In The Lancet HIV, Frits van Griensven and colleagues report high HIV incidence in men who have sex with men (MSM) in Bangkok, Thailand, in two different cohort settings: an MSM-friendly clinic, at which testing and counselling services and other sexual health services were provided on request and a closed prospective cohort of MSM testing at routine intervals. The HIV incidence of 5·5 per 100 person years in both groups is alarmingly high, but unsurprising because high and sustained transmission is being noted across the region in young homosexual, bisexual, and other MSM. Indeed, alarmingly high rates of HIV incidence in MSM have become the norm worldwide, and programmatic responses continue to fail in controlling ongoing transmissions.