This stands for the following:

• Lesbian: Women who are sexually attracted to women. 
• Gay: People who are sexually attracted to the same gender. Often used to describe men who are attracted to men. 
• Bisexual: People who are sexually attracted to their own gender and other genders.
• Transgender: Feeling the opposite gender to your sex. There is a difference between sex (the sex characteristics of a body, like the penis or vagina), sexuality (who someone is sexually attracted to) and gender identity (feeling male or female or a mix of both). 

+: This stands for people who might not identify with any of the terms above, but do not see themselves as heterosexual (straight) and/or cisgender (having a gender identity that matches their sex). Some people might call themselves terms like queer or non-binary instead. And some people do not like to use labels at all.

This stands for men who have sex with men. 

MSM is a term used to describe men who have sexual contact with other men, regardless of their sexual orientation or identity. 

It is not accurate to use MSM to describe someone who was born with male sex characteristics but feels female. The term to use here is likely to be transgender or transgender woman, or whatever term that individual likes to use. The only way to know the correct term to use for somebody is to ask them.

Respect people’s dignity, treat them with kindness, and ensure their privacy and confidentiality. Do not assume that every man who has sex with men will have the same lifestyle, experiences or issues. Take time to understand who they are as a person and what support they need from you. Do not judge people for being who they are.

If they use a specific term to describe themself, such as, ‘gay’ or ‘MSM’, use it too. Use neutral, non-gendered terms like ‘your partner’ until you know the terms they use, then copy what they say. 

Only ask questions that are relevant to whatever issue they have come to you with. It is not okay to ask them questions to satisfy your curiosity or to infer blame. Your body language, facial expressions, and the tone and pitch of your voice can suggest surprise or disapproval, so try to keep these things neutral. And remember that you are only human – if you make a mistake, apologise and move on.

Stigma is when people feel, think and talk negatively about LGBT+ people. Self-stigma is when someone has internalised negative stereotypes, public stigma and shame about themselves - this can often be around their sexuality, gender identity or HIV status.

Discrimination is when stigmatising views cause LGBT+ people to be treated unfairly. Discrimination can happen in many different circumstances, including at home, in school, at work and in healthcare. It also includes discriminatory laws, such as the criminalisation of homosexuality.

The stigma, discrimination and criminalisation that men who have sex with men face stops many from accessing sexual health services, including HIV and STI prevention, testing treatment and care. Men who have sex with men may be too scared to test for HIV, use PrEP, or take HIV treatment if they need it. 

Stigma and discrimination can cause some men who have sex with men to feel anxious or depressed, to misuse alcohol and drugs and to increase the sexual risks they take. Some of these things can increase the risk of getting HIV. Stigma and discrimination can also stop men who have sex with men from getting the mental health support they need to cope with what they are experiencing.

You can try the following things to provide support:

• arrange to meet them somewhere discreet and private
• let them know you are not here to judge or report on them: you are here to support their health
• tell them that whatever they tell you will be kept private.

The stigma, discrimination and criminalisation that men who have sex with men experience affects them in many ways, and some of these things increase their HIV risk. 

In some places, it means they are less able to get a job or a place to live. Some men who have sex with men turn to sex work to survive, and this increases their HIV risk further.

Stigma is linked to mental health issues like depression and anxiety among men who have sex with men. Having a mental health issue can lead people to take sexual health risks like having condomless sex. 

Sexual violence is another issue. Due to stigma, if a man who has sex with men is raped he is unlikely to go to a health service to get PEP (a pill that can prevent HIV in emergency, post-sex situations) or test for HIV. He is also unlikely to report it to the police, which means such rapes will continue.

Some HIV programmes do not collect data on men who have sex with men. This makes it hard to plan and provide services that suit their needs. Collecting data to prove that a community of men who have sex with men exist in a certain location can be an important first step in advocating for services. Collecting data to show what services men who have sex with men need, and measuring the impact of any services that are introduced on HIV infections or treatment uptake, can be a good way to get further investment.

Collecting data on human rights abuses that men who have sex with men experience, such as mistreatment from healthcare workers or the police, can be used to prove to decision-makers that these violations are happening and the effects they have. 

If you are a community health worker it is important to look at the evidence. And the evidence shows that the HIV response will not succeed unless all people at risk of HIV are included. This means, regardless of your personal views, it is essential to support men who have sex with men to access HIV prevention, testing and treatment services. And it is important to treat men who have sex with men with dignity and respect, otherwise they will shy away from these services.

If more men who have sex with men can access HIV services, fewer will get HIV. Because some men who have sex with men also have sex with women, this means fewer women will be at risk of HIV. In turn, other men that women have sex with will be less likely to get HIV, and so will their unborn children. But until everyone is able to access the HIV services they need, everyone will remain at risk.