Published on 16 January 2026
Cheshire and Merseyside Cancer Alliance has formed a partnership with George House Trust – a leading HIV charity – to launch a campaign raising awareness of anal cancer symptoms among men with HIV who have sex with men.
As part of the campaign, Dr Paul Hine, has written this blog about anal health...
HIV and Anal Health: We've Got Your Back
By Dr Paul Hine, HIV Clinical Lead, Liverpool
I’ve been looking after people living with HIV in Cheshire and Merseyside for ten years now. Thanks to modern HIV treatment, people have undetectable levels of virus, which means they can’t pass it on, and they live long and healthy lives. Because of this, most of what I speak to patients about in clinic is how to live well with HIV, and all the things people can do to stay well in the long term.
One of the things I think we need to talk about more is anal health. This is especially relevant for gay, bisexual, and queer men – including trans men and some non-binary people who have anal sex with men. Anal cancer is still relatively rare, but the risk is a bit higher if you’re living with HIV, so it’s worth knowing what to look out for.
Why cancers matter in people living with HIV – even when HIV is well controlled
Even when treatment keeps the levels of HIV undetectable in the blood, the virus still puts a small amount of background pressure on the immune system. This makes it slightly less effective at doing some of the housekeeping jobs – like clearing certain viruses and tidying up cells which are damaged. Over many years, this can raise the risk of certain cancers slightly. This isn’t something to panic about… it just means being aware of your body and getting new symptoms checked early.
So, what actually is anal cancer?
Anal cancer affects the skin of the anus, or the back passage. It’s rare – around 1,500 cases a year in the UK.
Most cases are linked to human papillomavirus (HPV), a very common virus passed through intimate skin-to-skin contact. This includes things like anal sex, oral sex, rimming, and sharing sex toys. Most people come into contact with HPV at some point in their lives, often without ever knowing. In most cases the body’s immune system clears away the virus on its own, without causing any health issues.
For a small number of people, HPV sticks around for years and can cause changes in the anal skin that may eventually turn into cancer. That process is slow, which means we have time to spot things early.
Why gay and bisexual men living with HIV are at higher risk
HPV is common in men who have sex with men. HIV – even when undetectable – makes it a bit harder for the immune system to fully clear HPV. The combination raises the risk slightly.
It is important to remember that the overall risk remains low, but it is increased, so it’s important to know what to look out for.
How to prevent getting the HPV virus
If you’re sexually active, HPV vaccination is one of the best ways to reduce your risk of anal cancer in the long term.
- Gay, bisexual and other men who have sex with men up to age 45 can get the vaccine for free in sexual health services.
- Many people living with HIV are also eligible – speak to your HIV team.
The vaccine prevents new HPV infections; it doesn’t treat HPV you already have – but it still offers protection against types you haven’t been exposed to.
Symptoms to look out for
A lot of anal symptoms turn out to be caused by minor conditions, like haemorrhoids or infections, or might be caused by irritation from sex. But please do speak to us (your doctor, or nurse) in clinic if you notice:
- Unusual bleeding from your bum.
- A new lump or bump in that area.
- Pain, itching or discomfort that doesn’t go away.
Getting to know what’s normal for your body helps. Having a gentle feel of the area in the shower can help you get to know what your bum and anus feel like. Then if something changes, tell us, and we can check it for you. We deal with this every day and will help you without any awkwardness.
What to do if you’re worried
- Contact your HIV or sexual health clinic – we’ll examine you and refer you to a specialist if needed.
- Ask about HPV vaccination – some men are eligible.
- If you’re unsure, just ask. You don’t need to self-diagnose or wait for things to get worse.
The key message
Anal cancer is still rare – but awareness matters.
People living with HIV, especially gay and bi men, have a slightly higher risk, so checking in early if something feels off is a smart, simple way to look after yourself.