Talk:Men who have sex with men/Archive 2

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Academic/Clinical Usage

Have now included some material on the academic origins of the term. A full discussion of these concepts took place in a number of different editions of the American Jounral of Public Health last year. It began with the article by Young and Meyer (which criticised the use of the concept, although I've only used the part of the article that describes the usage of MSM / WSW as behavioural categories - the rest may merit inclusion in a "Criticism of ... " section); a variety of responses from other authors followed (some of which may also merit inclusion in the article). --Nmcmurdo 20:38, 8 November 2006 (UTC)

Good add.  :) This looks much better, and actually helps the article out a bunch. I like to see how constructive input can be done, when people stop bickering about things ;) From a clinical view in this manner, then there are certainly distinctions to be made against self-identification. Namely, pre-operative transssexuals that engage in anal sex, are certainly at the same health risks as a man receiving anal sex (as is a woman receiving anal sex). A post-operative transsexual that engages in purely vaginal sex stands about the same level, if not less susceptable to HIV and sexually transmitted diseases as a natal female. (Natal females have a delicate balance of internal bacteria that they need to be careful not to upset, a post-op female needs to clean her vagina regularly in a way that is typically determined to be unhealthy for a natal female. Although, no studies have been done on this to my knowlege, so at this point, it would be OR)

So, now that there's a base and a reason for the definition of the term, a more enlightened discussion can be had about it. And as I noted, for risk of sexual diseases, the correct term would probably be to seperate out those who receive anal sex, those who receive vaginal/neo-vaginal sex, and the actual sexual behavior that causes the actual risk... considering that women can engage in just as risky sexual behavior as a man who has sex with a man, and in fact, the only reason why more women are infected with HIV in America, is that straight men generally don't have the disease, because at this time a straight man is highly unlikely to contract HIV. But a woman engaging in vaginal intercourse with someone who is HIV positive is at a very high change of contracting disease, and engaging in anal intercourse? Well, there's nothing about being a man that makes it particularly likely to spread HIV, the very act itself puts you at high risk.

So, as we mentioned before, the poor decision of "behavior" is what's causing this. They want to identify a group of people who are in a high likelihood of contracting an STD, which in America is definitely any man who engages in sex with other men. But if HIV were originally distributed randomly among the population, "women who have sex with men" would be the highest risk category... As it stands, a transsexual MTF who has sex with a male partner who would otherwise be dating a girl, would be at no significantly higher risk of contracting a disease than any other woman that he were dating. Pre-op, or post-op. Of course, this sort of classification becomes VERY sticky. --Puellanivis 03:33, 9 November 2006 (UTC)

Thanks. As I said, there is more in that particular journal that may also merit inclusion. Young & Meyer actually address the point you make above about behaviour and go a little further. Indeed, they suggest that the widespread clinical adoption of the 'MSM' concept has tended to obscure analysis of actual behavioural risks (e.g. anal sex as opposed to sex with men), whilst neglecting the socio-cultural dimension that can also be clinically important (e.g. in explaining why 'lesbian' intra-venous drug users have higher HIV prevalence than other intra-venous drug users).--Nmcmurdo 18:11, 10 November 2006 (UTC)

WOW

When I initially rewrote this page I could not foresee that it would generate so much debate! As someone who is in regular contact with MSM and sometimes work with them, I'd just like to point out that the philosophical/ethymologycal/foot massage (no offence there) meaning of MSM does not weight much in our everyday life ! My perpsective is that of people who actually know and work with /for MSM and my intent was to give a simple and honnest representation of Men who have sex with men in different society, context, occasion. MSM is just an "in"convenent term for a group of people at higher risk of contracting HIV. Keep your energy for fighting HIV/AIDS! Thanks for the improvement Roger jg 05:51, 11 December 2006 (UTC)

