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The global epidemiology of HIV-1 is changing in 2013 [1]. Encouraging declines in new infections in many high burden countries in Sub-Saharan Africa, declining trends in AIDS morbidity and mortality, and advances in treatment access and prevention science, have led to a new optimism that control of the HIV pandemic may be an achievable goal [2]. But the available data on HIV prevalence and incidence, from low, middle, and high income countries suggests that the HIVepidemics among gay, bisexual, and other men who have sex with men (MSM) are on markedly different, and expanding, trajectories [3, 4]. In many high income country settings, HIV epidemics have expanded among MSM in the HAART era–—and where access to HIV prevention, treatment and care services is widespread, including in the US, the UK, France, Australia, and the Netherlands [5, 6]. In many low and middle income countries MSM have many fewer resources, and may be much more hidden and stigmatized, compounding risks for HIV acquisition and transmission [7, 8] and limiting access to the most basic of services, including condoms and lubricants [3]. Sub-epidemics, most notably among Black MSM in the US and UK, are particularly severe and underscore the complex challenges addressing HIV among stigmatized men will require [9, 10]. While much of the work on HIV acquisition and transmission between men has focused on individual level risks for HIV infection, these have been shown to be insufficient to explain the divergence of MSM epidemics from those in other populations. How then, can these consistent and disturbing trends for HIV among MSM be …