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If HIV infection in MSM is heavily biologically determined, do present approaches to HIV programming for MSM, which rely heavily on information, education, and behaviour change strategies, make sense? The epidemiology suggests that urgent reform is needed. Programmes and research eff orts need to be informed by the realities of HIV transmission risks for MSM. The reduction of those risks will probably need combination approaches, the use of antiretrovirals for both treatment and prevention, and much greater understanding of why these men, their networks, and their communities,
102continue to bear such heavy burdens of HIV. HIV remains uncontrolled in MSM in 2012. This reality demands reinvigorated eff ort, new approaches grounded in biology and epidemiology, and concerted eff ort to reduce the structural risks that aid and abet HIV spread in these men.