[image: Bay Area Reporter] http://ebar.com/news/article.php?sec=news&article=69532
03/06/2014 Advocates take issue with 'MSM' by Chuck Colbert As more and more baby boomers age, some gay men are feeling a whole lot more than the physical challenges of growing older, especially in a youth-obsessed culture, perhaps more pronounced among LGBTs than overall society at large. For HIV-positive gay men now entering their 50s, some of whom have lived with HIV for decades, being alive is an achievement. And yet stigma around HIV-positive status, let alone gayness, persists, along with the general overall invisibility of long-term survivors of the epidemic, some of whom often experience trauma, depression, and isolation, even survivors' guilt. Just as the numbers of gay seniors are increasing, some of these gray-haired gays are organizing to press local AIDS service organizations and health care providers for better mental health and medical services to meet a host of health care needs of older people living with HIV. And along with organizing comes some push back against a widely used term by epidemiologists and researchers: MSM, or men who have sex with men. At issue is nothing less than preserving gay male (and bisexual) identity in the midst of MSM's widespread use. MSM was coined in 1994 and "moved beyond HIV literature to become established in both research and health programming," according to Rebecca Young, Ph.D., and Ilan H. Meyer, Ph.D., in a July 2005 article from the American Journal of Public Health, in which the authors suggest the term MSW, as well as WSW (women who have sex with women), erases sexual-minority persons from public health discourse. "MSM and WSW often imply a lack of lesbian or gay identity and an absence of community, networks and relationships, in which the same-gender pairings mean more than merely sexual behavior," the authors write, explaining, overuse of those terms "adds to a history of scientific labeling of sexual minorities that reflects, and inadvertently advances heterosexist notions." While not suggesting an outright jettisoning of the MSM or WSW terminology, Young and Meyer advocate "public health professionals should adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups." Voicing agreement, local and national HIV/AIDS activists, organizational leadership, and medical researchers flesh out in further detail the problematic nature of MSM terminology and usage. "Nobody says, 'Hi, I am an MSM,'" said Tez Anderson in a recent telephone interview. Anderson is a founder of the San Francisco grassroots group http://www.LetsKickASS.org <http://www.letskickass.org/>. (The acronym ASS stands for AIDS Survivor Syndrome.) Anderson readily acknowledges MSM came into acceptance with the changing face of the epidemic, particularly the rise of HIV infection among African Americans and Latinos, many on the down low and reluctant to identify as gay although enjoying sex with other men. Nonetheless, he said, "As a gay man, I kind of resent it because let's face it: AIDS has been, is, and probably will be a largely gay men's epidemic." Anderson went on to say, "What's wrong with [MSM] is that it separates a single sexual act from an identity." Longtime gay-rights and AIDS activist Jeff Sheehy also finds the term MSM somewhat problematic. However, he said during a recent telephone interview, "I think it made a lot of sense from a surveillance point of view in counting" HIV infections, adding, "It did capture a lot behavior" and is "a way to capture a much broader risk population, a way to define risk," that is "almost clinical." While MSM "made developing programming and programming more accessible," he said, "It is also disempowering to gay men." But MSM nomenclature is okay for blogger, educator, and HIV/AIDS activist Mark King. "It always sounded clinical to me, as an out gay man, but nothing that particularly offends me," he said. "I see it as casting a wider net to capture those who don't consider themselves gay, and that's cool." Dr. Kenneth Mayer, medical research director and co-chair of the Fenway Institute at Boston's Fenway Health, discussed MSM's usefulness within the nuanced and complicated landscape of human behavior. "Context is key. Sexuality involves a complex array of issues, including attraction, identity, and behavior, and they do not always vary together, and their alignment will differ among different individuals and between different cultures. Specific words are appropriate in different settings," he said in an email. "For example," Mayer continued, "when talking about identity, I think the majority of gay men and transgender women in the U.S. would probably not think 'MSM' was an appropriate term, but when the CDC [Centers for Disease Control and Prevention] or WHO [World Health Organization] is trying to explain how HIV is being transmitted in different parts of the world, then 'MSM' is highly appropriate." Rafael Mazin, a senior adviser for HIV, sexually transmitted infections, and hepatitis at the Pan American Health Organization, which is the WHO office for the Americas, said that the agency uses the term "MSM as a construct that explains behavior rather than identity or belonging to a certain group or cultures." He said the term is useful because it allows policy makers and people responsible for intervention development of provider services that target certain populations who don't identify as gay or bisexual men. The agency also acknowledges gay and bi men, for example using "gay men" in its reports, while at the same time "MSM" catches certain behavior and in some cases men who don't want to acknowledge a gay or bi identity. Scott Bryan, director of news media for the CDC, said