A staggering 67% of new HIV diagnoses in the US and nearly a third of new global infections occur among gay and bisexual men, a shocking disparity that reveals an urgent public health crisis hiding in plain sight.
Key Takeaways
- In the United States, gay and bisexual men accounted for 67% of all new HIV diagnoses in 2021, despite comprising about 2% of the population
- Globally, in 2022, an estimated 1.3 million gay men and other men who have sex with men (MSM) were living with HIV, representing 22% of all people with HIV worldwide
- In the US, the prevalence of HIV among Black gay and bisexual men aged 13-24 was 1 in 58 in 2019
- In 2021, new HIV infections among gay and bisexual men in the US totaled 24,733, a rate of 428 per 100,000
- Globally, MSM accounted for 29% of new HIV infections in 2022, estimated 380,000 cases
- In the US, incidence rate for Black/African American MSM was 1,097 per 100,000 in 2021
- 85% of gay and bisexual men with HIV in the US knew their status in 2021
- Only 64% of Black MSM with HIV were virally suppressed in 2021 US data, linked to late diagnosis
- In the UK, 92% of MSM HIV diagnoses were late-stage in 2021 among new cases
- 64% of US MSM with HIV achieved viral suppression in 2021
- Globally, 76% of MSM with diagnosed HIV on ART in 2022
- Black MSM viral suppression rate 55% in US 2021
- 41% of US MSM used PrEP in past year 2021
- Globally, PrEP coverage among MSM at risk 15% in 2022
- Condomless anal sex reported by 42% of US MSM in 2021 surveys
Gay men face alarmingly high HIV rates worldwide, with severe disparities by region and race.
Diagnosis and Testing
- 85% of gay and bisexual men with HIV in the US knew their status in 2021
- Only 64% of Black MSM with HIV were virally suppressed in 2021 US data, linked to late diagnosis
- In the UK, 92% of MSM HIV diagnoses were late-stage in 2021 among new cases
- In Australia, 95% of MSM with HIV diagnosed by 2021 due to high testing rates
- In San Francisco, median CD4 at diagnosis for MSM HIV was 432 in 2019, indicating earlier detection
- In EU/EEA, 47% of MSM HIV diagnoses were late (CD4<350) in 2022
- In Brazil, 70% of MSM HIV cases diagnosed within 3 months of infection 2021
- In South Africa, only 55% of MSM knew HIV status in 2020 surveys
- In Canada, testing coverage among MSM reached 60% annually in 2018
- 71% of Hispanic MSM with HIV diagnosed in US 2021
- In London, 7% of MSM HIV cases undiagnosed in 2021 clinic networks
- In China, HIV testing among MSM was 78% lifetime by 2022
- In India, only 42% of MSM tested for HIV in past year per NACO 2021
- In Netherlands, 89% diagnosis coverage for MSM HIV 2020
- In NYC, 90% of MSM with HIV aware of status 2019
- In France, late diagnosis in 38% of MSM HIV cases 2021
- In Russia, HIV testing uptake among MSM 45% in 2020
- In Thailand, 82% of MSM tested HIV negative confirmed 2022
- Home HIV testing increased diagnosis by 20% among US MSM 2014-2019
- In Western Europe, undiagnosed MSM HIV fraction 12% in 2022
- In Mexico, 65% MSM HIV diagnosis rate 2021
- In Peru, testing coverage 58% among gay men 2020
- In Vietnam, 70% MSM annual HIV testing 2022
- Routine screening reduced late diagnoses by 30% in US MSM clinics 2021
- In Berlin, 94% MSM HIV diagnosis coverage 2021
- In Kenya, only 40% MSM tested recently for HIV 2020
Diagnosis and Testing Interpretation
This global patchwork of statistics reveals a frustrating truth: we've built the tools to end HIV, yet our progress is wildly uneven because testing, like a good party invitation, isn't reaching everyone who needs it.
