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Men who have sex with men or males who have sex with males (MSM) refers to men who engage in sexual activity with other men, whether they identify as gay, bisexual, or neither.[1][2][3][4][5] This term was defined in the 1990s by epidemiologists in order to study the spread of disease among any and all biological males who have sex with other biological males.[2]

The term is intended to reference a particular category of males who are at higher risk for sexually-transmitted diseases such as HIV.[2][3] MSM is considered a behavioral category, not any kind of identity.[2][3][4][5] Its primary use is in terms of studying the spread of the HIV virus.[2]

MSM as behavioral category

Young and Meyer (2005) note that the term has been in use within the public health discourse since 1990 or earlier,[6] but that the coining of the initialism by Glick et al. (1994) "signaled the crystallization of a new concept."[7] They trace the emergence of this behavioural concept to two very distinct academic perspectives. First, it was pursued by epidemiologists seeking behavioral categories that would offer better analytical concepts for the study of disease risk than identity-based categories (such as "gay", "lesbian", or "straight", because a man who self-identifies as gay or bisexual is not necessarily sexually active with men). Second, its usage could in part be explained by the criticism of sexual identity terms prevalent in the "social construction" literature, which typically rejected the use of identity-based concepts across different cultural and historical contexts.

MSM as a construct

As a risk category, MSM are not limited to small self-identified and visible sub-populations, such as gay men and male sex workers. MSM and homosexual refer to different things: behaviors and social identities. MSM refers to sexual relationships between men, whether or not they identify as homosexual or bisexual. Homosexual orientation refers to sexual/romantic attraction between men and does not necessarily imply any history of sexual relationships. Homosexuality refers to more than the sexual relationship and may extend to broader relationships with the same sex. Its precise use and definition has varied with regard to transwomen.[2][3][4][5] Some sources consider transwomen to be MSM,[3] others considering transwomen "along side" MSM,[2] and others are internally inconsistent (defining transgender women to be MSM in one place but referring to "MSM and transgender" in another).[5]

In their assessment of the knowledge about the sexual networks and behaviors of men who have sex with men in Asia, Dowsett, Grierson and McNally concluded that the category of MSM does not correspond to a single social identity in any of the countries they studied.[8]

"The literature reveals that there are no socially or self-defined groups of men that fit into an overarching category of MSM. What the review shows is that there are just men!! Fishermen, students, factory workers, military recruits, truck drivers, and men who sell sex, and so on: all these categories of men are to be found in the studies and programmes reviewed."

There were no similar traits in all of the MSM population studied, other than them being males and engaging in sex with other men.

Health issues

Men who have sex with men are more likely to get HIV in the modern West,[9] Japan,[10] India,[11] and Taiwan,[12] as well as other developed countries than among the general population.[13] In the U.S., their HIV prevalence is 60 times higher than the general population.[14] An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men. This compares to an estimated 13% of American males who get HIV from sexual contact with a female who is known to have, or is at high risk for, HIV infection.[15]

Infection with the Hepatitis B virus is about 5-6 times more common, and Hepatitis C virus infections are about 2 times more common, in men who have sex with men than in the general population. They also have an increased incidence and prevalence of Kaposi's sarcoma-associated herpesvirus, which causes a cancer called Kaposi's sarcoma in immunocompromised individuals.[14] In 2006, 64% of the reported syphilis cases in the United States were among men who have sex with men.[16] Men who have sex with men are 17 times more likely to develop anal cancer than heterosexual men,[17] probably due to a higher risk of human papillomavirus.[18][19] Many people become infected with HPV soon after becoming sexually active.[20]

MSM also have high rates of intestinal parasitism throughout the world.[21][22]

Growth rate

HIV infection is increasing at a rate of 12 percent annually among 13-to-24-year-old American men who have sex with men.[23][24][25] During the last 10 years, syphilis outbreaks among men who have sex with men have been recorded in countries across Europe.[26] This follows the general increase in STDs among men who have sex with men.[27] This increase in cases among young Western males may have to do with the new generation being relaxed because of new treatments and being not personally affected by the initial AIDS breakout in the 80s.[23] In developing countries, HIV infection rates are skyrocketing among men who have sex with men.[28]


One reason for higher prevalence is that engaging in receptive anal intercourse carries a higher risk of transmitting STDs than other forms of penetrative sex,[29] and, according to one study's abstract, can be an important risk factor for intestinal parasitism,[30] although another study found no correlation between "detection of E. histolytica [the parasite which causes amoebiasis] and sexual practices".[31] Anal sex is more common in homosexual sex than in heterosexual sex.[32] The prevalence of anal sex among homosexual couples in the West has varied over time. Magnus Hirschfeld, in his 1914 work The Homosexuality of Men and Women, reports the rate of anal sex among homosexual men surveyed to be 8%, the least favored of all the practices documented.

