Men who have sex with men (MSM) are at high risk for HIV acquisition and transmission owing to the high risks associated with unprotected anal sex and barriers to accessing appropriate health services. Globally HIV prevention is failing among MSM, as evidenced by high seroconversion rates. Prevention interventions for MSM are more limited than for heterosexual individuals. Prevention programmes should embrace early initiation of antiretroviral therapy for positive clients as part of their programming. High transmission risk groups such as MSM will benefit from such interventions.