevalence: The proportion of individuals in a population living with HIV at a given time.

Pre-exposure prophylaxis (PrEP): A preventive regimen of antiretroviral drugs taken by HIV-negative individuals to reduce risk of acquiring HIV.

Syndemic: The co-occurrence and interaction of multiple epidemics (for example, HIV, mental health disorders, substance use) that exacerbate disease outcomes.

Transactional sex: Sexual activities exchanged for money, goods or services, which can heighten HIV exposure risk.

Seroconversion: The development of detectable antibodies against HIV in a person’s blood, indicating new infection.

References

1. Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory. Current HIV/AIDS Reports (2023).
2. HIV Incidence and Transactional Sex Among Men Who Have Sex With Men in Ningbo, China: Prospective Cohort Study Using a WeChat-Based Platform. JMIR Public Health and Surveillance (2024).
3. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China. Scientific Reports (2016).