HIV epidemic encompasses diverse scenarios among MSM around the world. Even when, prevalence and incidence data are lacking in more than 90 countries, available information shows that unprotected anal intercourse is the prominent exposure mode for HIV infection among MSM in Latin America, whereas intravenous drug use drives the epidemic in Asia. In the recent years, a previously neglected HIV epidemic has been recognised in settings where was initially thought was mainly heterosexual like in many countries in Africa. Although individual level risk factors for HIV acquisition have been clearly identified, structural level risk depends on stigma and discrimination. Promising biomedical intervention for HIV prevention depends on link to care which at the time are related to fear, denial or blackmail.