There is no single percentage that captures how many gay men are living with HIV, because the answer varies dramatically by age, race, and geography. But the numbers paint a clear picture of disproportionate impact: gay and bisexual men account for about 67% of all new HIV infections in the United States despite representing a small fraction of the total population. The best overall estimate comes from lifetime risk calculations, which put the average gay man’s chance of acquiring HIV at roughly 1 in 7.
Lifetime Risk by Race and Ethnicity
The 1-in-7 overall figure masks enormous disparities. Researchers at the 2024 Conference on Retroviruses and Opportunistic Infections calculated lifetime HIV risk for gay and bisexual men in the U.S. using data from 2017 to 2021. The breakdown is stark:
- Black gay and bisexual men: 1 in 3
- Latino gay and bisexual men: 1 in 5
- Native Hawaiian and Pacific Islander gay and bisexual men: 1 in 7
- White and Asian gay and bisexual men: 1 in 15
These differences are not explained by individual behavior. Black gay men do not report higher rates of risky sex than white gay men, but they are more likely to live in communities with higher background prevalence of HIV, less likely to have consistent access to preventive medication like PrEP, and more likely to face barriers in the healthcare system. The disparity is fundamentally structural: it reflects unequal access to testing, treatment, and prevention rather than different choices.
New Infections Are Declining, But Slowly
In 2022, an estimated 21,400 new HIV infections occurred among gay and bisexual men in the United States, making up 67% of all new infections and 87% of infections among males specifically. While new diagnoses have been trending downward over the past decade, the decline has been uneven. White gay men have seen the steepest drops. Progress among Black and Latino gay men has been slower, and in some younger age groups, diagnoses have remained stubbornly flat.
The introduction of PrEP, a daily or injectable medication that prevents HIV infection with over 99% effectiveness, has been the biggest driver of declining infections. But PrEP uptake mirrors the same disparities seen in HIV rates. White gay men are far more likely to be on PrEP than Black or Latino gay men, which means the tool most capable of closing the gap is instead widening it in some communities.
Young Gay Men Face the Highest Risk
In 2023, among males aged 13 to 24 who were diagnosed with HIV through male-to-male sexual contact, Black young men accounted for 47% of diagnoses. This age group is particularly vulnerable for several reasons. Younger men are less likely to have been tested, less likely to be on PrEP, and less likely to be connected to care if they do test positive. Many are navigating their sexuality for the first time and may lack access to comprehensive sexual health information, particularly in states with limited sex education.
The concentration of new diagnoses among young men also reflects a testing gap. Someone who has never been tested cannot know their status, cannot start treatment, and can unknowingly transmit the virus. The CDC recommends that all sexually active gay and bisexual men get tested at least once a year, and every three to six months if they have multiple partners.
Many People Living With HIV Don’t Know It
A significant portion of the HIV epidemic is driven by people who are unaware of their infection. Data from Australia, which tracks this metric closely, showed that the percentage of gay and bisexual men living with HIV who were undiagnosed dropped from about 14.5% in 2004 to 7.5% in 2015. U.S. estimates follow a similar pattern, with roughly 13% of all people living with HIV in America unaware of their status as of recent years.
This matters because undiagnosed individuals cannot access treatment, and untreated HIV means a higher viral load, which increases the chance of transmission. Conversely, someone who is diagnosed, on treatment, and has an undetectable viral load cannot transmit HIV sexually. This principle, known as “undetectable equals untransmittable” or U=U, has been confirmed by multiple large studies and is one of the most important facts in modern HIV science.
What These Numbers Mean in Context
It is easy to look at a statistic like “1 in 7” and feel alarmed. But context matters. That figure represents a lifetime cumulative risk, not a snapshot of who currently has HIV. It also reflects conditions that are actively changing. PrEP use is expanding, treatment has improved dramatically, and public health infrastructure around HIV is stronger than it was a decade ago.
For any individual, actual risk depends on specific factors: whether you or your partners use PrEP, whether partners with HIV are on effective treatment, condom use, number of partners, and access to regular testing. A gay man on PrEP with an undetectable partner faces a functionally negligible risk of HIV transmission. A gay man without PrEP, without knowledge of his partners’ status, and without regular testing faces a much higher one. The population-level statistics describe averages across millions of people in widely different circumstances.
HIV remains a serious and disproportionate health challenge for gay and bisexual men in the United States, especially for Black and Latino men and young men under 25. But the tools to prevent and manage it are more effective than at any point in the epidemic’s history, and the gap between current reality and what is achievable with better access to those tools is the central public health challenge.