The issue at hand, is that you attempt to place transsexuals in this group, while not all transsexuals are at the same higher risk of contracting HIV. Post-operative transsexuals, who have sex with men, are certainly not at any higher risk of contracting HIV than heterosexual females. And also, there are numerous transsexuals (even pre-operative) who never have sex with any men, because they are attracted to females. There is easily also a group of pre-operative transsexuals, who engage in no more risky sexual behavior than a woman who engages in anal sex with a heterosexual man. While I understand that MSM is an inconvenient term to group people at hgher risk of contracting HIV, the determination of "who is a man" is sticky, and there exist people, whom you would classify as male, who have sex with men, but their activities put them in no way at any greater risk for contracting HIV. --Puellanivis 07:15, 11 December 2006 (UTC)

MSM as contruct

I disagree with the statememnt that to be part of the MSM group, one needs "fundamemntaly to perceive himself as a man." How people perceived themselves is irrelevant since the concept describes a sexual practice (within a context etc...). MSM is sex between men (as genetically defined). That they don't look like men (Thai Ladyboys) or don't feel like men (Hijras) is irrelevant.

Then the following sentences "It is possible for only one member of a sexual encounter to be having sex with another man..." is completely unclear to me. I don't understand this sentence or what it tries to illustrate. Clarification welcome Roger jg 06:04, 11 December 2006 (UTC)

Your genetic definition fails, as women with Androgen Insensitivity Syndrome are still genetically male, but they should not qualify in any definition of MSM that is well formed. There are also post-op transsexual women who have sex with men, but do not engage in any riskier behavior than the average woman. This is why it is necessary to qualify and define the definition of "who is a man".

That sentence is perfectly clear. Let me give you an example. Take a pre-op transsexual woman who does not engage in any risky sexual behavior, and she begins dating a man, who does not engage in risky sexual behavior. They become attracted to each other and begin to engage in sex. Although, at a later point, the woman realizes that he fundamentally percieves her as a male, due to some inaccurate definition of masculinity (such as the misguided notion that genetics determines sex conclusively), and she breaks up with him as a result of this perception of her. He liked the sex that he had with what he felt was a him, and immediately goes out seeking pre-operative (or non-operative) transsexuals in a form of a fetish, who (I will grant they do exist) engage in risky sexual behavior. The pre-operative transsexual however, goes on to have her surgery, and begins dating another man, and then marries him, and engages in typical female sexual behavior for the rest of her life. To claim that she qualifies as an MSM, simply because her genes say she is a male, is ridiculous, while to label her former partner's behavior as anything but MSM would be important.

Likewise, take for example a virilized person with a karyotype of 46,XX (genetically female), who has a male self-identity, but no male gonads, and people just thought that he had cryptochidism, until his condition was accurately determined, but he's also attracted to men. To suggest that he would be unable to be classified as an MSM on the account that his genetics say that he is genetically female, denies the situation that he is in, and the actual behavior that he engages in, and the HIV risk group that he is associated with.

In any case, in order to have any significant impact upon the HIV susceptability that a person has, it has to be a more or less regular behavior. Let us say that HIV contraction rates of MSM is 90%, and HIV contraction of MSW (for the male) is 10%. If he has 100 partners, only one of them male, and only one time, and all other partners he has sex with at least 10 times, that gives us an occurance bias for those percentages closer to 10% than 90%, and thus not a significant risk group to qualify for any reason as an MSM, even though he has engaged in homosexual behavior at least once.

The entire basis of this grouping is entirely flawed in the first place, as much as saying that homosexuals have HIV/AIDS, and homosexuals do not. In Africa, HIV is an everybody disease, even men who only have ever had sex with females. Remember the 3 H's of who gets HIV/AIDS? Homosexuals, Herion addicts and Hatians? We know why they were at a higher risk now, and not that HIV/AIDS is restricted solely to those people. The perception that a classification of MSM as useful for anything, is ridiculous. Especially, assigning this grouping to people outside of the US, where HIV risk rates are entirely different.

And all of this entirely ignores that women who engage primarily in anal sex are just as likely to contract HIV/AIDs as MSMs anyways. And then, women are simply more likely to contract HIV/AIDs than a man in the first place, should we make a classification of "women who have sex with more than one man"? Just to have a category to group women who are at a higher risk of contracting STDs, and/or HIV/AIDs?

