Background:  The literature describing HIV prevention for men who have sex with men (MSM) in the United States has many paradoxical qualities. On the one hand, an independent set of meta-analyses of randomized clinical trials (RCT) tests of model HIV prevention programs demonstrate that HIV prevention lowers risk among gay men. On the other hand, the effectiveness of current prevention practices for MSM in the United States raises questions because of ongoing reports of outbreaks of sexually transmitted infections and HIV transmission, high prevalence rates of risky sexual behavior, anecdotal reports of prevention fatigue, and underfunding of prevention programs designed for gay men.

Conclusions:  This presentation will review current HIV incidence data among MSM in the United States to provide estimates of expected prevalence rates of HIV infection among emerging cohorts of young gay men if incidence rates are not lowered. The presentation will also present findings from a qualitative review of ongoing correlates of HIV risk-taking and HIV incidence among MSM in the United States to show what new areas of prevention efficacy need to be tapped if we are to lower HIV infection rates among MSM. The qualitative review will focus on:  the need for greater information regarding the precise risks of HIV transmission for very specific sexual practices among men; enhancing a sense of responsibility for sexual safety; enhancing self-knowledge regarding sexual risk; dealing with racism and cultural differences; addressing multiple epidemics that drive sexual risk; creating strategies to reduce community viral loads; and finding ways to translate program efficacy into effectiveness. The presentation will culminate with an argument for a “prevention cocktail” approach to lower HIV incidence rates, in which multiple mechanisms of prevention action can be marshaled in tandem to enhance health among MSM in the United States.