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In cases where sexual activity is prolonged there is also a concern that participants living with HIV may forget to take ART medication, or that those who are HIV-negative will miss the 72-hour window to be eligible for receiving post-exposure prophylaxis (PEP) after suspected exposure to HIV.27 Men in this groups often become HIV-positive while still young.

For example, a study in London, United Kingdom (UK) reported that 27% of infections among men who have sex with men were from a partner recently infected with HIV.

HIV testing and status awareness in 2014 was lower among young men who have sex with men (36%) than among this group as a whole (43%).31 Data from more than 9,000 USA-based men who have sex with men who took part in an online survey found being young, from a black or ethnic minority, and having a low level of education were all significantly associated with not being aware of HIV status.32 As of 2019, 67 countries criminalised same-sex conduct, affecting the rights of men who have sex with men and other members of the LGBTQ community.

In eight countries including Iran, Sudan, Saudi Arabia, Yemen and parts of Nigeria and Somalia, homosexuality is punishable by death.33 As a result, men who have sex with men are far less likely to access HIV services for fear of their sexual orientation and identity being revealed.

Many fear a negative reaction from healthcare workers.

As a result, men who have sex with men are less likely to access HIV services than heterosexuals.37 Men who have sex with men are more likely to experience depression due to social isolation and being disconnected from health systems.

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