According to UNAIDS, in 2018, MSM globally have 22 times higher risk of acquiring<unk>  compared to all adult<unk> . A 2007 study analyzing two large population surveys found that "the majority of gay<unk>  had similar numbers of unprotected<unk> ual partners annually as straight<unk>  and women." However, a 2006 study found that<unk>  who reported 4 or more male<unk> ual partners were at increased risk of<unk>  infection. Study participants who reported amphetamine or heavy alcohol use before<unk>  were more likely to have<unk>  or other<unk> ually transmitted infections. A Kaiser Family Foundation study indicated that fewer Americans view<unk>  as a top health priority today compared to ten years ago. In 1996, 25% of Americans viewed<unk>  as an “urgent problem” to their community but in 2009, only 17% listed it as “urgent.” The percentage of 18- to 29-year-olds that were personally concerned about contracting the virus dropped from 28% in 1995 to 17% in 2009 A study conducted in 6 major U.S. cities found that only one in 4 teenage<unk>  who have<unk>  with<unk>  believed they were personally at risk for contracting the<unk>  virus. Unprotected anal intercourse The<unk>  virus is more easily transmitted through unprotected anal intercourse than through unprotected vaginal intercourse and<unk>  who report unprotected receptive anal intercourse are at increased risk of contracting the<unk>  virus. Generally, the receptive partner is at greater risk of contracting the<unk>  virus because the lining of the rectum is thin and may allow the virus to enter the body through semen exchange. The insertive partner is also at risk because STIs can enter through the urethra or through small cuts, abrasions, or open sores on the penis. Also, condoms are more likely to break during anal<unk>  than during vaginal<unk> . Thus, even with a condom, anal<unk>  can be risky. A 2004 study of<unk>  positive<unk>  found<unk>  who had unprotected anal intercourse (UAI) in the past year were put at risk for contracting the virus. The study found that<unk>  who reported engaging in UAI had increased from 30% in 1996 to 42% in 2000. Almost half of all<unk>  who participated in UAI in 1996-1997 said that they had not known the<unk>  status of their partner Studies have found that risk factors for<unk>  infection are anal intercourse with a man in the past 12 months, having unstable housing, and having inhaled alkyl nitrites (“poppers”). A 2009 study on the prevalence of unprotected anal intercourse among<unk> -diagnosed MSM found that majority protected their partners during<unk> ual activity, but a sizeable number of<unk>  continue to engage in<unk> ual behaviors that place themselves and others at risk for<unk>  infections. Condom fatigue Although<unk>  transmission rates fell throughout the 1990s, they hit a plateau at the end of the decade. The increasing rates of<unk> ually transmitted diseases in major cities in the United States, Canada, and the United Kingdom led to reports in the gay and mainstream media of condom fatigue and "AIDS optimism" as causes of the new "laxness" in safe<unk>  practices. This is supported by research on the tendency of couples (heterosexual or homosexual) to use condoms less over time. A 2010 study found that gay and bisexual<unk>  choose to have unprotected<unk>  for a variety of reasons and cannot be generalized. Erectile dysfunction,<unk> tal health problems and depression, lack of communication or intimacy, and a subculture of unprotected<unk>  were all listed as reasons why<unk>  had<unk>  without condoms voluntarily.
HIV and men who have sex with men
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