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This is because the walls of the anus are thin and more easily torn, creating an entry point for HIV into the bloodstream.11 12 Having a sexually transmitted infection (STI) also makes a person more susceptible to HIV infection.

STI rates among men who have sex with men are high and have been rising for the last 20 years.13 Despite these heightened biological risks, HIV testing and sexual health check-up frequency remains relatively low among this group (fewer than 55% across all regions in 2013).

Parliaments in Kyrgyzstan, Kazakhstan, Poland, Romania, Tajikistan, Azerbaijan, and Armenia have also attempted to pass anti-propaganda laws but none have been successful – yet.36 Many men who have sex with men have experienced homophobic stigma, discrimination and violence.

This drives men who have sex with men to hide their identity and sexual orientation.

In 33 countries less than 60% of men who have sex with men had reported using a condom at last anal sex, and only 15 countries had rates higher than 80%.18 Data on other STIs among men who have sex with men are further evidence of inconsistent condom use.19 20 Access to HIV testing services among men who have sex with men is also varied.It is important that a combination of prevention programmes are available.In recognition of this, in 2015, a group of international agencies and non-governmental organisations (NGOs) released a tool for use by public health officials, HIV and STI programmes officials, NGOs (both international and community-based) and health workers.43 The tool, Implementing Comprehensive HIV and STI Programmes with Men Who Have Sex with Men [pdf], provides recommendations for HIV prevention, testing and treatment for men who have sex with men and is based on successful community-led approaches.This is more common in countries where HIV prevalence among the whole men who have sex with men population is relatively high.28 One study carried out in Bangkok found HIV incidence was more than twice as high among men aged 18 to 21 years compared to men over 30 years of age.29 Where race intersects with age and sexuality, HIV risk can also be affected.For example, in the USA, young black men (aged between 13 and 24) who have sex with men are around three times more likely to have HIV than white men who have sex with men of the same age.30 Young men who have sex with men often find it harder to access HIV services, due to age of consent laws or unsociable opening times.

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