More than just M in MSM

So 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/

Click to access 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.