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Men who have sex with men (MSM) is a term used to classify men who have sex with men, regardless of whether they self-identify as gay or bisexual. The term is intended to reference a particular category of people as a risk-group for HIV, and is considered a behavioural category. As this label can only be reliably applied where the sex of individuals is unambiguous, this term should be avoided for transsexuals, transgendered individuals and intersexuals, except in cases where it is clear that they engage in risk behaviors similar, or equivalent to the risk behaviors of unambiguous men having sex with unambiguous men. Since risk factors can and do vary between cultures, the application of this group should also be avoided in cases where this specific risk behavior is no longer a significant category for the contraction of HIV or other STDs.

MSM groups include:

• men who self-identify as homosexual, and are sexually active
• men who self-identify as bisexual, and are sexually active with men
• men who self-identify as heterosexual, but nonetheless have sex with other men, regardless of the percentage of their partners who are male
• transgendered, or transsexual individuals, who engage in behavior similar or equivalent to sex between men
• men who have sex with men, and whose cultural paradigm may not lead to defining oneself as heterosexual or homosexual as most modern/Western cultures tend to, so long as the risk-factors for this category continue to be significant

Young and Meyer (2005) note that the term has been in use within the public health discourse since 1990 or earlier, but that the coining of the acronym by Glick et. al. (1994) "signaled the crystallization of a new concept." 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", since 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.

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 social identities. ‘MSM’ refers to the sexual relationships between men, whether or not they identify with same-sex sexual desire. ‘Homosexuality’, however, 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.^[1]

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

• Sexually active gay males
• Men on the down-low, especially among African Americans
• Glory holers
• Sex workers (commercial or not)
• FTM transsexuals, who engage in sex with men
• Males who engage in sex with transgendered individuals, or transsexuals with behaviors similar or equivalent to other MSM
• Transgendered individuals, or transsexuals who engage in sex with men with behaviors similar or equivalent to other MSM

• Any woman, including post-operative MTF transsexuals, regardless of any other factors
• Men, including FTM transsexuals, who engage in sex exclusively with women, regardless of any other factors
• 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 transgendered 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 is raped by another man
• 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: transgendered individual)

1. ^ A review of knowledge about the sexual networks and behaviours of men who have sex with men in Asia. Dowsett, Grierson and McNally.[1]>

• UNESCO Guidelines on Language and Content in HIV and AIDS-Related Materials. [2]

• Assessment of sexual health needs of males who have sex with males in Laos and Thailand. Naz Foundation International [3]

• 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 [4]

• Playing Back the Nation: Waria, Indonesian Transvestites [5]

• 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

• 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

• Gay-for-pay
• Terminology of homosexuality
• Women who have sex with women ("WSW")

• 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