Men who have sex with men (MSM) are male persons who engage in sexual activity with members of the same sex.[1] The term was created in the 1990s by epidemiologists to study the spread of disease among all men who have sex with men, regardless of sexual identity, to include, for example, male prostitutes. The term is often used in medical literature and social research to describe such men as a group for research studies. It does not describe any specific sexual activity, and which activities are covered by the term depends on context.
The term men who have sex with men 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]
haveing sex with a man
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 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.[10]
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.[19][20][21]
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[28] 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 do not realize it.[29]
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.[47] About a third of the world's population, more than 2 billion people, have been infected with hepatitis B virus (HBV).[48] 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.[49] Sores also can occur on the lips and in the mouth.[49] Transmission of the organism occurs during vaginal, anal, or oral sex.[49] In 2006, 64% of the reported cases in the United States were among men who have sex with men.[49] 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.[50][51]
Many countries impose restrictions on donating blood for men who have or have had sex with men, as well as their female sexual partners. 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.[59] Most national standards require direct questioning regarding a donor's sexual history, but the length of deferral varies.
Epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. We sought to understand the epidemiological drivers of the global epidemic in MSM and why it continues unabated. We did a comprehensive review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and modelled the dynamics of HIV transmission with an agent-based simulation. Our findings show that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiological data show substantial clustering of HIV infections in MSM networks, and higher rates of dual-variant and multiple-variant HIV infection in MSM than in heterosexual people in the same populations. Prevention strategies that lower biological transmission and acquisition risks, such as approaches based on antiretrovirals, offer promise for controlling the expanding epidemic in MSM, but their potential effectiveness is limited by structural factors that contribute to low health-seeking behaviours in populations of MSM in many parts of the world.
Performing a detailed and comprehensive sexual history is the first step in identifying vulnerability and providing tailored counseling and care (3). Factors associated with increased vulnerability to STI acquisition among MSM include having multiple partners, anonymous partners, and concurrent partners (185,186). Repeat syphilis infections are common and might be associated with HIV infection, substance use (e.g., methamphetamines), Black race, and multiple sex partners (187). Similarly, gonorrhea incidence has increased among MSM and might be more likely to display antimicrobial resistance compared with other groups (188,189). Gonococcal infection among MSM has been associated with similar risk factors to syphilis, including having multiple anonymous partners and substance use, especially methamphetamines (190). Disparities in gonococcal infection are also more pronounced among certain racial and ethnic groups of MSM (141).
STI screening among MSM has been reported to be suboptimal. In a cross-sectional sample of MSM in the United States, approximately one third reported not having had an STI test during the previous 3 years, and MSM with multiple sex partners reported less frequent screening (221). MSM living with HIV infection and engaged in care also experience suboptimal rates of STI testing (222,223). Limited data exist regarding the optimal frequency of screening for gonorrhea, chlamydia, and syphilis among MSM, with the majority of evidence derived from mathematical modeling. Models from Australia have demonstrated that increasing syphilis screening frequency from two times a year to four times a year resulted in a relative decrease of 84% from peak prevalence (224). In a compartmental model applied to different populations in Canada, quarterly syphilis screening averted more than twice the number of syphilis cases, compared with semiannual screening (225). Furthermore, MSM screening coverage needed for eliminating syphilis among a population is substantially reduced from 62% with annual screening to 23% with quarterly screening (226,227). In an MSM transmission model that explored the impact of HIV PrEP use on STI prevalence, quarterly chlamydia and gonorrhea screening was associated with an 83% reduction in incidence (205). The only empiric data available that examined the impact of screening frequency come from an observational cohort of MSM using HIV PrEP in which quarterly screening identified more bacterial STIs, and semiannual screening would have resulted in delayed treatment of 35% of total identified STI infections (206). In addition, quarterly screening was reported to have prevented STI exposure in a median of three sex partners per STI infection (206). On the basis of available evidence, quarterly screening for gonorrhea, chlamydia, and syphilis for certain sexually active MSM can improve case finding, which can reduce the duration of infection at the population level, reduce ongoing transmission and, ultimately, prevalence among this population (228).
Syphilis serologic testing is indicated to establish whether persons with reactive tests have untreated syphilis, have partially treated syphilis, or are manifesting a slow or inadequate serologic response to recommended previous therapy. 2ff7e9595c
Comments