Men who have sex with men 591031 225951101 2008-07-16T04:27:54Z Joshuajohanson 3773005 Restructuring STDs and add informaion {{worldwide}} '''Men who have sex with men''' ('''MSM''') is a classification of men who engage in sexual activity with other men, regardless of their declared [[sexual orientation]] or [[sexual identity]]. The term is intended to reference a particular category of men who are at higher risk for sexually-transmitted diseases such as [[HIV]]. MSM is considered a behavioural category, not a sexual identity. Because persons with [[Intersexuality|intersexual]] conditions, as well as [[transgender]], or [[transexualism|transsexual]] gender identities are difficult to definitely place as male or female, their inclusion in MSM should be carefully considered. Due to the higher risk of HIV in the MSM demographic, in many jurisdictions they are [[MSM blood donor controversy|restricted from donating blood]] or tissue for transplantation. Restrictions on donors are often called "deferrals" since in some cases blood donors who are found ineligible may be accepted at a later date. ==MSM as behavioural category== Young and Meyer (2005) note that the term has been in use within the [[public health]] discourse since 1990 or earlier,<ref>Young, R M & Meyer, I H (2005) The Trouble with "MSM" and "WSW": Erasure of the Sexual-Minority Person in Public Health Discourse American Journal of Public Health July 2005 Vol. 95 No. 7.</ref> but that the coining of the [[initialism]] by Glick et al. (1994) "signaled the crystallization of a new concept."<ref>Glick, M Muzyka, B C Salkin, L M Lurie, D (1994) Necrotizing [[ulcerative periodonitis]]: a marker for immune deterioration and a predictor for the diagnosis of [[AIDS]] Journal of Periodontology 1994 65 p. 393-397.</ref> They trace the emergence of this [[behavioural]] concept to two very distinct academic perspectives. First, it was pursued by [[epidemiologists]] seeking behavioural 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 worker]]s. "MSM" and "homosexual" refer to different social identities. "MSM" refers to the sexual relationships between men, whether or not they identify as homosexual, or bisexual. "Homosexuality" refers to more than the sexual relationship and may extend to broader relationships with the same sex, i.e., lifestyle, sexuality, etc. In their assessment of the knowledge about the sexual networks and behaviours of men who have sex with men in Asia, Dowsett, Grierson and McNally observed that using MSM as a category does not always work. From the material they have reviewed there is not any clearly identifiable group of men who can be labelled MSM in any of the countries that they investigated.<ref> A review of knowledge about the sexual networks and behaviours of men who have sex with men in Asia. Dowsett, Grierson and McNally.[http://www.latrobe.edu.au/arcshs/downloads/Reports/Asia%20MSM.pdf]> </ref><!-- This paragraph is not supported by the following quote, as is implied by the layout/structure. The quote appears to support the paragraph above this one (that there is no homogeneity between MSM), and not this paragraph (that application of MSM outside of western-culture doesn't always work.) RE: This paragraph comes straight out of the Report and the quote below was used in the report to illustrate this --> <blockquote>"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 [[prostitution|sell sex]], and so on: all these categories of men are to be found in the studies and programmes reviewed."</blockquote> There were no similar traits in all of the MSM population studied other than them being males, and engaging in sex with other men.<!-- expand this from a reference citing examples, notable situations showing lack of similarity, etc. RE: The report provide all the facts about this quote, If i have time I'll get into it!