(unaids) published a paper in 2005 offering specific policy solutions for alleviating the spread of the hiv virus in the msm population for specific regions around the world. they pointed to "a profound lack of knowledge" and stigma about sexual identity as worldwide barriers to preventing transmission and encouraging those infected to seek treatment. the unaids program has recommended that the south african government implement "sex positive" policies to reduce societal stigma around homosexuality and promote the use of water-based lubricants. particularly in morocco, the program has advocated distributing condoms in prisons. in recent years, the chinese government has begun to acknowledge the sexuality of its constituents. according to unaids, the "government has made significant progress in recognizing the issue of male-to-male sexual health and hiv." in latin america, outreach to rural areas is critical to ensuring care to all individuals. the united nations also emphasizes a focus on lgbt populations that are most vulnerable in latin american nations. in jamaica, as in many countries across the globe, homosexuality is outlawed so there are unique challenges to hiv prevention in the msm community. the un is trying to implement community-based strategies in jamaica while still ensuring the anonymity of the people served. in norway, unaids has observed an increasing number of msm who have untreated sexually transmitted infections, and their emphasis is on promoting condom use within the gay community. despite canada's "liberal and progressive" reputation on the world stage, hiv-related stigma is still related to the gay community. the united nations believes the united states needs to recognize sexual education as a fundamental human right. additionally, better research on msm in the u.s. would positively affect funding for hiv prevention and treatment programs. studies have shown that although there is a large market for vaginal microbicides in developing nations, rectal microbicides are stigmatized and less researched. no microbicide has yet been proven to effectively protect against the risks of unprotected anal intercourses, but advocates believe greater funding for research is needed since condom usage rates are so low. however, stigma and homophobia would potentially be barriers to individuals buying the product. the authors mention this is especially a concern in caribbean countries where hiv prevalence is high but homosexuality is still illegal and highly stigmatized (see hiv/aids in the caribbean.) access to testing unaids has observed "sero-selection" (choosing a partner based on their hiv status) becoming increasingly prevalent in partner choice and transmission in the united states. a 2008 cdc study found that one in five (19%) of msm in major u.s. cities were infected with hiv and almost half (44%) were unaware of their infection. many hiv-infected individuals do not seek treatment until late in their infection (an estimated 42% do not seek treatment until they begin to experience signs of illness.) furthermore, a significant portion of individuals who are tested for hiv never return for their test results. studies have advocated for funding and implementation of hiv tests that can be administered outside medical settings since 2003. home testing is considered especially important because 8%-39% of partners tested in studies of partner counseling and referral services (pcrs) were found to have a previously undiagnosed hiv infection that their partner was unaware of. in october 2012, oraquick, the first rapid hiv home-testing kit, went on sale for $40. the test is nearly 100% accurate when it predicts hiv-negative results for hiv-negative individuals. however, for hiv-positive individuals that are not yet producing the antibodies detected by the test, it produces a false negative 93% of the time. although the manufacturer, orasure technologies, is not advertising the test for use for selection of partners, experts have suggested that it may prevent unprotected sexual contact with partners that lie about or are unaware of their hiv status. a recent study examined how the oraquick test would identify the behavior of 27 self-identified gay men who frequently had unprotected sex with acquaintances. the researchers gave each participant 16 tests to use over the course of three months. 101 potential partners were tested, and 10 were positive. none of the participants had sex with someone who tested positive. 23 other potential partners refused testing and left the encounter. 2 men admitted they were hiv-positive. most participants said they would continue using home tests after the study ended to test potential partners on their own. the researchers considered home testing to be an effective prevention method for high-risk groups. however, the test's $40 cost is considered a major deterrent to commonplace partner testing. list of estimated hiv infection rates by country disclaimer: estimated hiv rates can be inaccurate. for example, unaids reported that the hiv rate among msm in australia was 18.1%, but the actual rate reported by the australian federation of aids was 7.3%. this is due to the fact unaids relied on a convenience sample of men who were more at risk to hiv, and thus did not capture an accurate representation of the msm population. country msm hiv prevalence rate estimate (%) mauritania 53.6 senegal 27.6 cameroon 20.6 lesotho 32.9 jamaica 29.8 