This is entirely just a logical category that people are picking up to discriminate against homosexual behavior, the same as they were able to discriminate aganst homosexuals in the first place, just now they need a politically correct reason to their classification, not just "oh, well, he's gay." It's like people racist against blacks changing from "blacks are poorer because they're black" to "blacks are poorer because they don't try as hard"... only the truely non-racist say "blacks are poorer because they are in a socially disadvantaged situation".

If this category is intended to be used to classify people based on HIV risk, then let's dump ALL non-American groups from it, explicitly state that it is an American/Western Culture-only standard, and that the risks of HIV will vary from culture to culture, such that the classification of MSM is entirely useless in Africa, where all sexual behavior is risky, regardless of who is engaging in it with whom. --Puellanivis 07:39, 11 December 2006 (UTC)

I think the idea that this sentence is "perfectly clear" is a little silly. I discussed its usefulness earlier - which I think is dubious. But whatever we think about the underlying meaning here, I think it's difficult to argue that it's clear, never mind perfectly so. --Nmcmurdo 19:10, 13 December 2006 (UTC)

Sorry, the use of "perfectly clear" there was rhetorical and hyperbole. I don't think that it's perfectly clear, but many of the simple assumptions that people make typically make the sentence appear to be wrong, even if it is perfectly valid, or even true. Physics is full of things that if you hear them, you think "Pff, that has got to be totally wrong." But low and behold, it turns out to be correct, it just turns out that your basic assumptions about how the world works were wrong. Not your fault, it's typical observation... we're used to things getting hotter because they're closer to heat sources, not because they're recieving more direct light rays (not to mention that the scale is a significant factor with seasons, also) Someone above asked how two ducks could be in a pond but only one of them be a duck in a pond with another duck. The problem with that, is that there is an implicit assumption that there is an objective criteria for labeling things a duck. Turns out, that one of the ducks could have imprinted with a goose, and would argue (were it able to) that it were certainly not a duck in a pond with another duck, because it weren't a duck!

I'm sorry that the logical statement that I made violates typical assumptions about human gender, and thus tends to appear to be a contradiction. I have accepted that it need be reworded, but at this time, I cannot think of a better way to reword it to make it better, and thus is the reason why I have not returned it to the page yet.

But the entire sentence is truly moot my argument anyways though. The assertion for MSM as a model is that it allows for a convenient construct that allows one to group people of similar HIV risk together. My point is that the actual behavior that is typical of MSM (anal intercourse) is risky itself, not simply being a man who has sex with a man. In fact, some would say that if you are a man, and you engage in oral sex with another man, you would fit the criteria of MSM, but if MSM serves to cluster HIV risk values, then a man who only gives oral sex to another man is not at the same risk level as a typical MSM. Risk factors also vary depending on culture, climate, and location, as I mentioned, in Africa, if you are having sex, then you are at high risk for getting HIV, regardless of how careful you are, or any other factor of your sexual partner. Should researchers in Africa make a construct of "People who have sex" as a risk category for HIV? Would MSM have even a single valid criterium in Africa?

If you want MSM as an HIV risk category, then you cannot immediately just dump every person who is male and has sex with another man in this category, especially if they are not part of the United States, or other western culture where HIV is primarily only risky for those who engage primarily in receptive anal and/or vaginal sex. In order to establish a group of people outside of the western culture as valid for this category, you would need to show how this risk category applies to them.

But if I'm wrong and this is not just an HIV risk category, then there are aspects that intrude and make this issue cloudy murky, and beyond simply "behavior", as there are a hojillion edge cases, and grey areas that make this category a nightmare to attempt to apply for anyone who is anything but cisgender. --Puellanivis 02:26, 14 December 2006 (UTC)

Remember when I spoke of just accepting that to most people Transsexuals like us will just be really really gay men and that we should just accept it. This is one of those times. Accept it and move on to more productive things. I don't think a well crafted arguement by Johny Cochrane could convince this guy we are not strictly MSM. Telling the person that transsexuals exist, lots of them who were always attracted to women... if that undisputable fact is lost on him then nothing will change his mind. Well I'll take one more crack at it.