--> ==Examples of persons inside and outside of MSM demographic== ===Examples of men within the MSM demographic=== * Sexually active men that identify as [[gay]] * [[Bisexuality|Bisexual]] men sexually active with other men * Men who do not identify as gay or bisexual, or may be on the [[Down-low (MSM)|''down low'']] * Anonymous or casual sexual encounters, such as at [[Glory hole (sexual)|glory holes]] * Male [[sex workers]] with male clients <!-- Additions to this list, outside of the Western-cultures should be referenced as having significant risk-factors equivalent to western MSM. --> ===Examples of persons that are ''not'' considered part of the MSM demographic=== * Post-operative male-to-female transsexual women * Any intersexual person, who does not engage in risk behaviors similar or equivalent to sex between MSM, regardless of self-identity, genital appearance, or social assignment * Any transgender or transsexual individual, who does not engage in risk behaviors similar or equivalent to sex between MSM, regardless of self-identity, genital appearance, or social assignment * A man who participates in a sexual act with another person, unknowing that their partner may otherwise satisfy some particular individual criteria typically asserted to be exclusive to males (for example: genetically, a woman with [[Androgen Insensitivity Syndrome]]; genitalia: a pre-op transsexual; gonads/hormones: transgender individual) == Sexually transmitted diseases == Men who have sex with men are more likely to get HIV in the modern West,<ref name=HIVprevention /> in Japan,<ref>[http://www.japanetwork.org/aidsnews/stats/06jul-sep.html Statistics from the Ministry of Health, Labor and Welfare]</ref> India,<ref>[http://www.ncbi.nlm.nih.gov/pubmed/15076248?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India]</ref> and Taiwan<ref>[http://www.ncbi.nlm.nih.gov/pubmed/18492625?ordinalpos=31&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan]</ref> as well as other developed countries than among the general population.<ref>UNAIDS 2006 report on the global AIDS epidemic, [http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH05_en.pdf Chapter 05], June 2006</ref> In the US, their HIV prevalence is 60 times higher than the general population,<ref name="FDA">[http://www.fda.gov/Cber/faq/msmdonor.htm FDA Policy on Blood Donations from Men Who Have Sex with Other Men]</ref> 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 AIDS from sexual contact with a female who is known to have, or is at high risk for, HIV infection.<ref>[http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/table9.htm 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</ref> 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 other men than in the general population. They also have an increased incidence and prevalence of Human [[Herpes]] Virus-8, which causes a cancer called [[Kaposi's sarcoma]] in immunocompromised individuals.<ref name="FDA" /> In 2006, 64% of the reported [[syphilis]] cases in the United States were among men who have sex with men.<ref>[http://www.cdc.gov/std/syphilis/STDFact-MSM&Syphilis.htm#concern Syphilis & MSM (Men Who Have Sex With Men) - CDC Fact Sheet], Centers for Disease Control and Prevention</ref> Men who have sex with men are 17 times more likely to develop [[anal cancer]] than heterosexual men,<ref name="CDC men">{{cite web |url=http://www.cdc.gov/std/hpv/STDFact-HPV-and-men.htm |title=STD Facts - HPV and Men |accessdate=2007-08-17}}</ref> probably due to a higher risk of [[Human papillomavirus]].