For straight men sexual orientation can be taken for granted, but for a gay or bisexual man sexual orientation is a defining characteristic and may have a greater significance in their lives .
There is an increased incidence of erectile dysfunction among gay and bisexual HIV positive men. Up to 30% of HIV positive men experience eretile dysfunction due to either treatment or disease process causing peripheral neuropathies and lower levels of testosterone. Anal penetration requires a more rigid erection than does vaginal penetration.
Gay men have been denied treatment due to stigmatization and the belief that they shouldn’t be having sex if they are HIV positive. Fear of infecting, or having infected, others can also lead to a decreased ability to enjoy sexual relations .