Men who have sex with men

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Men who have sex with men (MSM), also known as males who have sex with males, are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves. [1] They may identify as gay, homosexual, bisexual, pansexual, or heterosexual; or dispense with sexual identification altogether.


The term MSM was created in the 1990s by epidemiologists to study the spread of disease among men who have sex with men, regardless of identity. [1] The term MSM is often used in medical literature and social research to describe such men as a group for research studies without considering issues of self-identification. It does not describe any specific sexual activity, and which activities are covered by the term depends on context.

As a constructed behavioral category

The term MSM had been in use in public health discussions, especially in the context of HIV/AIDS, since 1990 or earlier, but the coining of the initialism by Glick et al. in 1994 "signaled the crystallization of a new concept." [2] [3] This behavioral concept comes from two distinct academic perspectives. First, it was pursued by epidemiologists seeking behavioral categories that would offer better analytical concepts for the study of disease-risk than identity-based categories (such as "gay", "bisexual", or "straight"), because a man who self-identifies as gay or bisexual is not necessarily sexually active with men, and someone who identifies as straight might be sexually active with men. Second, its usage is tied to criticism of sexual identity terms prevalent in social construction literature which typically rejected the use of identity-based concepts across cultural and historical contexts. The Huffington Post postulates that the term MSM was created by Cleo Manago, the man who is also credited for coining the term same gender loving (SGL). [4]

MSM are not limited to small, self-identified, and visible sub-populations. MSM and gay refer to different things: behaviors and social identities. MSM refers to sexual activities between men, regardless of how they identify, whereas gay can include those activities but is more broadly seen as a cultural identity. Homosexuality refers to sexual/romantic attraction between members of the same sex and may or may not include romantic relationships. Gay is a social identity and is generally the preferred social term, whereas homosexual is used in formal contexts, though the terms are not entirely interchangeable. Men who are non-heterosexual or questioning may identify with all, none, a combination of these, or one of the newer terms indicating a similar sexual, romantic, and cultural identity like bi-curious .

In their assessment of the knowledge about the sexual networks and behaviors of MSM in Asia, Dowsett, Grierson and McNally concluded that the category of MSM does not correspond to a single social identity in any of the countries they studied. [5] There were no similar traits in all of the MSM population studied, other than them being males and engaging in sex with other men.

In some countries, homosexual relationships may be illegal or taboo, making MSM difficult to reach. [6] [7]

As applied to transgender individuals

The term's precise use and definition has varied with regard to trans women, people born either biologically male or with ambiguous genitalia who self-identify as female. [8] Some sources consider trans women who have sex with men to be MSM, [9] others consider trans women "alongside" MSM, [1] and others are internally inconsistent (defining transgender women to be MSM in one place but referring to "MSM and transgender" in another). [10]


Determining the number of men who have ever had sex with another man is difficult. Worldwide, at least 3% of men, and perhaps as high as 16% of men, have had sex at least once with a man. [11]

In the U.S., among men aged 15 to 44, an estimated 6% have engaged in oral or anal sex with another man at some point in their lives, and about 2.9% have had at least one male sexual partner in the previous 12 months. [12]

Sexual practices

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Men kissing intimately

Historically, anal sex has been popularly associated with male homosexuality and MSM. However, many MSM do not engage in anal sex, and may engage in oral sex, frotting or mutual masturbation instead. [13] [14] [15] Among men who have anal sex with other men, the insertive partner may be referred to as the top , the one being penetrated may be referred to as the bottom , and those who enjoy either role may be referred to as versatile . [16]

Number of sexual partners

A 2007 study reported that two large population surveys found "the majority of gay men had similar numbers of unprotected sexual partners annually as straight men and women." [17] [18] According to the 2013 NATSAL (a representative population study in the UK) MSM typically had 17 lifetime sexual partners (median), which included all forms of sexual contact including oral and anal sex. [19] An epidemiological article in The BMJ reported that national probability surveys like the NATSAL have been found to better reflect the population of MSM but are limited by their smaller samples of MSM. Convenience sample surveys recruit larger samples of MSM but tend to over-represent MSM identifying as gay and reporting more sexual risk behaviors. [20]

Health issues

Sexually transmitted infections

Among men who have anal sex with other men, anal sex without use of a condom is considered to be high-risk for STI transmission. A person who inserts their penis into an infected partner is at risk because sexually transmitted diseases (STDS/STIs) can enter through the urethra or through small cuts, abrasions, or open sores on the penis. Also, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. [21] [22]


Acquired immune deficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). [23] [24] [25] HIV can infect anybody, regardless of sex, ethnicity, or sexual orientation. [26] Worldwide, an estimated 5–10% of HIV infections are the result of men having sex with men. [27] However, in many developed countries, more HIV infections are transmitted by men having sex with men than by any other transmission route. [26] In the United States, "men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population". [28]

In 2007, the largest estimated proportion of HIV/AIDS diagnoses among adults and adolescents in the U.S. were men who have sex with men (MSM). While this category is only 2% of the U.S. population [29] they accounted for 53% of the overall diagnoses and 71% among men. According to a 2010 federal study, one in five men who have sex with men are HIV positive and nearly half don't realize it. [30]

According to a CDC study, HIV prevalence in the MSM population of the U.S. varies widely by ethnicity. "As many as 46% of black MSM have HIV" while "the HIV rate is estimated at 21% for white MSM and 17% for Hispanic MSM." [31] [32] [33] In the United States from 2001 to 2005, the highest transmission risk behaviors were sex between men (40–49% of new cases) and high risk heterosexual sex (32–35% of new cases). [34] HIV infection is increasing at a rate of 12% annually among 13–24-year-old American men who have sex with men. [35] [36] [37] Experts attribute this to "AIDS fatigue" among younger people who have no memory of the worst phase of the epidemic in the 1980s and early 1990s, as well as "condom fatigue" among those who have grown tired of and disillusioned with the unrelenting safer sex message. The increase may also be because of new treatments. [35] In developing countries, HIV infection rates have been characterized as skyrocketing among MSM. [38] Studies have found that less than 5% of MSM in Africa, Asia, and Latin America have access to HIV-related health care. [38]

HIV prevention with PrEP

Pre-exposure prophylaxis (PrEP) is the use of medication to prevent HIV transmission in people who have not yet been exposed to the virus. When used as directed, PrEP has been shown to be highly effective, reducing the risk of contracting HIV up to 99%. [39] As of 2018, numerous countries have approved the use of PrEP for HIV/AIDS prevention, including the United States, South Korea, [40] France, Norway, [41] Australia, [42] Israel, [43] Canada, [43] Kenya, South Africa, Peru, Thailand, the European Union [44] [45] and Taiwan. [46] New Zealand was one of the first countries in the world to publicly fund PrEP for the prevention of HIV in March 2018. [47]

Other sexually transmitted infections

Men who have sex with men are at a higher risk of acquiring Hepatitis B and Hepatitis A through unprotected sexual contact. The U.S. CDC and ACIP recommend hepatitis A and hepatitis B vaccination for men who have sex with men. [48] About a third of the world's population, more than 2 billion people, have been infected with hepatitis B virus (HBV). [49] Hepatitis B is a disease caused by HBV which infects the liver and causes an inflammation called hepatitis.

Syphilis (caused by infection with Treponema pallidum ) is passed from person to person through direct contact with a syphilis sore; these occur mainly on the external genitals, or in the vagina, anus, or rectum. [50] Sores also can occur on the lips and in the mouth. [50] Transmission of the organism occurs during vaginal, anal, or oral sex. [50] In 2006, 64% of the reported cases in the United States were among men who have sex with men. [50] This is consistent with a rise in the incidence of syphilis among MSM in other developed nations, attributed by Australian and UK authors to increased rates of unprotected sex among MSM. [51] [52]

Genital human papillomavirus (HPV) is a common virus that most sexually active people in the U.S. will have at some time in their lives. [53] It is passed on through genital contact and is also found on areas that condoms do not cover. [53] Most men who get HPV of any type never develop any symptoms or health problems. [53] Some types of HPV can cause genital warts, penile cancer, or anal cancer. [53] MSM and men with compromised immune systems are more likely than other men to develop anal cancer. [53] The incidence of anal cancer among HIV‐positive MSM is 9 times higher than among HIV‐negative MSM, even in antiretroviral therapy. HIV-negative MSM has a higher incidence than the general population. [54] Men with HIV are also more likely to get severe cases of genital warts that are hard to treat. [53] [55] [56]

Though not commonly classified as an STI, giardiasis can be transmitted between gay men, [57] and it can be responsible for severe weight loss and death for individuals who have compromised immune systems, especially HIV. [58]

Mental health

According to the U.S. Centers for Disease Control, the majority of gay and bisexual men have and maintain good mental health, though research has shown that they are at greater risk for mental health problems. Stigma and homophobia can have negative consequences on health. Compared to other men, gay and bisexual men have a higher chance of having depression and anxiety disorders. [59]

MSM blood and tissue donor controversy

Many countries impose restrictions on donating blood for men who have or have had sex with men, as well as their female sexual partners—see the maps. Similar restrictions in many countries also prohibit donation of tissues such as corneas by men who have sex with men, often with far longer deferral periods than for MSM blood donors. [60] Most national standards require direct questioning regarding a donor's sexual history, but the length of deferral varies.

Blood donation policies for men who have sex with men
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Men who have sex with men may donate blood; No deferral
Men who have sex with men may donate blood; No deferral, except for blood transfusions
Men who have sex with men may donate blood; Temporary deferral
Men who have sex with men may not donate blood; Permanent deferral
No Data MSM Blood Donation Map New.svg
Blood donation policies for men who have sex with men
  Men who have sex with men may donate blood; No deferral
  Men who have sex with men may donate blood; No deferral, except for blood transfusions
  Men who have sex with men may donate blood; Temporary deferral
  Men who have sex with men may not donate blood; Permanent deferral
  No Data
Blood donation policies for female sex partners of men who have sex with men
Female sex partners of men who have sex with men may donate blood; No deferral
Female sex partners of men who have sex with men may donate blood; Temporary deferral
Female sex partners of men who have sex with men may not donate blood; Permanent deferral
No Data Female partners of men who have sex with men blood ban by country.svg
Blood donation policies for female sex partners of men who have sex with men
  Female sex partners of men who have sex with men may donate blood; No deferral
  Female sex partners of men who have sex with men may donate blood; Temporary deferral
  Female sex partners of men who have sex with men may not donate blood; Permanent deferral
  No Data

See also

Related Research Articles

Safe sex Ways to reduce the risk of acquiring STDs

Safe sex is sexual activity using methods or devices to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not completely eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.

HIV/AIDS in the United States

The AIDS epidemic, caused by HIV, found its way to the United States as early as 1960, but was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in gay men in Los Angeles, New York City, and San Francisco in 1981. Treatment of HIV/AIDS is primarily via a "drug cocktail" of antiretroviral drugs, and education programs to help people avoid infection.

Down-low is an African American slang term that typically refers to a subculture of black men who usually identify as heterosexual, but who have sex with men; some avoid sharing this information even if they have female sexual partner(s), they are married, or they are single. The term is also used to refer to a related sexual identity. Down-low has been viewed as "a type of impression management that some of the informants use to present themselves in a manner that is consistent with perceived norms about masculine attribute, attitudes, and behavior".

Frot Penis-to-penis sexual contact

Frot is a non-penetrative form of male-to-male sexual activity that usually involves direct penis-to-penis contact. The term was popularized by gay male activists who disparaged the practice of anal sex, but has since evolved to encompass a variety of preferences for the act, which may or may not imply particular attitudes towards other sexual activities. Owing to its non-penetrative character, frot has the safe sex advantage of minimizing the transmission risk for HIV/AIDS; however, it still carries the risk of skin-to-skin sexually transmitted infections, such as HPV and pubic lice (crabs), both of which can be transmitted even when lesions are not visible.

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

The relationship between circumcision and HIV has been researched since the late 1980s. Voluntary male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV+ women to men.

Bareback sex is physical sexual activity, especially sexual penetration, without the use of a condom. The topic primarily concerns anal sex between men who have sex with men without the use of a condom, and may be distinguished from unprotected sex because bareback sex denotes the deliberate act of forgoing condom use.

Emtricitabine/tenofovir Drug combination for HIV/AIDS prophylaxis and treatment

Emtricitabine/tenofovir, sold under the brand name Truvada among others, is a fixed-dose combination antiretroviral medication used to treat and prevent HIV/AIDS. It contains the antiretroviral medications emtricitabine and tenofovir disoproxil. For treatment, it is used either alone or together with other antiretroviral medications. For prevention before exposure, in those who are at high risk, it is recommended with safe sex practices. It does not cure HIV/AIDS. Emtricitabine/tenofovir is taken by mouth.

Serosorting, also known as serodiscrimination is the practice of using HIV status as a decision-making point in choosing sexual behavior. Frequently the term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus in order to engage in unprotected sex with them for a reduced risk of acquiring or transmitting HIV/AIDS.

Pre-exposure prophylaxis HIV prevention strategy using preventative medication for HIV-negative individuals

Pre-exposure prophylaxis (PrEP) is a term used to describe the use of medications used to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent, usually a virus. The term typically refers to the specific use of antiviral drugs as a strategy for HIV/AIDS prevention.

Women who have sex with women (WSW) are women who engage in sexual activities with other women, whether or not they identify themselves as lesbian, bisexual, heterosexual, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.

Sexually transmitted infection Infection transmitted through human sexual behavior

Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs), are infections that are commonly spread by sexual activity, especially vaginal intercourse, anal sex and oral sex. STIs often do not initially cause symptoms, which results in a greater risk of passing the disease on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. STIs can be transmitted to an infant before or during childbirth, which may result in poor outcomes for the infant. Some STIs can cause infertility.

Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year– in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.

HIV prevention refers to practices that aim to prevent the spread of the Human Immunodeficiency Virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

A rectal microbicide is a microbicide for rectal use. Most commonly such a product would be a topical gel inserted into the anus so that it make act as protection against the contract of a sexually transmitted infection during anal sex.

Since reports of the human immunodeficiency virus (HIV) began to emerge in the United States in the 1980s, the HIV epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981 and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi’s Sarcoma, and eight had died less than 24 months after the diagnosis was made. By 1982, the condition was referred to in the medical community as Gay-related immune deficiency (GRID), "gay cancer," and "gay compromise syndrome." It was not until July 1982 that the term Acquired Immune Deficiency Syndrome (AIDS) was suggested to replace GRID, and even then it was not until September that the CDC first used the AIDS acronym in an official report.

Gay sexual practices Sexual practices between men

Gay sexual practices are sexual activities involving men who have sex with men (MSM), regardless of their sexual orientation or sexual identity. Evidence shows that sex between men is significantly underreported in surveys due to social desirability bias.

Transgender sex worker

A transgender sex worker is a transgender person who works in the sex industry or performs sexual services in exchange for money or other forms of payment. The term transgender refers to an individual whose gender identity differs from their sex assigned at birth. A transgender woman is a woman who was assigned male at birth and a transgender man is a man who was assigned female at birth.

Under the new laws, the sesh requires 1 substantial meal to every 16 jagerbombs, SESH is a partnership between Southern Medical University Dermatology Hospital and the University of North Carolina Project-China that uses crowdsourcing to improve health. In China, the team lead the “Sex + Health” image crowdsourcing contest, a condom contest, crowdsourcing for patterns for HIV testing and referrals, and the "HepTestContest,” a global hepatitis testing contest. Together with the World Health Organization, SESH helped develop the HepTestContest. The purpose was to identify and evaluate Hepatitis B/C testing projects throughout the world. They also organized the "Healthy Cities Contest" and helped to advise on "2BeatHIV."

In January 2018, the provincial government of British Columbia (BC) began providing individuals at high risk of HIV infection with pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) at no cost. High risk individuals include men and trans women who have sex with men, people who inject drugs, and people who have sex with people living with HIV. One year following this policy change, which is delivered as part of the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE)'s Drug Treatment Program, almost 3,300 people have been prescribed with PrEP or PEP.


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Further reading