Homosexual men remain the group at the greatest risk of getting infected with HIV in the western world. Throughout the 1990s, there were modest falls in the number of new diagnoses among homosexual men. Estimation of current HIV incidence rate among men who have sex with men is difficult. The often long period of time between the infection and diagnoses can make predicting the incidence rates hard. Also, some of the new infections will have occurred abroad either in the course of travel o before moving to abroad. The great majority of new infections in this risk group will, however, have been acquired in the West world, and there are indications of rises in behaviors associated with increased risk among men who have sex between men in the west world. On the basis of these figures gay men have been criticized for being promiscuous and taking unnecessary sexual risks. However, evidence suggests that on the contrary gay men have been very sensitive and responsive in regard to safer sex promotion and condoms are widely and properly used. The high rate of infection reflects a complex relationship between a lack of information in the early days of the epidemic, patterns of sexual activity, the risk of infection and prevalence of the virus among gay men. The primary mode of transmission of HIV between men is through anal sex without a condom (sometimes called "bare back sex").
For young gay men there may be particular problems with trying to practice safer sex. Some young gay men may not feel secure about obtaining or using extra strong condoms for anal sex because if they are seen purchasing or in possession of them it might be interpreted as a disclosure of gay identity. They also rarely have the benefit of sex education in school in which sexual behavior between same-sex partners is discussed. This can make it very hard for young gay men to feel comfortable about negotiating safer sex. And the result is unsafe sex.