Roger. "Men who have sex with men" Seems to be refereing to specifically "male bodied people who engage in anal sex with other male bodied people". Looking at this that way. Then we can make the defintion that sexually active pre/non operative "Homosexual transsexuals" are MSM. That seems to be the TS's you are thinking about and work with being at increased risk for HIV infection. I mean I realize that the transsexuals you have worked with have probably all fit that description to some extent. Plus are economically disadvantaged on some level. So your attitude is no surprise. I suggest that you open your eyes to the larger transsexual community. Realizee that not every TS would meet even the loosest definition of MSM. (For the record I personally object to TS women being called men but what can we do about it? Such is the way of the world. ) --Hfarmer 04:42, 14 December 2006 (UTC)

Hfarmer I did not comment on TS.Roger jg 06:14, 27 January 2007 (UTC)

Maybe I misread but what the fact that someone engage or not in risky sexual behaviour has to do with MSM??? I don't really see the point in nitpicking about highly theoretical rhetoric on this subject, such as as women with Androgen Insensitivity Syndrome which certainly not represent the vast majority of MSM. We all agree that MSM is a loose concept and that is what the article should say and not enter into a long and rather useless definition of what a man is. Beside I don't think that most "men" (for the sake of simplification) go into a lenghty debate about their feeling and perception of their masculinity when they are having sex.Roger jg 06:14, 27 January 2007 (UTC)

The point is that women with Androgen Insensitivity Syndrome should *not* classify as an MSM, despite your intentions, as it appears, that you seem determined to place them as an MSM: "such as as women with Androgen Insensitivity Syndrome which certainly not represent the vast majority of MSM". A woman with AIS has a vagina, and is likely to engage in sexual variations no different than any other woman. So, why would there be any justification for placing them into a grouping that refers specifically to men? They are neither more likely to contract HIV than any other woman, nor are they by any reasonable defintion a "man", so why would you attempt to group them as an MSM? --Puellanivis 21:13, 29 January 2007 (UTC)

M2M instead of MSM?

Male to male or M2M is also usually used to rever to men having sex with men. Is MSM more commonly used in the states? Berserkerz Crit 16:39, 30 December 2006 (UTC)

This is frankly OR, and anecdotal (as it must be -- I cannot find any research on this subject), but my experience is that I have never seen "M2M" used in research literature, but only in personals ads, chat rooms, and social-networking Websites. The pattern is reversed for "MSM". Since this article is chiefly concerned with a concept in medical, sociological, and psychological research, it makes sense to use the abbreviation that is used in that context. --7Kim (talk) 22:32, 15 January 2008 (UTC)

references

There are a few references to this article, they only need to be inserted properly in the text. I am not sure why there is a factual challenge here. But there is space for improvements. Roger jg 06:17, 27 January 2007 (UTC)

Why this article is {{disputed}}

I will lay out the grounds why I entered that part of the text.

Reasoning for this category's existence

There are only two possible reasons for the existence of this construct:

1. We are creating a construct that describes an at-risk group outside of self-definition (this view is presented by proponents for this article)
2. We are creating a group in order to describe people who engage in what we percieve as homosexual activities as "homosexuals", with a term that's been gerry-mandered specifically to include them. (this view is presented by opponents of this article)

I think we can all agree that the second reason for this article is patently discriminatory, and if this is the actual basis for this construct, then we should treat this article no different than any article dealing with a derogatory construct. I however do not feel that we should even promote this article, if this is the reason for this construct in the first place, as it is an entirely subjective view point constructed to promote discrimination.

If the first reasons is the most valid of the two alternatives, and becomes no longer a subjective standpoint, but rather an objective standpoint. Thus, we can validly discuss it outside of the realm of "this is just a person's attempt to discriminate against others."

The problem with this first reason though, is that defining a man for the context of this article becomes immediately convoluted, because the at-risk behavior that you're refering to is not males have sex with males, but rather having anal penetration. This at-risk group would include females, active homosexuals, pre/non op transsexuals that engage in sex with men, and transsexual that would engage in anal sex.

