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Martin Foreman

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Men, males and MSM

Since this column first appeared, it has been published on the Asia-Pacific Rainbow listserv. Responses to the column are reprinted below.

December 2003: For many years it has been recognised that HIV/AIDS programmes directed at "gay" men are likely to reach only a small proportion of their intended audience, particularly in the developing world. For many men who have sex with men, "gay" is a foreign concept; it is American, middle-class, effeminate, transvestite, transgender or a word they seldom hear. They have their own words, such as panthi in India, cachero in Costa Rica and the gathoey in Thailand, which reflect local interpretations of sexual identity and sexual behaviour.

Furthermore, not every man who has sex with men does so because they want to. The man raped in prison and his violator might be exclusively heterosexual in the world outside, while the young man who has sex for money may go home to his wife and children. Few, if any, of these individuals would understand that safer sex messages for gay men were also intended for them. In other words, while the sexual acts were the same* across the world, HIV prevention was bound to fail if it did not address men in the terms they themselves used.

And so the term "men who have sex with men" emerged to describe all those involved in sex between men, whatever their circumstances, preferences or self-identification. Most importantly, it was a behavioural term, which describes what someone does, not an identity, which is how they identify themselves or how others identify them.

So far, so good. In a number of countries programmes were established which based prevention messages on local definitions of identity and sexuality and which saw significant changes in awareness and behaviour in men who have sex with men. However, a number of issues have begun to muddy the waters forcing us to reexamine this useful and comprehensive term.

The first of these is the fact that many of the men who have sex with other men are not men. Physically mature fourteen-, fifteen-, sixteen-year old boys and older have sex with other boys the same age and / or with older men, sometimes voluntarily, sometimes under coercion.  (So do boys who have not yet reached the age of puberty, but that is the different issue of child abuse.) To ensure that prevention programmes reach these younger men, a number of groups, most notably in South Asia, have dropped the phrase men who have sex with men in order to refer to "males who have sex with males".

My head sympathises, but my heart screams. For me "male" is dehumanising and offensive, as it places us on a level with animals. (While the physicality of the sexual act is something we have in common with animals, our minds usually bring a dimension to sexuality that animals lack.) I would prefer to talk about "men and boys who have sex with men and boys", but I recognise the phrase is both cumbersome and subject to misinterpretation (eg some may think it includes pre-pubescent boys or others use it referring only to men and boys who have sex with both men and boys etc etc). I usually compromise by using "men who have sex with men" and prefacing any article or speech with the rider that by men I include sexually mature boys, but the rider isn't always heard and the viewpoint isn't shared by everyone.

Leaving that issue unresolved, my second problem is the almost universal reduction of the phrase "men who have sex with men" to "MSM". Again, there is a superficial logic; the phrase is long and can be clumsy. MSM is short and is merely one more in a world of acronyms - HIV, UNAIDS, PWA** etc. What harm can there be in these three letters?

Well, the first problem is that MSM creates a barrier for those unfamiliar with the term. It either prevents them from understanding whatever they are reading or hearing, or interrupts their flow as they search for the meaning. In other words it reinforces the privilege of insider information and, temporarily at least, ostracises those who do not understand. "Men who have sex with men" is always clear and requires no explanation; it does not set up barriers between those who understand and those who don't, but includes everybody.

Secondly, acronyms that refer to people have a tendency to dehumanise, reducing them people to cyphers and statistics. MSM can be dismissive; "men who have sex with men" can also be pejorative but it is less likely to be so. And if the term is too long to be repeated, other alternatives can be used, such as "between men" or "sex between men" or "the men who." or "such men", depending on the context.

Thirdly, and most importantly, "MSM" encourages lazy thinking. It leads people to think there is such a thing as a single identifiable group of MSM, while the reality is that the expression came into being because there is no such thing. Men who have sex with men are as varied as all men, as are the circumstances in which they have sex and the identities they give themselves.

Unfortunately, some people who work in HIV/AIDS say that they speak for MSM; they don't; no-one can. They talk about the MSM community; there isn't one. They talk about having an MSM identity; they can't. MSM leads people down the same mistaken path that gay did - it reduces the variety of men who have sex with men to a single identity and a single response.

We all come from, live in and work in specific geographical and social communities. None of us, no matter how well informed we are, can claim familiarity with all men who have sex with men. We can only claim to represent our own particular group. There are not even communities of men who have sex with men, because many men reject the notion that they share any values with other men who have sex with men. (The man who rapes another man is unlikely to think of himself as a member of a community of rapists, but he is definitely a man who has sex with at least one man.)

So, can we agree to banish MSM to history? It is not an identity, it is not a description and it is not a community. If you are only referring to one specific group of men who have sex with men, use the term appropriate to that community. And if you are genuinely referring to all men who have sex with men, including the many who you may have read about but are never likely to meet, then use the full - informative, respectful, thoughtful - term. Working with MSM limits our vision; trying to work with the many different men who have sex with men should be our goal.

And once we've agreed on that point, can resolve the question of males.?

* The sex is the same in the sense that male bodies can only interact in a number of limited ways; it is different in the sense that there are fashions in sex that change over time and from place to place and some sex acts may be more common in one community than in another. In the mid-20th century, for example, it seems that British gay men were more likely to fuck / be fucked while USAmericans preferred to suck / be sucked.

