Key messages
- •
Governmental, academic, and community strategies have been insufficient to curb the HIV epidemic in men who have sex with men (MSM).
- •
HIV prevention is difficult for MSM because of the high biological risk associated with anal intercourse, high frequency and variety of sexual activity, little acknowledgment of male–male sex by governments and health-care providers, discrimination, few specific services for MSM, and syndemic challenges (eg, substance misuse).
- •
In most parts of the world, restricted resources and legal barriers complicate the effective provision of HIV prevention services for MSM.
- •
Resources are scarce for HIV prevention services in MSM and scale-up is problematic. Available interventions are insufficient, largely untested in most developing countries, and not sufficiently tailored to MSM.
- •
Several behavioural interventions are somewhat efficacious in reduction of the frequency of unprotected anal intercourse in MSM, but none effectively decreases the incidence of new HIV infections. However, behavioural interventions have not been fully assessed in some environments, and they have a crucial role in combination with barrier and biomedical interventions.
- •
Coordinated behavioural, biomedical, and structural interventions that incorporate efficacious strategies could substantially reduce the incidence of HIV infection in MSM.
- •
Prevention efforts reach only a small proportion of MSM, and scalability should be considered when new interventions and packaging approaches are developed.