trinidad and tobago 26.6 saint vincent and the grenadines 10 lebanon 12 south africa 18.1 congo 41.2 indonesia 25.8 central african republic 6.1 bolivia 25.4 nigeria 23.0 liberia 19.8 bahamas 19.6 australia 7.3 romania 18.2 kenya 18.2 haiti 12.9 france 14.0 united republic of tanzania 8.4 niger 11.5 ghana 18 mexico 12.6 malawi 7.0 mauritius 17.2 colombia 17.0 paraguay 20.7 peru 3.0 netherlands 15.0 cabo verde 15.0 madagascar 14.9 canada 6.7 united states 14.5 barbados 2.8 sierra leone 14.0 belize 13.9 mongolia 9.2 mali 13.7 ecuador 16.5 uganda 13.2 seychelles 13.2 botswana 14.8 panama 6.7 togo 22.0 greece 12.7 costa rica 15.4 eswatini 12.6 montenegro 12.5 belgium 12.3 honduras 8.4 argentina 15.7 spain 11.3 switzerland 8.0 côte d'ivoire 12.3 singapore 2.2 brazil 18.3 el salvador 12.0 uruguay 8.5 thailand 11.9 tunisia 9.1 malaysia 21.6 nicaragua 8.6 ukraine 7.5 serbia 8.3 viet nam 8.2 guatemala 8.0 latvia 7.8 ireland 7.8 china 7.75 jordan 7.5 portugal 7.2 poland 7.2 dominican republic 7.1 benin 7.1 italy 6.7 new zealand 6.5 myanmar 6.4 kyrgyzstan 6.3 egypt 6.2 germany 6.0 yemen 5.9 lithuania 5.9 republic of moldova 5.7 morocco 5.7 belarus 5.7 philippines 4.9 guyana 4.9 japan 4.8 czech republic 4.8 burundi 4.8 india 4.3 algeria 4.3 hungary 4.1 sweden 4.0 slovenia 4.0 burkina faso 3.6 uzbekistan 3.3 democratic republic of the congo 3.3 kazakhstan 3.2 libya 3.1 south korea 3.0 tajikistan 2.7 croatia 2.7 united kingdom 7.7 antigua and barbuda 2.5 nepal 2.4 cambodia 2.3 azerbaijan 2.2 republic of north macedonia 1.9 cuba 1.8 lao people's democratic republic 1.6 sri lanka 1.5 sudan 1.4 timor-leste 1.3 saint kitts and nevis 1.3 bosnia and herzegovina 1.1 armenia 0.8 fiji 0.5 albania 0.5 afghanistan 0.5 finland 0.4 bangladesh 0.2 pakistan 0.1 hiv infection rates in the u.s. the hiv virus affects the human immune system and, if left untreated can eventually lead to acquired immune deficiency syndrome (aids). the cdc reported that in 2009 that male-to-male sex (msm) accounted for 61% of all new hiv infections in the u.s. and that those who had a history of recreational drug injection accounted for an additional 3% of new infections. among the approximately 784,701 people living with an hiv diagnosis, 396,810 (51%) were msm. about 48% of msm living with an hiv diagnosis were white, 30% were black, and 19% were hispanic or latino. although the majority of msm are white, non-whites accounted for 54% of new infections hiv related msm infections in 2008. in 2010 the cdc reported that msm represented approximately 4 percent of the male population in the united states but male-to-male sex accounted for 78 percent of new hiv infections among men and 63 percent of all new infections. men overall accounted for 76% of all adults and adolescents living with hiv infection at the end of 2010 in the united states, and 80% (38,000) of the estimated 47,500 new hiv infections. 69% of men living with hiv were gay, bisexual, and other men who have sex with men. 39% (14,700) of new hiv infections in us men were in blacks, 35% (13,200) were in whites, and 22% (8,500) were in hispanics/latinos. the rate of estimated new hiv infections among black men (per 100,000) was 103.6—six and a half times that of white men (15.8) and more than twice the rate among hispanic/latino men (45.5) as of 2010. the cdc (2015) reported that gay and bisexual men accounted for 82% (26,375 out of 1,242,000 adults and adolescents) of hiv diagnoses among males and 67% of all diagnoses in the united states, while six percent (2,392) of hiv diagnoses were attributed to injection drug use (idu) and another 3% (1,202) to male-to-male sexual contact plus idu. heterosexual contact accounted for 24% (9,339) of all hiv diagnoses. among all gay and bisexual men with hiv infection classified as aids in the united states in 2015, african americans accounted for the highest number (3,928; 39%), followed by whites (3,096; 31%) and hispanics/latinos (2,430; 24%). at the end of 2014, 508,676 gay and bisexual men were living with diagnosed hiv infection (53% of everyone living with diagnosed hiv in the us). of gay and bisexual men living with diagnosed hiv, 157,758 (31%) were african american, 212,558 (42%) were white, and 109,857 (22%) were hispanic/latino. from 2005 to 2014 diagnoses among african american gay and bisexual men increased 22% but has increased less than 1% between 2010 and 2014. hiv diagnoses among african american gay and bisexual men aged 13 to 24 increased 87% between 2005 and 2014, but with diagnoses declining 2% between 2010 and 2014. a 2010 study estimated that for every 100,000 msm, 692 will be diagnosed with hiv. this makes msm 60 times more likely to contract the virus than other men and 54 times more likely than women. since its height in 1993-1994 the death rate due to hiv has fallen more than 9 other leading causes of death, yet as of 2013 hiv continues to be one of the 10 leading causes of death among persons 25-44, especially among men, african americans and in the south. also as regards hiv relation to mortality, a study in the united kingdom reported that in 2008 the overall mortality rate among the hiv-diagnosed population aged 15–59 years remained more than five times higher than that in the general population. however, as the study acknowledges data on the impact of hiv/aids on mortality among gay and bisexual men as well as among other populations, is very limited, and methods to use this are problematic.