This at-risk grouping seems to provide a more direct correlation to actual behavior, which can be directly linked to risky behavior for the spread of HIV and other STDs, while the blanket term "Men who have sex with men" runs into a difficult situation that the proposed "simple" behaviour being described is actually tied intrinsically to the identity of the two participants, such that it becomes a classification of dubious reasons, namely a strict classification of an at-risk behavior (anal sex) where the identity of the participants is explicitly stated (male and male), thus automatically restricting a valid at-risk behavioral construct to such a narrow area that by its name seems to be intended to draw an immediate association to homosexual men.

It is a known fact that HIV has a lower chance of spreading through oral intercourse than through vaginal intercourse through which HIV has a lower chance of spreading through anal intercourse. Presume if you would, a man who has sex with other men, who only performed blowjobs, or recieved blowjobs. Should he be labeled in the same group as MSM due to at-risk behaviour? Certainly not, as he does not perform the central at-risk behavior central to this whole issue: anal penetration.

Thus, is my position on why this article is disputed. There appears to be no valid reason to make this criteria, as the particular at-risk grouping that covers the intended group of this category, and others who are equally in the same at-risk level, would be "People who receive anal penetration". Otherwise this category serves simply as a method to discriminate against any person perceived to be a homosexual, but only under the auspice of being a medical category.

Applicability Internationally

The second reason that this article is disputed, is working under the premise that this article is about a particular at-risk group, which is valid, and free of any claims of discrimination, or unjustified application.

Assuming that this category is perfectly valid as an at-risk group, it's important to note that at-risk groups change based on where you are in the world. While homosexuals here in the United States are more at-risk than heterosexuals, the same is simply not true in Africa, and other places around the world. At this point, defining MSM against a culture where HIV is not only prevalent among homosexuals, but also among heterosexuals, such that women are more likely to have HIV than a homosexual man, then this categorization fails to improve anything.

Looking at the CIA world fact book: the United States has an HIV prevalence rate of 0.6%, while Germany has a HIV prevalence rate of 0.1%. Should we start up an article "People who have sex with Americans", as this is a statistically higher at-risk group for HIV than "People who have sex with Germans"? I don't think that's necessary.

So, even assuming with all Good Faith that this article is not simply just veiled discrimination, we should not include any specific groups of people without cited research and evidence that they are in the same at-risk group as MSM in America/the UK/the Western World, and document specifically what geopolitical areas this term is applied to specifically, and note that anyone outside of that boundary has no cited evidence justifying their inclusion with this group. Otherwise, you're just blanket applying an at-risk category to people who are not in the same at-risk category, and thus breaking the only good reason for even including this category in the first place. --Puellanivis 21:48, 29 January 2007 (UTC)

Men having sex with men? That sounds really gay to me. Zomghax 18:04, 1 February 2007 (UTC)

Puellanivis, I'm impressed by your discussion of the article. I think the article should much more directly discuss MSM as a "risk category," and should include a lot of the text you've written here. This article is a great opportunity to deal with some of the thornier questions of MSM as Western shorthand for "non-standard gay." As you point out, if this article really were "just about behavior," it's not just the category "men" that's problematic, but "sex" as well. The article should discuss the mismatch between "MSM," anal penetration, and contracting HIV. Good job. I've added the "worldwide view" box. Citynoise 19:53, 1 February 2007 (UTC)

As suggested

As suggested much of the material hashed out in this talk page is now included on the article itself. Stated explicitly, the article is a risk-factor category primarily for describing virus and bacteria propogation. Also detailed is that risk-factors vary between cultures, and that application of this term may not work outside of western-culture (as supported by a particur given paragraph placed by a proponent of the term). Wording has been changed to make it more clear where the division is in cases of ambiguous gender.

The article specifically states that the term is best applied where gender and sex are clearly unambiguous as is the case in close to 99% of cases. (It's presumed that the prevalence rates for transsexuality, and intersexuality is near-to or less than one percent.) It makes specific note that the term should be avoided where the sex of the individual is ambiguous, as classifying anything as anything against their behavior is inappropriate for any category defined as a behavioral category.

