As the worldwide AIDS epidemic enters its second quarter-century, HIV prevalence among men who have sex with men (MSM) is a growing concern, especially in Asia. In recent years, MSM in Asia have experienced an extraordinary rise in HIV prevalence. Various studies report infection rates as high as 14% in Phnom Penh, Cambodia; 16% in Andhra Pradesh, India; and 28% in Bangkok, Thailand. Unless dedicated resources and political will can be mustered in support of innovative and creative ways to stem rising infection rates, MSM in Asia will face a crisis more devastating than that experienced by gay men in the West during the epidemic’s earliest years.