By the 1950s in the United Kingdom, it was thought that about fifteen percent of male homosexuals practiced the method. The Gay Urban Men's Study (P.I. Stall, UCSF) and the Young Men's Study (YMS, PI Osmond/Catania, UCSF) indicate that 50% of men surveyed engage in anal sex. The Laumann study claims that 80% of gay men practice it.

A survey conducted from 1994 to 1997 in San Francisco by the Stop AIDS Project indicated that, over the course of the study, the proportion of men who have sex with men engaging in anal sex increased from 57.6% to 61.2%.

A comparison study of HIV-infected men found that those who had sex with men were especially unlikely to receive HIV preventative services even though they were more likely to report unprotected sexual intercourse with seronegative and unknown serostatus casual partners.[9] This can lead to the rapid transmission of HIV among small clusters of gay men.[33]

A 1990 study called The Social Organization of Sexuality showed that men who had at least one male sexual partner in the previous 5 years had an average of 16.7 sexual partners during that time period, while men who only had sex with women had an average of 4.8 sexual partners during that time.[34]

One study based on the Amsterdam Cohort Study (which includes only MSM who have had two sexual partners in the previous six months)[35] concluded that young MSM were more likely to have contracted HIV from a steady partner than from a casual partner, compared with older MSM, possibly due to higher rates of unprotected anal intercourse.[36]

However, the persistence of disparities in HIV between heterosexual individuals and MSM in the United States cannot be explained solely by differences in risky sexual behavior between these two populations; it is also contributed to by both the lack of "sexual role segregation" between male sex partners and "the differential anal/vaginal transmission probabilities".[37]

James Chin, clinical professor of epidemiology at UC Berkeley, has charged that political correctness has led to the under-targeting of those at greatest risk of acquiring HIV (including MSM) in HIV/AIDS prevention programs.[38]

In developing countries, homosexual relationships may be illegal, making MSM difficult to reach.[1][39] Studies have found that less than 5 percent of MSM in Africa, Asia, and Latin America have access to HIV-related health care.[28]