<ref>{{cite journal |author=Frisch M, Smith E, Grulich A, Johansen C |title=Cancer in a population-based cohort of men and women in registered homosexual partnerships |journal=Am. J. Epidemiol. |volume=157 |issue=11 |pages=966–72 |year=2003 |pmid=12777359| url = http://171.66.121.65/cgi/content/full/157/11/966 | quote=However, the risk for invasive anal squamous carcinoma, which is believed to be caused by certain types of sexually transmitted human papillomaviruses, notably type 16, was significantly 31-fold elevated at a crude incidence of 25.6 per 100,000 person-years. |doi=10.1093/aje/kwg067}}</ref><ref>{{cite journal |author=Chin-Hong PV, Vittinghoff E, Cranston RD, ''et al'' |title=Age-related prevalence of anal cancer precursors in homosexual men: the EXPLORE study |journal=J. Natl. Cancer Inst. |volume=97 |issue=12 |pages=896–905 |year=2005 |pmid=15956651 |doi=10.1093/jnci/dji163}}</ref> Many people become infected with HPV soon after becoming sexually active.<ref>{{cite news |url=http://www.nytimes.com/2007/01/30/health/30virus.html |title=New Vaccine for Cervical Cancer Could Prove Useful in Men, Too |first=David |last=Tuller |date=[[January 30]], [[2007]] |publisher=New York Times}}</ref> === 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.<ref name=HIVrising>{{cite news |url=http://www.medicalnewstoday.com/articles/112998.php |title=HIV Rising Among Young Gay Men In The US |date=[[27 June]] [[2008]] |publisher=Medical News Today |first=Catharine |last=Paddock}}</ref><ref>"Trends in HIV/AIDS Diagnoses Among Men Who Have Sex with Men --- 33 States, 2001--2006." A Mitsch, MPH, X Hu, MS, K McDavid Harrison, PhD, T Durant, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. MMWR Weekly, June 27, 2008 / 57(25);681-686.</ref><ref name=NewYork /> During the last 10 years, syphilis outbreaks among men who have sex with men have been recorded in countries across Europe.<ref name=EuropeSyphilis>[http://www.medicalnewstoday.com/articles/92656.php Risky Sexual Behavior Among MSM In Europe Increasing Number Of Syphilis Cases, Health Officials Say]</ref> This follows the general increase in [[STD]]s among men who have sex with men.<ref>[http://www.cdc.gov/std/stats/msm.htm STD Surveillance 2006: Men Who Have Sex With Men], Center for Disease Control</ref> 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.<ref name=HIVrising /> In developing countries, HIV infection rates are skyrocketing among men who have sex with men.<ref name=skyrocketing>[http://www.iht.com/articles/ap/2007/07/24/asia/AS-MED-Australia-AIDS-Conference-Male-Sex.php HIV rates skyrocketing among men who have sex with men]</ref> === Explanations === One reason for higher prevalence is that engaging in receptive [[anal intercourse]] carries a higher risk than other forms of penetrative sex.<ref>Stuttaford, Thomas and Suzi Godson, "Blown out of proportion; Agony and ecstasy; Sex advice; Sex", ''Times'' (UK) (December 23, 2006), 22.</ref> A comparison study of HIV-infected men found that men who have 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.<ref name=HIVprevention>{{cite journal |url=http://www.ajph.org/cgi/content/abstract/98/6/1011 |title=Receipt of Prevention Services Among HIV-Infected Men Who Have Sex with Men |last=Steward |first=Wayne T. |date=June 2008 |volume=Vol 98 |number=No. 6 |publisher=American Journal of Public Health}}</ref> This can lead to the rapid transmission of HIV among small clusters of gay men.<ref>{{cite journal |url=http://www.mdconsult.com/das/article/body/98760047-2/jorg=journal&source=&sp=N&sid=0/N/642675/1.html?issn= |title=Rapid HIV transmission in men who have sex with men |last=Hayward |first=Peter |publisher=The Lancet Infectious Diseases |volume=Volume 8 |issue=Issue 5 |date=May 2008}}</ref> Men who have male partners tend to have more sexual partners overall.