in an email that the agency uses the term "MSM" in CDC surveillance systems and when referring to specific HIV risk behaviors. He added that the following notation is used in many of the agency's communications materials: "The term men who have sex with men is used in CDC surveillance systems. It indicates the behaviors that transmit HIV infection, rather than how individuals self-identify in terms of the sexuality." *Trans exclusion* In offering an assessment, Lance Toma, executive director of San Francisco's Asian and Pacific Islander Wellness Center, voiced concerns about transgender exclusion and divisions caused within the LGBT community over MSM's continued usage. "The term 'MSM' emerged during a time when we were trying to identify and target high-risk behaviors in our approach to HIV prevention," he said in an email. "As our efforts have evolved over time, we now approach this work from both a behavioral lens and an identity lens, meaning that the identity of gay and bisexual men matters when it comes to addressing their needs and concerns related to HIV prevention. MSM must only reflect those men who do not identify as gay or bisexual, but who do have sex with other men. MSM should no longer be used as a catchall term that encompasses identity and behavior." Toma continued, "The long-standing injustice of the term MSM at a national level is that it also encompassed the behavioral category of transgender women who were having sex with men. It is imperative that we move beyond this. Our country lagged in its response to the HIV epidemic in the transgender community because of this behavioral targeting in isolation of sexual orientation and gender identity. This was exacerbated by the fact that data was being collected in this way, completely obscuring the HIV epidemic in the transgender community. The current unacceptably high rates of HIV prevalence in the transgender community is a horrible ramification, and it is our responsibility as a community to make this right and go above and beyond for the health of our transgender community." Toma also said the term creates division between the HIV and LGBT communities. "'MSM' does not fit in the LGBT community-organizing framework, and it shouldn't have to. This is where language matters. If we are truly committed to an AIDS-free generation, we must have both the HIV community and the LGBT community working together," he said. Based in Lansing, Michigan, freelance journalist and HIV/AIDS educator Todd Heywood went even further, calling out MSM as "inherently transphobic," adding he struggles with MSM terminology for a couple of reasons. "The term was adopted by CDC, WHO and other health officials in an attempt to identify behavior and not identities," Heywood said in an email. "This was done in large part to minimize the stigma of being male and HIV-positive - the implication, of course, was that you were gay. In real terms, there are real people, often young people, struggling for economic survival, who engage in male/male sexual activity as survival sex strategies. They do not identify as gay, and in fact many of them are not gay. They are gay for pay, as the old porno adage goes. So messaging to men at risk because of male/male sexual activity was hampered by this barrier of identity. So on that point, it makes absolute sense." But he added that the number of people who fall into that "gay for pay" category is small. "On the other hand, I believe this risk group is extremely small. So we are catering to a small group of people who are at risk, and in the process dismissing identities," Heywood said. "As a self-identified queer man, I find this troubling. It allows, and has allowed, the LGBT national community to completely avoid the continuing impact of this epidemic on gay and bisexual men in particular, and homosexually active men in general. You certainly don't see the National Gay and Lesbian Task Force or Human Rights Campaign announcing they represent the MSM community, and the thought of that would appall most American LGBT community members, because it strips us of our community, our social identities and reduces us to sex - something we have always been defined by, and often oppressed for. So being defined solely by what we do, or do not do, in our bedrooms, becomes deeply offensive. It ignores this rich diverse community of ours." Yet another concern said Heywood, "Is this construct implies that somehow all MSM activity is inherently the same risk level, and that all MSM engage in the same sexual activity. It also implies that somehow heterosexuals do not practice the riskiest sexual activity, anal sex, which we know is simply untrue. This in turn serves to create us as 'other' in the minds of modern America, when in fact, we do many of the same things sexually." Heywood advocates finding "a balance between the behavioral risk and identity - both for more accurate epidemiology and for more effective prevention messaging." "I would caution, however, so many younger folks reject labels, and are happy just being who they are, with whomever they choose." For her part, Julie JD Davids, director of the Chicago-based HIV Prevention Justice Alliance, said in an email that her organization "considers MSM to be an epidemiological term, which even at that is often used incorrectly or incompletely, for example, to include men who have sex with men and women, or is used too broadly as with transgender women." She added, "Gay and bisexual men is generally preferred as descriptive and culturally-relevant language." Still, said Davids, "I sometimes write, cumbersomely, 'gay and bisexual men, and other men who have sex with men' if I want to be as all-encompassing as possible."
