Objective: To identify the risk of HIV infection among men who have sex with men (MSM) with different sex roles, so as to provide insights into the prevention and control strategies for HIV infection among MSM. Methods: Peer-driven sampling method was employed to recruit MSM in a city in Xinjiang Uygur Autonomous Region in 2022, a questionnaire survey was conducted to collect demographic information and sexual behaviors, and laboratory tests were conducted to detect HIV and syphilis antibodies. The characteristics of sexual behaviors among MSM with different sex roles and prevalence of HIV infection were analyzed, and factors affecting HIV infection among MSM were identified using a multivariable logistic regression model. Results: A total of 666 MSM were investigated, with a mean age of (28.70±8.09) years and 577 local residents (86.64%). There were 166 insertive MSM (24.92%), 179 receptive MSM (26.88%) and 321 both receptive and insertive MSM (48.20%). The HIV infection rate was 8.26%, with 3.61% in insertive MSM, 13.41% in receptive MSM, and 7.79% in both receptive and insertive MSM. Significant differences were seen in age, recruitment route, sexual orientation, age of first homosexual sex, condom use with temporary partners and HIV infection rate among different sex roles (all P<0.05). Multivariable logistic regression analysis showed that insertive MSM had a lower risk of HIV infection than both receptive and insertive MSM (OR=0.513, 95%CI: 0.272-0.969), while there was no significant difference in the risk of HIV infection between receptive MSM and both receptive and insertive MSM (OR=2.088, 95%CI: 0.081-5.380). Conclusions The risk of HIV infection among receptive and both receptive and insertive MSM are higher than that among insertive MSM. Classified measures should be taken to reduce the transmission of HIV in this population.