Abstract
In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental
health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global
syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical
and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the
burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is
strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from
sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems
that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental
health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships
with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with
locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM.