Why epidemiologists created the term MSM to track health risks beyond social identity
In the 1990s, public health experts coined the term men who have sex with men (MSM) to bypass the limitations of identity labels like gay or bisexual. By focusing on behavior rather than self-identification, researchers gained a more accurate lens for tracking the spread of HIV and other infections.
The MSM category was formalized by Glick et al. in 1994, crystallizing a concept that separates sexual activity from cultural identity. Epidemiologists recognized that relying on labels like gay or straight was analytically flawed, as a man who identifies as straight might still engage in sexual activity with other men, while a man who identifies as gay may not. This behavioral focus allows for more precise data collection regarding disease transmission, as the risk is tied to specific sexual practices rather than how an individual defines their social or romantic life.
The utility of the term is particularly evident in the context of HIV/AIDS, where MSM are disproportionately affected. In the United States, although MSM represent only 2% of the population, they accounted for 53% of overall HIV diagnoses in 2007. This disparity is influenced by a complex interplay of factors, including the biological risks associated with anal sex, where condoms are more prone to breakage than in vaginal intercourse. Furthermore, experts point to phenomena like AIDS and condom fatigue, particularly among younger generations who lack the lived experience of the epidemic's peak in the 1980s and 1990s.
Beyond HIV, the MSM classification is critical for monitoring other health outcomes, including syphilis, hepatitis, and mpox. Research indicates that MSM are at higher risk for certain infections, leading organizations like the CDC to recommend specific vaccinations. However, the category remains broad and non-homogenous; it does not describe a single social identity or uniform set of behaviors. Because the term is used to track health risks, it often intersects with sensitive policy areas, such as the ongoing global debate regarding blood and tissue donation restrictions for men who have sex with men.
Source: Men who have sex with men
