HIV epidemics in West Africa appear far more concentrated among key populations including men who have sex with men (MSM) and female sex workers (FSW) as compared to the more generalized epidemics of Southern and Eastern Africa. Since there has been no prior quantitative assessment of HIV risk among MSM in the Gambia, this study aims to describe the burden of HIV and associations of HIV infections. A total of 207 study participants reporting anal sex with another man in the previous 12 months were accrued using snowball sampling for this cross-sectional study and were administered an anonymous structured questionnaire. Bivariate and multivariate logistic regression models were used to identify factors associated with prevalent HIV infections. HIV prevalence was 9.8% (20/205) and the highest HIV prevalence age group was among the participants who were older than 25 years with 22.9% (8/35) living with HIV. Less than 10% of participants reported always using condoms with male partners (19/201) while 33.8% (69/204) of men reported no access to condoms and 82.5% (146/177) reported no access to latex condom-compatible lubricants (CCL). Knowledge of HIV risks was low with 3.5% (7/200) knowing that receptive anal intercourse was the highest risk sexual practice and CCL were the safest to use. This study highlighted that, similar to other West Africa countries, MSM are a high risk and underserved population for HIV prevention, treatment, and care services in the Gambia. Multilateral efforts including government, service providers, and community are needed to achieve reductions in HIV incidence and eventually prevalence among MSM in the Gambia.