The average HIV transmission rate during anal sex is estimated to be 18 times higher than the rate during vaginal intercourse. The risk of acquiring HIV during an act of unprotected anal intercourse is estimated to be 1.4 percent.
The role variability of gay men increases transmission risk. Role variability refers to taking different “roles” during sexual encounters. Men who practice receptive, unprotected anal intercourse are at higher risk of contracting HIV. Men who practice insertive, unprotected anal intercourse are more likely to transmit HIV to their partners. This combination optimizes the spread of HIV between gay men in a way not seen in heterosexual couples. In heterosexual couples, men are far more likely to penetrate and women to be penetrated. Because of this, HIV is far more likely to spread from the male partner to the female partner than vice versa.
Homophobia against gay men makes it more difficult for them to access health care. Other forms of legal and social discrimination affect their access as well. Problems getting care may cause delays in diagnosis and treatment of HIV infection. That’s really unfortunate. People are often most infectious during acute (new) infection, and treatment reduces infectivity. Therefore, delaying healthcare further increases the HIV risk among MSM.
In addition, certain groups of gay men are at particularly high risk another reason. Their risk is high because a large percentage of their potential partners are infected with the virus. This is particularly problematic for black MSM. They often date within very small, high-risk communities. As such, their HIV risk is often higher than that of other MSM. That’s true even when their behavioral and lifestyle choices are safer.