Escalating trends and burden of HIV among men who have sex with men (MSM) in Bangladesh: A newly emerging concentrated epidemic

Bangladesh has historically maintained a low-level human immunodeficiency virus (HIV) epidemic; however, recent surveillance indicates a shifting burden toward men who have sex with men (MSM). This study aimed to assess temporal trends and comparative HIV risk among key populations in Bangladesh. National HIV surveillance data from 2016 to 2025 were analyzed using univariate logistic and Poisson regression models. MSM showed a markedly higher risk (OR = 5.89; 95% CI: 5.05–6.90; P < 0.001) of HIV infection compared with people who inject drugs and a significantly higher incidence rate (Log [IRR] = 1.2, 95% CI: 1.1–1.3; P < 0.001). Temporal analysis revealed a steep increase in HIV risk among MSM, with odds rising from 2.20 in 2020 to 15.2 in 2025 relative to 2019. These findings indicate an emerging concentrated HIV epidemic among MSM in Bangladesh, underscoring the need for strengthened, context-specific prevention strategies, particularly considering known socio-structural barriers.