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Īdult HIV prevalence in Ghana is estimated at 2% and 17.5% among MSM aged 18-35 years. Same-sex relationships are illegal throughout the region and discrimination and harassment are widespread, contributing to low uptake of services that are not widely known to be “MSM-friendly”. Although a variety of steps have been taken in different countries to expand HIV prevention and treatment programs for MSM, this group continues to experience poor access to prevention, testing, and early treatment. Yet a number of studies point to far higher infection rates among MSM in Nigeria (35%), Côte d’Ivoire (18%-50%), and The Gambia (10%). Adult prevalence in this region is comparatively low-ranging from 1-3%. Nowhere is this difference more striking than in West Africa. In sub-Saharan Africa, where the HIV burden is greatest, overall adult prevalence is 4.4%, but typically much higher among MSM. Currently, there are signs of intensifying HIV epidemics among MSM-both in generalized epidemics and where MSM are considered to be at high risk of infection. While HIV prevalence has declined globally, MSM continue to be disproportionately affected, particularly in low resource settings. More than three decades have passed since HIV was first characterized among men who have sex with men (MSM) in North America.