Perhaps a rose by any other name would smell as sweet, but when it comes to talking about HIV prevention, ‘men who have had sex with men’ (MSM) is just not the same as using sexual identity terms. The term MSM was introduced in response to the HIV epidemic as an ‘identity-free’ category to separate sexuality (gay, homosexual) from behaviour (anal sex between men) and to provide a less stigmatizing option for men who did not want to identify as gay. However, MSM came long after sexual minorities in the United States and Canada had begun to adopt social, political and cultural identities. Since the term was first published in 1988, community leaders, activists, and scholars have pointed to its shortcomings in the context of meaningful HIV prevention work, yet the term has still gained widespread use in research and programming (Boellstorff, 2011; Young & Meyer, 2005; Dowsett, 2009). Drawing from academic work and community voices, this article provides an overview the shortcomings of MSM specifically highlighting the 2005 article by Rebecca Young and Ilan Meyer, The Trouble with “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse.

At the most basic level, there is a lot of ambiguity about what exactly MSM means. While MSM was intended to describe the risk associated with sex between two men, it is too simplistic to treat men in this category as if they all have the same level of HIV risk. There are many factors that impact the potential for HIV transmission: the kind of sex (anal sex, fisting, frontal receptive sex, oral sex, rimming), sexual position (top or bottom), whether or not a condom is used, partners’ HIV status, and their sexual networks. There are also questions about who is included in the category. For example, Prestage (2011) states it is unclear how recently or how frequently a man must have had sex with a man to be considered MSM, as well as whether or not transmen who have sex with men are counted as MSM. Given these ambiguities, MSM is a challenging category from an HIV prevention perspective, as it does not provide a concrete understanding of risk behaviours in question or the audience to be addressed.

In addition to the ambiguity about who is included in the category of MSM, Young & Meyer (2005) argue that MSM is problematic because it focuses only on behaviour, which undermines the way men self-identify. Men categorized as MSM identify in many ways, including gay, down low, queer, straight, bisexual or two-spirit (to name a few), and oftentimes these identities are not only their sexual partners, but also have social, political, and cultural aspects that must be taken into account for effective HIV prevention. These social, political and cultural aspects often include shared communities and social networks, which may impact HIV risk, access to prevention information and resources, and behavioural and social norms. Using the term MSM diverts attention from the complex role of these communities play in prevention. This was seen clearly in changes to social norms in some gay communities, which, at the outset of the HIV epidemic, helped to normalize condom use rates (see Dowsett, 2011; Kubicek et al., 2009).

In addition to overlooking social identity, MSM “avoid[s] discussing the impact of homophobia and heterosexism, and our internal processing of these” (Bartlett, 2012 in HIV Prevention Justice Alliance), despite evidence that illustrates the importance of these factors in the lives of gay men (see Stall et al., 2008; Meyer, 2007; Arnold & Bailey, 2009). Heterosexism and homophobia impact the well-being of some men categorized as MSM: some are excluded from their social networks and homes if they decide to disclose their sexual identity or their same-sex partners. Taken in its strictest sense, MSM does not recognize these complicating risk factors but instead promotes a singular focus on changing behaviour during ‘risky’ sexual activity.

Lastly, using MSM takes away the political and social power of self and group identification. Diverse sexual minority and queer communities have long fought battles to articulate their own identities and for the recognition of the diversity within these identities. Self-identification empowers marginalized or minority communities that are often overshadowed by mainstream institutions and discourses.

Perhaps MSM is best used only as an umbrella term to bring together the work being done internationally to strengthen the well-being of men having sex with other men. As Young & Meyer (2005) argue, however, it is vital to use sexual identity terms that reflect the local context of sexual activity between men in order to develop meaningful, relevant and culturally competent prevention initiatives. Despite the widespread use of MSM, much more nuance than this simplistic category is required when describing the populations we work with and for.

Further reading:

• HIV Prevention Justice Alliance (2012): Rethinking MSM and the Politics of Identity in HIV Prevention
• Tom Boellstorff (2011): But Do Not Identify As Gay: A Proleptic Genealogy of the MSM Category
• Prestage (2011): The term ‘MSM’ demeans us all
• Gary Dowsett (2009): The “Gay Plague” Revisited: AIDS and its enduring moral panic
• Rebecca Young and Ilan Meyer (2005): The Trouble with “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse
• Gary Dowsett (2001): HIV/AIDS and constructs of gay community: Researching educational practice within community-based health promotion for gay men