Proponents may still argue that MSM is entirely a strictly behavioral grouping, and may attempt to apply a specific determinator upon ambiguous individuals in order to classify them as male, or as female for the purposes of this category, but that goes beyond the scope of this classification. This classifcation is based on a specific set of behaviors that may not be shared by people that one might otherwise choose to label as a man. Genetics is not sufficient, genital appearance is not sufficient, existence of gonads is not sufficient, and hormone levels of the individual are not sufficient. Whether the proponents of MSM as a valid term like it or not, but because the term is tied by definition to a secondary condition (male), they depend entirely upon the definition of male, and inherit all of the sticky issues that exist regarding ambiguity of genders and sexes.

I must admit however that from a medical and epidemiological view, that any individual who participates in behaviors that are essentially equivalent to MSM behaviors, should be classified as an MSM. So long as you can apply the definition "man" to the person. --Puellanivis 22:46, 1 February 2007 (UTC)

I am not sure I have followed your dissertion fully or in which group I could or should be put, but i like the new introduction. Roger jg 05:03, 26 February 2007 (UTC)

Merge?

Shouldn't this page be merged with homosexuality? As a man having sex with another man would make both men homosexual, or at the very least bisexual. (Animedude 02:55, 14 March 2007 (UTC))

No it should not. There is a difference between homosexuality, and bisexuality, and having sex with other men. It's known to occur that men when removed from females, will look for substitutes to simply get over their urges. Conflating this particular issue with homosexuality, is just as bad as the MSM article that was here before, where it simply was a facade article saying that it was classifying people based on behavior, but in truth was just subjectively assigning people into a group with homosexuals. --Puellanivis 07:38, 14 March 2007 (UTC)

No. 'Homosexuality' and 'bisexuality' etc. are peculiar concepts emanating for 19th century Western psychiatry. They are thus not suitable generic headings for many other aspects of human sexuality. —The preceding unsigned comment was added by Nmcmurdo (talk • contribs) 21:40, 30 March 2007 (UTC).

Yes. 'Having sex with same sex' ones is 'homosexuality' (yes, even under ausence of females, Puenllanivis). Homo => Equal (from the Ancient Greek).

A man having sex with another man is, yes, a "homoerotic" or "homosexual experience". However, "homosexuality" implies that the person oft engages in that activity. A Christian is not a Christian simply because they have had perhaps one and only one Christian experience. A Christian is a Christian, because they have an ongoing engagement with Christian beliefs and experiences.

Now, to address your statement of "yes, even under ausence of females", first, "ausence" is not a word, but in good faith, I would imaging you were attempting the word to be "auspice", and I will precede in my argument as such.

Now, recall, that the purpose of MSM is to classify a high-risk group of people, who engage in activities that are high-risk. Males by the nature of having significantly more testosterone, and a constant gonadotropine pulse are more likely to engage in sexual activities, in addition to that, males that engage in sex with other men, are more likely than any other group to engage in anal sex. As anal sex is an extremely risky activity for any person to engage in, regardless of who that person is. The anus was not designed for regular sexual activity, and as a result anal sex regularly results in anal fissures, which are open sores, which immediately presents the increased risk in anal sex.

Recall that the article addresses specifically that if a transgender individual engages in such risky behaviors that are equivalent to regular MSM activities, that they should be considered MSM. Even if the transgender person is "under the auspice" of being female. Regardless of your personal biases and beliefs, a transgender person is not guaranteed to engage in such risky behavior as MSM. First, they may typically be taking anti-androgens, which reduces their libido, and they are not necessarily likely to engage in anal sex. Blowjobs and handjobs are not even as risky behavior as vaginal sex.

I would like you to know, that when this article first came out it was targeted towards your biased opinion and I insisted that such an article is pointless, as a strict euphemism for "gay, or bisexual" should be merged with their respective articles. I have heavily edited the article to ensure that it deals strictly with the research term, and not the biased opinion that it is simply a euphemism of "gay or bisexual". --Puellanivis 06:55, 10 October 2007 (UTC)