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Sexual Identity Labels...

Sexual Identity Labels May Be Dangerous

In America, we tend to categorize others and ourselves as a way of identification—she’s a Texan, he’s a liberal, they are golfers. In terms of sexual identity, we’ve done the same, with people generally falling into homosexual, heterosexual, or bisexual groupings. But simple categorization often belies behavior. What if the self-identified golfer hasn’t played in ten years? What if the guy who everyone calls a liberal voted for a conservative in the last election? And what if the man who is in a heterosexual marriage sometimes has sex with men?

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This might confuse the casual observer (and probably the guy’s wife) and might lead one to conclude the married man is a homosexual or bisexual that has “wrongly” self-identified. Or, the presence of such a person might help blow the lid off of our somewhat arbitrary sexual labels, and thus spur us to come up with new ones. Like MSM.

Save for certain public health and cultural circles, most people haven’t heard of the term MSM which stands for Men Who Have Sex with Men. This phrase may seem like a long-winded way of saying homosexual, but it’s not. While many use it to encompass homosexual and bisexual men, HIV researchers created the term when they realized there was a group of men that were having sex with men but not checking off the traditional survey box. These men self-identified, and lived, as heterosexual men.

By grouping all men who have sex with men together, researchers were able to identify those men potentially engaging in high-risk behavior for HIV without having to address the apparent dissonance that occurred between a person’s self-identity and his behavior.

Furthermore, it broadened the target audience for prevention messages, while acknowledging the need to tailor those messages. A 2006 study conducted in New York City found that 10 percent of “straight” men have sex with other men; these straight-identified men who have sex with men were less likely than gay men to report using a condom during their last sexual encounter. And according to the Centers for Disease Control and Prevention, due to cultural stigma, many minority men do not self-identify as gay or bisexual and therefore, disease prevention messages and resources aimed at the gay community do not reach them. This indicates perception of sexual identity may play a role in perception and actuation of risk.

MSMs who identify as heterosexual are not unique to any part of the world. In the U.S., they are sometimes referred to as being on the “down-low.” In Indonesia, self-identified heterosexual men may have sex with a waria, or transgender. Though sodomy is illegal in India, a man having sex with a hijrat, or enuch, is not. In the Philippines, a lalake is someone who identifies as heterosexual but has sex with men for pleasure, often because it is difficult to find a female partner.

The reasons why a man may identify as heterosexual while having sex with other men are as numerous as the places where they occur: cultural stigma of homosexuality, the criminalization of homosexuality, obligation or contractual sex, transactional sex, situational sexual encounters, livelihood, institutions (prisons), and so on. A recent article in the Times of India profiles a truck driver, who, because of the lack of female companionship during his long drives, had sex with his truck cleaner. The driver was married with two kids and neither considered himself homosexual nor did he know that having unprotected sex put him at risk for HIV.

The denial in many cultures that MSMs exist results in the pressure for men to have female partners, thus putting women at risk. During heterosexual sex, women are at greater risk of contracting HIV from men than men are from women. And in many cultures, women do not have the social capital to demand their partners use protection.

To be sure, men having sex with men is not the problem—unprotected sex with an HIV+ person combined with multiple partners is. Women partake in this set of risk factors just as men do. But the stigma associated with same sex relationships, coupled with lack of prevention resources, puts certain groups at higher risk than others. According to UNAIDS, sex between men accounts for roughly 5 to 10 percent of global HIV infections; however, in some countries, it is the main mode of transmission, while in others, it accounts for a small proportion.

But even though the idea of MSM may serve a useful research purpose, aggregating all these men based on one behavior may have its downfalls. MSMs are not a homogenous group and thus do not have the same set of risk factors. Men with female partners have very different characteristics than self-identifying gay men. Gary Dowsett, a researcher at Latrobe University, speaking at the 2006 International AIDS Conference, criticized the MSM label and our culturally constructed ideas of sexual identity. Dowsett contends that the clustering of MSM tends to aggregate diverse same-sex desires, and by doing this we lose the richness in cultural patents that can teach us a lot about prevention.

Globally, it is estimated that less than one in twenty MSMs have access to the HIV prevention they need. Regardless of how people are categorized for research or identification purposes, one thing is clear: to prevent new HIV infections, culturally appropriate prevention resources must be made available. Only when the stigma, discrimination, criminalization, and denial of same-sex relationships ends can this truly happen.

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