** People With AIDS,  often supplanted by PLWHA (People Living With HIV/AIDS) or similar combinations. I prefer the increasingly used term Positive People.

Responses to the above column appear below. Partly as a follow-up and partly in response to the comments it generated, I wrote "Shivananda Khan is a real man" which can be read here.

The use of 'male' in preference to 'men' in MSM is not only about including a wider range of ages, but it's also used to contrast individuals belonging to a biological sex (male) with those identifying with a gender (man). This is appropriate because of the presence of males whose gender is not aligned with their anatomy, eg. transgendered males. Further, not all men who have sex with men are biologically male. Some are transmen (biologically female), and are rarely considered when we talk of MSM.
Apart from this, I do agree that the notion of 'community' is dubious when applied to MSM. It's also dubious when applied to gay men or bisexual men.
Ramki Ramakrishnan, SAATHII: Solidarity and Action against the HIV Infection in India

"Whilst the term "male" is not and ideal term to use, because, as you rightly point out, it can refer to non-humans, we are working on sexual health issues for humans and not for zoo animals, so I am not convinced that anyone will really be confused! The term "male" is better to use than "man", as we need to include people who don't identify as men, because of their age or gender, and how this is culturally and socially defined. With respect to "MSM" being used as an identity, we actually find that some males use "MSM" as their identity, event though we don't promote this! Some males in South Asia don't want to use the current indigenous terms, such as kothi, panthi or "gay", or even when they do, they understand that "MSM" describes a behaviour, so some of the males will say they are an "MSM", as well as for example, a "double decker" (someone who likes to fuck and be fucked), and they are being technically and culturally correct! Identity is complex issue as you might know, and many people want to define themselves with an identity for a number of reasons. Reasons that include, a validation for their feelings and actions, and their need to feel part of a group, the reason why a "gay" identity has been so popular in the west.
Kim Mulji, Naz Foundation International

The following letter has also been reprinted on number of listservs where the above article first appeared. I have slightly respelt it and may have altered the paragraphing - apologies to Aditya if my minor editing has changed his argument in any way.

Thanks to Aditya for his respect in the use of the word Mr - I certainly feel the same respect for him; I just don't come from a culture that expresses it in the same way.

First I agree that with the progress made in the intervention efforts with Men/Males who have sex with other Men/Males, the usage of the acronym MSM has increased and has increasingly been conflated with an identity construct by itself [you increasingly come across statements like "I am MSM" or questions like "is he MSM?"]. This as is rightly pointed out is a problem as it defeats the very purpose behind the coinage of the phrase and its acronym.

But what I would like to add is to the appeal/desire of many to replace 'Men' with 'Males'. I must say here that I have increasingly been convinced with the case for the change over to 'males'.

Before I give my reasons I shall like to paraphrase two points that Mr Martin makes: First, Mr Martin states that his understanding of why people say that 'males' should replace 'men' is that it does not include mature boys who either have sex with each other or with other men. I shall explain later that this is a correct but limited understanding and that there is a far bigger reason for desiring this change/shift.   Second, Mr Martin states that the usage of males would somehow take away the humane element from human sexuality [of men]. Again I would state that this argument, while may be true in some contexts is actually again a limited understanding.  

The limit that I ascribe to the two above positions adopted by Mr. Martin is the fact that Mr Martin does not take into account the role played by gender and gender constructs in male lives in many parts of the world including South Asia. Feminised males who adopt many indigenous identities [kothi, dhurrani, murat, zennana, Aqwa Hijra, Kathoy, Bacqla, Waria, Faffafini, et al], do not consider themselves as 'Men'. They just possess the physical body of a 'male' individual. Their self definition, more often than not, is that they are 'women' or 'women like'. Here the factor of import is the feminine gendered psychological makeup of bilogical males.  

It is also now very clear that often it is the gendered males who are most at risk of HIV and also most disadvantaged [being largely penetrated in the sexual act and also having to deal with the baggage of societal patriarchy and the oppressions that it brings to bear on gender non-conformity]. Therefore it is they that need greater attention of the limited intervention resources, if a meaningful dent in the HIV infection rates are to be affected.   In light of the above, I would suggest that as much as calling the "MEN' of the world 'Males' is de-humanising and pathologising their sexuality similarly called those who are 'not-men' as 'men' to suit the needs of the EGO of men is similarly de-humanising, oppressing, and unnecessarily patronising, if not outright inaccurate.

Moreover it actually has the risk of keeping those most at risk and most in need of services out of the purview of all HIV intervention efforts.   The usage of 'males' is not debated by either side, nor contested as to its scientific validity. Only its de-humanising of 'MEN's sexuality' is asserted. But since MSM was brought in to take the discourse away from [American/Western] gay politics [of gay MEN?] to a more scientifically accurate behavioural description, I feel the pathology of usage of the term 'male' is more acceptable to the grave risk of denial of service that the MAN's ego can bring to bear on those who do not wish to conform to the stereotype of the MAN. They deserve better.  
Aditya Bondyopadhyay

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