Incidence
- In 2021, new HIV infections among gay and bisexual men in the US totaled 24,733, a rate of 428 per 100,000
- Globally, MSM accounted for 29% of new HIV infections in 2022, estimated 380,000 cases
- In the US, incidence rate for Black/African American MSM was 1,097 per 100,000 in 2021
- In the UK, new HIV diagnoses among MSM fell 29% from 2015 to 2021, to 1,039 cases
- In Australia, HIV incidence among MSM was 17.5 per 1,000 in 2021
- In San Francisco, HIV incidence among MSM declined to 0.9% annually in 2019
- In the EU/EEA, 26,000 new HIV cases among MSM in 2022, 42% of total
- In Brazil, HIV incidence among MSM was 2.1% per year in 2021 cohorts
- In South Africa, HIV incidence among MSM was 3.8% annually in 2020
- In Canada, new HIV infections among MSM were 18% of total in 2018
- In the US, HIV incidence among white MSM was 194 per 100,000 in 2021
- Among Hispanic MSM in US, incidence was 614 per 100,000 population in 2021
- In London, HIV incidence among MSM was 1.2% in 2021 clinic data
- In China, HIV incidence among MSM was 2.5% per year in 2022
- In India, new HIV infections among MSM totaled 12,000 in 2021 NACO
- In the Netherlands, HIV incidence among MSM declined 50% since 2008 to 0.8% in 2020
- In NYC, HIV incidence among MSM was 1.5% in 2019
- In France, 2,200 new MSM HIV diagnoses in 2021
- In Russia, HIV incidence among MSM estimated 3.2% annually 2020
- In Thailand, HIV incidence among MSM 2.8% in 2022 surveys
- In the US, PrEP prevented an estimated 91,000 infections among MSM 2014-2019
- In Western Europe, MSM HIV incidence stable at 5-10% of new cases
- In Mexico, HIV incidence among MSM 3.1% per year 2021
- In Peru, HIV incidence 4.2% among gay men in 2020
- In Vietnam, new HIV cases among MSM 25% of total 2022
- In US South, MSM HIV incidence rate 50% higher than national average 2021
- In Berlin, HIV incidence among MSM 1.8% in 2021
- In Kenya, MSM HIV incidence 5.1% urban 2020
Incidence Interpretation
While a global roadmap shows powerful tools like PrEP are helping some communities dramatically turn the tide, the stark and stubbornly high infection rates—particularly among men of color—tell a story where inequity, not just epidemiology, remains the most dangerous co-infection.
Prevalence
- In the United States, gay and bisexual men accounted for 67% of all new HIV diagnoses in 2021, despite comprising about 2% of the population
- Globally, in 2022, an estimated 1.3 million gay men and other men who have sex with men (MSM) were living with HIV, representing 22% of all people with HIV worldwide
- In the US, the prevalence of HIV among Black gay and bisexual men aged 13-24 was 1 in 58 in 2019
- Among white gay men in the UK, HIV prevalence was 7.1% in 2020 surveys
- In Australia, HIV prevalence among MSM was estimated at 6.5% in 2021
- In San Francisco, HIV prevalence among MSM was 28% in 2019 behavioral surveys
- In Europe, HIV prevalence among MSM ranged from 5-15% across major cities in 2022 ECDC data
- In Brazil, HIV prevalence among gay men was 10.5% in 2021 respondent-driven sampling
- In South Africa, HIV prevalence among MSM was 15.6% in urban areas per 2020 studies
- In Canada, HIV prevalence among MSM was 8.3% nationally in 2018
- In the US, lifetime HIV risk for gay and bisexual men is 1 in 6 overall
- Among Hispanic gay men in the US, HIV prevalence was 18% in 2020 estimates
- In London, UK, HIV prevalence among MSM attending clinics was 12.4% in 2021
- In China, HIV prevalence among MSM in major cities reached 9.8% in 2022
- In India, HIV prevalence among MSM was 7.4% in high-risk groups per NACO 2021
- In the Netherlands, HIV prevalence among MSM was 10.2% in 2020 cohort studies
- In New York City, HIV prevalence among MSM was 19% in 2019 surveillance
- In France, HIV prevalence among MSM was 13% in 2021 ANRS surveys
- In Russia, HIV prevalence among MSM was estimated at 12.5% in 2020
- In Thailand, HIV prevalence among MSM was 11.6% in 2022 behavioral surveillance
- In the US, gay and bisexual men represent 69% of people living with HIV diagnosed and undiagnosed in 2021
- In Western Europe, HIV prevalence among MSM averaged 8-10% in 2022
- In Mexico, HIV prevalence among MSM was 13.4% in 2021 national survey
- In Peru, HIV prevalence among gay men reached 14.2% in Lima per 2020 studies
- In Vietnam, HIV prevalence among MSM was 8.7% in 2022
- In the US South, HIV prevalence among MSM was 22% in Black communities 2021
- In Berlin, Germany, HIV prevalence among MSM was 15.8% in 2021
- In Kenya, HIV prevalence among MSM was 18.2% urban estimate 2020
- In the US, undiagnosed HIV prevalence among MSM is 13% per 2021 CDC
Prevalence Interpretation
These statistics are not a series of disconnected numbers but a damning global indictment, revealing a virus that, with chilling precision, has mapped itself onto the fault lines of sexuality, race, and geography, creating a pandemic within a pandemic that the world has too often met with a shrug.
