Mexico, which is hosting the XVII International AIDS Conference, is having difficulty addressing HIV/AIDS transmission risks for men who have sex with men (MSM) due to social stigma there and throughout Latin America that force homosexual activity underground, The New York Times reports. While Mexico’s overall HIV prevalence in the general population is 0.3 percent, it approaches 15 percent among MSM.

Although the country has made strides in accepting same-sex relationships—including adopting a law in Mexico City that allows for civil unions for same-sex couples—homophobia persists, making it difficult to raise HIV/AIDS awareness among MSM.

“I’d say most of the men in Mexico who have sex with men will never recognize that they are gay or bisexual,” said Jorge Saavedra, MD, MPH, MHPM, an HIV-positive gay man who directs the Mexican government’s AIDS-fighting program. “Only if you go into in-depth interviews will the information slowly come out. It makes our job all the harder since there is so much shame involved.”