What's in a Name?

The ''MSM'' label negates community, the very key to our health

By David Phillips
Published on July 12, 2012, 7:02am | Comments

In the late 1980s, epidemiologists adopted the expression "men having sex with men" to categorize routes of HIV transmission, to acknowledge that not all such men identify as gay or bisexual. For a moment, many LGBT and HIV activists were relieved to find a spectrum of male sexual attraction recognized in public health, though by 1994 ''men who have sex with men'' had become a category of people and abbreviated for the first time in the literature as ''MSM.'' Soon, in public circles around the world, any discussion of male non-heterosexual orientation would be tucked under the label MSM, narrowing multifaceted sociopolitical and cultural gay and bisexual identities to genital acts, while failing to name outright a significant population of ''straight'' men and the elements of their desire. Even as studies over the past decade have demonstrated significant differences in social influences and supports between self-named gay and bisexual men and ''straight'' men who have sex with men in major U.S. cities, MSM is applied monolithically, with rare critical analysis in academe, the media, and even agencies serving these groups, to the detriment of all men concerned.

Being branded ''an MSM'' is reminiscent of growing up as ''David'' and being called ''Dave,'' a name to which I don't respond based on self-conditioning and sheer obstinance. In the 1970s, communities tired of being defamed with slurs coalesced around the label ''gay''; and no sooner had we become comfortable with ''gay'' – I was 16, in college, and socially out in 1981 – our friends and loved ones began dying in frightening numbers. Gay and bisexual men became subject to stigma associated with HIV disease, and then ''MSM'' and its long form were hypothesized by some to have potential for easing stigma. Instead, the label reduced GBTQ men in all of their diversity to vectors for a new disease. On hearing ''MSM,'' gay and bisexual men thought, ''Not me.''

As some gay activists and allies connected with policymakers and researchers, then and since, they have challenged the coarse definition of MSM and warned that the lack of attention to the identities behind the label fundamentally undermines education and prevention efforts. The late Eric Rofes, one of the founders of the gay men's health movement, noted that gay men's health is not only a product of individual behaviors, but is also supported – or opposed – by the communities in which one associates, communities formed around facets of identity. Soon after, in 1999, the American Journal of Public Health urged the deployment of community-level interventions against HIV, remarkably without using the words MSM, gay or bisexual. By 2004, the Centers for Disease Control and Prevention had recognized one community-level intervention model for gay and bisexual men – the same and only model recognized for our communities today. However, most HIV service agencies continue to heavily rely on individual and group interventions that generate for their government funders easy-to-tally numbers of condoms distributed and people counseled, absent any thought of how race, class, sexual orientation and other identities conspire to build communities and how those communities create health.

So, while attending AIDS 2012 from July 22 to 27, I will continue speak out to encourage others working in the HIV field to think beyond the haggard MSM label and say ''Gay, Bisexual, and other men who have sex with men'' whenever possible. Beforehand, I will strengthen myself and those around me by attending the 2012 Gay Men's Health Summit, a place to celebrate gay identities and to examine health as more than just the absence of disease, including HIV.

David Phillips is a federal IT strategist and a graduate student in the University of Maryland School of Public Health. He can be reached at dmp@umd.edu.


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