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This is more common in countries where HIV prevalence among the whole men who have sex with men population is relatively high.28 One study carried out in Bangkok found HIV incidence was more than twice as high among men aged 18 to 21 years compared to men over 30 years of age.29 Where race intersects with age and sexuality, HIV risk can also be affected.

For example, in the USA, young black men (aged between 13 and 24) who have sex with men are around three times more likely to have HIV than white men who have sex with men of the same age.30 Young men who have sex with men often find it harder to access HIV services, due to age of consent laws or unsociable opening times.

However, access varies greatly between regions and within countries.

For example, men who have sex with men on a higher income are more likely to be able to afford, and therefore access, prevention initiatives than those on a low income.42 When men who have sex with men are targeted by HIV prevention campaigns they can be extremely effective.

This can make it harder to cope with aspects of HIV such as adherence to medication.38 39 It is evident that prevention strategies are failing to reach this group due to high HIV prevalence in communities around the world.