Prevention and Risk Behaviors
- 41% of US MSM used PrEP in past year 2021
- Globally, PrEP coverage among MSM at risk 15% in 2022
- Condomless anal sex reported by 42% of US MSM in 2021 surveys
- UK MSM PrEP use rose to 25% among high-risk 2021
- Australia 35% MSM on PrEP 2021
- San Francisco 60% MSM PrEP coverage 2019
- EU MSM condom use 50% consistent in partnerships 2022
- Brazil MSM group sex 30% increased risk behavior 2021
- South Africa MSM multiple partners 65% 2020
- Canada MSM chemsex use 20% linked to risk 2018
- 25% US Black MSM used PrEP 2021
- London MSM serodiscordant condomless 18% 2021
- China MSM app-based partner seeking 70% 2022
- India MSM paid sex 15% risk factor NACO 2021
- Netherlands DAA chemsex 25% MSM 2020
- NYC MSM PrEP 45% 2019
- France MSM barebacking 35% reported 2021
- Russia MSM alcohol/drug use sex 40% 2020
- Thailand MSM tourism sex 22% 2022
- PEP use after exposure 15% US MSM 2021
- Western Europe MSM geosocial apps 55% 2022
- Mexico MSM receptive anal 50% risk 2021
- Peru MSM network density high 60% 2020
- Vietnam MSM migrant workers 30% mobile risk 2022
- Circuit parties MSM STI/HIV risk 25% US 2021
- Berlin MSM PrEP 40% 2021
- Kenya MSM bisexual concurrency 45% 2020
Prevention and Risk Behaviors Interpretation
The global patchwork of PrEP use and sexual behaviors reveals a precarious truth: while biomedical prevention tools have become more accessible in some fortunate pockets, vast disparities persist, leaving many communities vulnerable to HIV through a complex web of socioeconomic barriers, stigma, and evolving sexual practices.
Treatment and Viral Suppression
- 64% of US MSM with HIV achieved viral suppression in 2021
- Globally, 76% of MSM with diagnosed HIV on ART in 2022
- Black MSM viral suppression rate 55% in US 2021
- In UK, 97% of MSM on HIV treatment virally suppressed 2021
- In Australia, 92% viral suppression among treated MSM 2021
- San Francisco MSM HIV viral suppression reached 89% in 2019
- EU/EEA MSM on ART 85% suppressed 2022
- Brazil MSM viral load suppression 78% among diagnosed 2021
- South Africa MSM treatment coverage 65% with 70% suppression 2020
- Canada MSM HIV suppression rate 87% in 2018
- Hispanic MSM suppression 62% in US 2021
- London MSM 96% virally suppressed on ART 2021
- China MSM ART adherence 82%, suppression 75% 2022
- India MSM on treatment 60%, suppressed 55% NACO 2021
- Netherlands MSM viral suppression 95% 2020
- NYC MSM suppression 84% in 2019
- France MSM 91% suppressed on treatment 2021
- Russia MSM treatment suppression 50% 2020
- Thailand MSM 80% viral suppression 2022
- US MSM U=U awareness 70% correlated with suppression 2021
- Western Europe MSM suppression 90-95% 2022
- Mexico MSM ART suppression 72% 2021
- Peru MSM viral suppression 68% 2020
- Vietnam MSM on ART 75% suppressed 2022
- Long-acting ART increased suppression to 92% in US MSM trials 2021
- Berlin MSM 93% viral suppression 2021
- Kenya MSM suppression rate 62% 2020
Treatment and Viral Suppression Interpretation
While we’ve built skyscrapers of medical success where treatment virtually eliminates transmission, the stubborn, inequitable gaps—especially along lines of race and geography—reveal we're still laying the foundation in far too many communities.
Sources & References
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