Category Archives: gay health

More than just M in MSM

transSo I had an enlightening experience the other day.  As a public health professional for years I had been thrown into the throngs of using the “MSM” categorization when discussing HIV risk and sexual behavior.  For those of you that are unaware this refers to “men who have sex with men”.   I am not sure where the MSM moniker arose from, however if you have information, please feel free to leave as a comment.

What I do know, is that a more appropriate risk category would be termed “people that have anal or oral sex with men”.  While it is biologically true that receptive anal sex is one of the most risky sexual encounters in terms of HIV transmission, it is not just “male” homosexuals that engage in this activity.  This came to light yesterday when I was interviewing a transgender patient about restarting female hormones.   She reported having sex with men only, however does not necessarily fit the classification of “MSM”.  She is a male to female transgender and although at the moment biologically male, she identifies as female, and I’m sure would me scathing if I called her a “man who has sex with men”.  The “scientific” term MSM  refers to sex (i.e. biology – i.e. something with a penis) and not gender.  Gender is complex, a social construct, including social norms,  how one identifies with these norms, etc.

Providers must be cautious when using such terminology to assess HIV and STI risk.  For example saying to a transgender male to female “many men who have sex with men are at higher risk for HIV and STIs.  Let’s do a HIV test and a rectal and throat gonorrhea and chlamydia culture”” is completely inappropriate and will turn her away from ever receiving care.  She does not identify as man, and although she has receptive anal sex, she cannot be labeled as a MSM.  Additionally, many biological women who also identify as a female gender, especially in developing countries are also in this high risk receptive anal sex category, even though they are not “MSM” .

There are several other articles that I found that talk about this in more detail:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470585/

http://www.med.unsw.edu.au/nchecrweb.nsf/resources/HeppReports/$file/The-term%27MSM%27demeans-us-all.pdf

So basically, I obviously never use this term with patients and am now cautious when throwing it around in scientific circles.  I just basically consider any person that takes a cock up their ass (more so with regular frequency and unprotected) at risk.

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Bareback.com?

So perhaps these websites for men interested in bareback sex have been around for a while, but I have been unaware of them.  Recently, a friend informed me of one such site, barebackrt.com, however several more exist.   At first I wasn’t quite sure what to think.   Upon digesting this concept some more, I came to an initial conclusion that perhaps these sites could serve as an online forum for serosorting i.e. a place where HIV+ men could find other HIV+ to have bareback sex with, and where HIV- men could presumably find other HIV- men for bareback anal sex.

Indeed, this is what bareback.com, the “original bareback only site” envisions:

“Now at BareBack.com you know that we are not AIDS Nazis, condom wrappers or fearful fools! What we are is a community of gay men who like the feel of raw nasty sex and want the whole world to be able to spray our holes!

That’s why we embrace a policy of containment. What does that mean – It’s simple. If poz boys stick to poz boys and neg boys stick to neg boys AIDS will be over. It’s just that simple.”

Or is it?  So although the same site site intro states that “The only drugs you should use should come from your doctor! Nothing makes you more likely to fuck up, get sick or be an asshole than poppers, meth or other party drugs.” So, I can say that I have heard negative men, who know they are negative, fucked up by drugs, tell me that they have used this site to search for men, and HIV status was irrelevant – the bottom line was the negative men just wanted bareback sex and such sites were the easiest place to find it.   Then of course there are the men who don’t really know if they are negative since they haven’t been tested (the site encourages people to know their status), but just like to assume that they are negative even though they have had unprotected sex with everyone under the sun, because it is easier for them to personally accept.  Such “negative” men will go onto to have sex with men who truly are negative who utilize the site.  Also, positive men may not always sero sort, and may have sex with negative men who agree to take the risk of having bareback sex with a positive man, simply because they like bareback sex.

While I am not judging anyone’s sexual preferences (I can not with a clear conscience say that plastic up one’s ass is sensual or comfortable), I guess the thing that irks me about such sites as a physician and public health practitioner, is that there are no sites (at least that I know of) promoting dirty needle use  for IV drugs or unsafe blood transfusions.  While I acknowledge men who want to have bareback sex will, and will find any avenue to do so, why must we create an avenue to directly promote this behavior? Why can we not have a “safe only” site? Upon googling I have found nothing.  While mainstream sites such as Grindr and Manhunt allow users to state their safe/bareback preference, are there sites dedicated exclusively to safe sex?

As bareback.com notes, users need to be made aware that not only can HIV be contracted by bareback sex, but other STDs such as gonorrhea and herpes can also be shared between bareback partners.   I just still can’t see the value of such sites from a HIV eradication/prevention standpoint.  Perhaps someone can comment to offer me some insight?  I know the mainstream porn movement has sought to not glamorize bareback pornography, and this is a battle that is still being fought as one can find bareback porn as easily as they can a hookup on Grindr.  In my ideal corner of the earth, I would hope that everyone using such sites was already aware of their HIV status, understood the risks that bareback sex poses, and made an educated choice which would put both them and their partner at the least risk possible.

Yes, Virginia, there is a gay health clinic in Indonesia!

Bali Medika Clinic, Bali, Indonesia

So just when I didn’t think my day could get any better I stumbled across some news that Indonesia has opened its first clinic for LGBT patients this past October.  As a medical student, it has been my pipe dream to open similar gay health clinics all over the world, especially in areas where homosexuality is denounced, and there is the most need.  Knowing that this has been done in Indonesia, gives me extreme optimism, hope and happiness. One of the main reasons I am studying medicine is so I can be equipped to meet the special needs of GLBT individuals, wherever the need arises.

The clinic is called  is called the Bali Medika Clinic, and is located in the city of Denpasar, and is the first of its kind in the country.  Since opening in October, the clinic has treated more than 100 patients.  The HIV rates in Indonesia are definitely on the increase, and in a predominately Muslim country where strict traditional values shun homosexuality and related sex acts, many men remain closeted and have unprotected MSM sex in the dark.   The mission of the clinic is to provide a safe place for gays, seen as sexual and social deviants by some members of society, to come for sexual health care and HIV and other sexually transmitted infection screenings.  The clinic offers counseling on safe sex practices and HIV prevention, and provides condoms and antiretroviral drugs for HIV patients.

I did find a website for a Bali Medika Clinic, but I am not convinced that it is the same one.  If anyone has any information about this clinic, I would love to receive it, as I would love to do some sort of medical work with them.

So for all all GLBT who feel stigmatized when seeking healthcare, and feel that huge barriers still exist in receiving equitable high quality care, hope does exist.

Here is the link to the AP article I found about the clinic.