• HIV
• homosexual
• men
• prevention
• sexual health

The data are clear: the sexual health of gay, bisexual and other men who have sex with men (MSM) continues to deteriorate in many western industrialised countries.1 2 The epidemiological trends appear consistent: a resurgence of bacterial and viral sexually transmitted infections (STI); rising or stable HIV incidence; recent outbreaks of lymphogranuloma venerum and hepatitis C, especially among HIV-positive MSM;3 4 accompanied by a stable or increasing prevalence of risky sexual behaviours including unprotected anal intercourse, serodiscordant unprotected anal intercourse and high rates of partner change.5 These individual level changes are occurring within a wider context of evolving social, cultural and risk environments and norms and at a time when MSM in many developed country settings are enjoying unparalleled social acceptance and freedoms.6 Concomitant changes in the availability, use and abuse of recreational drugs, including alcohol, continue to fuel risk behaviour and drive disease incidence.1 Similarly, the growing population of HIV-infected MSM, many of whom are unaware of their HIV infection, may be increasing the burden of infection at a time when more men are reporting homosexual sexual behaviours and partnerships.7 8

The reality is that in many developed countries, gay, bisexual and other MSM continue to bear the brunt of the HIV epidemic. In the USA, nearly 60% of incident HIV infections are among MSM (including MSM who inject drugs), and HIV incidence has been rising unabated within this group since the early 1990s.9 HIV diagnosis rates among MSM are now many times those of women and heterosexual men in the USA, with HIV prevalence among MSM ranging between 18% and 40% in some large metropolitan areas.10 11 There are now more than 500 000 gay, bisexual and other MSM living with HIV infection in the USA, including an ageing cohort of …