Men who have sex with men

HIV PrEP is recommended for men who have sex with men who are at risk of HIV infection, defined as having any of the following HIV acquisition risks.

HIV acquisition risk in the previous 3 months that is expected to continue in the next 3 months:

  • at least one episode of condomless anal sex (insertive or receptive) with a regular HIV-positive partner who is either not on treatment, or on treatment with a detectable viral load
  • more than one episode of anal sex without effective condom use (eg condom slipped off or split) with a partner of unknown HIV status, or who is HIV positive but not on treatment or on treatment with a detectable viral load
  • at least one episode of receptive condomless anal sex with any casual male partner
  • one or more episodes of rectal gonorrhoea, rectal chlamydia, or syphilis, including infections diagnosed at screening for HIV PrEP
  • one or more episodes of sexualised drug use (chemsex), typically involving crystal metamfetamine (ice) or gamma hydroxybutyrate (GHB).

Expected HIV acquisition risk in the next 3 months, despite not having had HIV acquisition risk in the previous 3 months; examples include a person who:

  • plans to travel and anticipates they will be having condomless sex with casual partners while away
  • reports recently leaving a monogamous relationship and plans to have condomless sex with casual partners in the future
  • will be entering or leaving an institutional or correctional facility in the near future where they may have condomless sex with casual partners
  • presents with deteriorating mental health and a history of having increased their HIV acquisition risk behaviour in this setting
  • presents with a history of binge drinking of alcohol or recreational drug use and a history of having increased their HIV acquisition risk behaviour in this setting.

HIV PrEP should also be considered for men who have sex with men if they:

  • have an HIV-positive partner, and the couple experiences stress and anxiety about HIV transmission despite the HIV-positive partner being on treatment and not having a detectable viral load
  • report being anxious about HIV infection to the extent that it may prevent them from having regular HIV testing, or engaging in anal sex
  • present with a history of recurrent genital ulceration or dermatoses (eg psoriasis) that may increase the risk of HIV acquisition.

When assessing risk of HIV exposure, also ask whether the person shares intravenous drug equipment (see People who inject drugs).