See also



  1. 1.0 1.1 MSM in Africa: highly stigmatized, vulnerable and in need of urgent HIV prevention
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 UNAIDS: Men who have sex with men. (asp) UNAIDS. URL accessed on 2008-07-24.
  3. 3.0 3.1 3.2 3.3 3.4 Greenwood, Cseneca, Mario Ruberte African American Community and HIV (Slide 14 mentions TG women). (ppt) East Bay AIDS Education and Training Center. URL accessed on 2008-07-24.
  4. 4.0 4.1 4.2 Operario D, Burton J, Underhill K, Sevelius J (January 2008). Men who have sex with transgender women: challenges to category-based HIV prevention. AIDS Behav 12 (1): 18–26.
  5. 5.0 5.1 5.2 5.3 Operario D, Burton J (April 2000). HIV-related tuberculosis in a transgender network--Baltimore, Maryland, and New York City area, 1998-2000. MMWR Morb. Mortal. Wkly. Rep. 49 (15): 317–20.
  6. Young RM, Meyer IH (July 2005). The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse. Am J Public Health 95 (7): 1144–9.
  7. Glick M, Muzyka BC, Salkin LM, Lurie D (May 1994). Necrotizing ulcerative periodontitis: a marker for immune deterioration and a predictor for the diagnosis of AIDS. J. Periodontol. 65 (5): 393–7.
  8. A review of knowledge about the sexual networks and behaviors of men who have sex with men in Asia. Dowsett, Grierson and McNally.[1]>
  9. 9.0 9.1 Steward WT, Charlebois ED, Johnson MO, et al (June 2008). Receipt of prevention services among HIV-infected men who have sex with men. Am J Public Health 98 (6): 1011–4.
  10. Statistics from the Ministry of Health, Labor and Welfare
  11. Go VF, Srikrishnan AK, Sivaram S, et al (March 2004). High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India. J. Acquir. Immune Defic. Syndr. 35 (3): 314–9.
  12. Lee HC, Ko NY, Lee NY, Chang CM, Ko WC (May 2008). Seroprevalence of viral hepatitis and sexually transmitted disease among adults with recently diagnosed HIV infection in Southern Taiwan, 2000-2005: upsurge in hepatitis C virus infections among injection drug users. J. Formos. Med. Assoc. 107 (5): 404–11. Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan
  13. UNAIDS 2006 report on the global AIDS epidemic, Chapter 05, June 2006
  14. 14.0 14.1 FDA Policy on Blood Donations from Men Who Have Sex with Other Men
  15. Estimated numbers of persons living with HIV/AIDS at the end of 2006, by race/ethnicity, sex, and transmission category—33 states with confidential name-based HIV infection reporting, Center for Disease and Control Prevention
  16. Syphilis & MSM (Men Who Have Sex With Men) - CDC Fact Sheet, Centers for Disease Control and Prevention
  17. STD Facts - HPV and Men. URL accessed on 2007-08-17.
  18. Frisch M, Smith E, Grulich A, Johansen C (2003). Cancer in a population-based cohort of men and women in registered homosexual partnerships. Am. J. Epidemiol. 157 (11): 966–72.
  19. Chin-Hong PV, Vittinghoff E, Cranston RD, et al (2005). Age-related prevalence of anal cancer precursors in homosexual men: the EXPLORE study. J. Natl. Cancer Inst. 97 (12): 896–905.
  20. includeonly>Tuller, David. "New Vaccine for Cervical Cancer Could Prove Useful in Men, Too", New York Times, January 30, 2007.
  21. Stark DJ, Fotedar R, Ellis JT, Harkness JL (October 2006). Locally acquired infection with Entamoeba histolytica in men who have sex with men in Australia. Med. J. Aust. 185 (8): 417.
  22. Amano K, Takeuchi T (July 2001). Amebiasis in acquired immunodeficiency syndrome. Intern. Med. 40 (7): 563–4.
  23. 23.0 23.1 includeonly>Paddock, Catharine. "HIV Rising Among Young Gay Men In The US", Medical News Today, 27 June 2008.
  24. (June 2008)Trends in HIV/AIDS diagnoses among men who have sex with men--33 States, 2001-2006. MMWR Morb. Mortal. Wkly. Rep. 57 (25): 681–6.
  25. New HIV diagnoses rising in New York City among young men who have sex with men
  26. Risky Sexual Behavior Among MSM In Europe Increasing Number Of Syphilis Cases, Health Officials Say
  27. STD Surveillance 2006: Men Who Have Sex With Men, Center for Disease Control
  28. 28.0 28.1 HIV rates skyrocketing among men who have sex with men
  29. Stuttaford, Thomas and Suzi Godson, "Blown out of proportion; Agony and ecstasy; Sex advice; Sex", Times (UK) (December 23, 2006), 22.
  30. Wiwanitkit V (June 2006). Intestinal Parasitism among Homosexual Male. Sexuality and Disability 24 (2): 113–5.
  31. Law CL, Walker J, Qassim MH (1991). Factors associated with the detection of Entamoeba histolytica in homosexual men. Int J STD AIDS 2 (5): 346–50.
  32. Bell R (February 1999). ABC of sexual health: homosexual men and women. BMJ 318 (7181): 452–5.
  33. Hayward P (May 2008). Rapid HIV transmission in men who have sex with men. Lancet Infect Dis 8 (5): 285.
  34. Laumann, Edward O. (1994). The Social Organization of Sexuality: Sexual Practices in the United States, University of Chicago Press.
  35. Overview of the Amsterdam Cohort Studies among homosexual men and drug users, page 2
  36. Increase in the share of steady partners as a source of HIV infection: a 17-year study of seroconversion among gay men
  37. Goodreau SM, Golden MR (October 2007). Biological and demographic causes of high HIV and sexually transmitted disease prevalence in men who have sex with men. Sex Transm Infect 83 (6): 458–62.
  38. includeonly>Chin, James. "The risks in hiding the HIV/AIDS truth", Business Day, March 12, 2007. - online available here
  39. Criminalizing high-risk groups such as MSM

Further reading

External links

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