<ref>[http://www.hivandhepatitis.com/recent/ad/051805_c.html Having a Large Number of Male Sex Partners, Use of Nitrite Inhalants, and Receptive Anal Sex Explain the Majority of Infections in a Cohort of 3,257 Men Who Have Sex with Men]</ref><ref name=India>[http://infochangeindia.org/200801116825/Agenda/HIV/AIDS-Big-Questions/Criminalising-high-risk-groups-such-as-MSM.html Criminalising high-risk groups such as MSM]</ref> A 1990 study of 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. <ref>{{cite book |title=The Social Organization of Sexuality: Sexual Practices in the United States |last=Laumann |first=Edward O. |date=1994 |publisher=[[University of Chicago Press]] |url=http://books.google.com/books?id=72AHO0rE2HoC&pg=PA4&lpg=PA4&source=web&ots=kHfFtQQH7j&sig=ZS5sk4GqzcR4e8mLVIHTNPsHt-Y#PPA315,M1 |page=315}}</ref> New York Health Commissioner Thomas Frieden said "We are very concerned about the increase in HIV among young men who have sex with men... Unless young men reduce the number of partners they have, and protect themselves and their partners by using condoms more consistently, we will face another wave of suffering and death from HIV and AIDS."<ref name=NewYork>[http://www.nyc.gov/html/doh/html/pr2007/pr079-07.shtml NEW HIV DIAGNOSES RISING IN NEW YORK CITY AMONG YOUNG MEN WHO HAVE SEX WITH MEN]</ref><ref>[http://www.medicalnewstoday.com/articles/82336.php New York City Records Increasing Number Of HIV Cases Among MSM Younger Than Age 30]</ref> 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.<ref>[http://www.ncbi.nlm.nih.gov/pubmed/17855487?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Biological and demographic causes of high HIV and sexually transmitted disease prevalence in men who have sex with men.]</ref> Critics charge that political correctness has led to the association of MSM and HIV being downplayed.<ref>James Chin, “The risks in hiding the HIV/AIDS truth”, ''Business Day'' (March 12, 2007), 9.</ref><ref>"The people punish Mr Blair", ''Daily Mail'' (UK) (May 6, 2005), 14.</ref> In developing countries, homosexual relationships may be illegal, making MSM difficult to reach.<ref>[http://www.aidsportal.org/News_Details.aspx?id=5208&nex=5 MSM in Africa: highly stigmatised, vulnerable and in need of urgent HIV prevention]</ref><ref name=India /> Studies have found that less than 5 percent of MSM in Africa, Asia and Latin America have access to HIV-related health care.<ref name=skyrocketing /> ==See also== * [[Gay-for-pay]] * [[Terminology of homosexuality]] * [[Women who have sex with women]] ("WSW") * [[MSM blood donor controversy]] ==References== {{reflist}} == Further reading == * UNESCO Guidelines on Language and Content in HIV and AIDS-Related Materials. [http://portal0.unesco.org/en/ev.php-URL_ID=2860&URL_DO=DO_TOPIC&URL_SECTION=201.html] * Assessment of sexual health needs of males who have sex with males in [[Laos]] and [[Thailand]]. Naz Foundation International [http://www.nfi.net] * Sexual Identity Among Men Who Have Sex with Men in [[Shanghai]]. Sun Zhongxin, James Farrer, Kyung-hee Choi. China Perspectives n°64, March - April 2006, page n°2 [http://www.cefc.com.hk/uk/pc/articles/art_ligne.php?num_art_ligne=6401] * Playing Back the Nation: Waria, Indonesian Transvestites [http://web.hku.hk/~sjwinter/TransgenderASIA/paper_waria_national_transvestites.pdf] * Gay Guise: What To Do When Your Client Has Sex with Men and is not Gay, 2007 July/August Psychotherapy Networker [http://www.psychotherapynetworker.org/index.php?category=magazine&sub_cat=articles&page=1&type=article&id=Gay%20Guise] ==External links== *[http://www.jlking.net J.L. King, Mr. "Down Low"], author of ''On the Down Low: A Journey into the Lives of "Straight" Black Men Who Sleep with Men'' *[http://www.aidsportal.org/overlay_details.aspx?nex=5 MSM and HIV] research and needs assessments from AIDSPortal *[http://www.cdc.gov/hiv/topics/msm/resources/factsheets/msm.htm CDC: HIV/AIDS among Men Who Have Sex with Men] [[Category:Sexual orientation and identity]] [[Category:Same-sex relationship]] [[Category:Sexual orientation and science]] [[Category:Sexual orientation and society]] [[Category:Public health]] [[br:MSM (revelezh)]] [[de:Männer, die Sex mit Männern haben]] [[no:Menn som har sex med menn]] [[sv:Män som har sex med män]] [[zh:男男性接触者]]