What is MSM?
MSM stands for “Men who have sex with Men”. Men who have sex with men (MSM) is an inclusive public health term used to define sexual behaviour between males, regardless of their sexual or gender identity, their motivation for engaging in sex or their identification with any or no particular community. The term MSM is of particular significance to the field of HIV as there are certain sexual behaviours amongst MSM which have high risk factors for HIV transmission/infection. The words “man” and “sex” are interpreted differently in diverse cultures and societies as well as by the individuals involved.
The term MSM was intended to cover a large variety of settings and contexts in which male-to-male sex takes place without getting into identity politics, however, questions have been raised about how the term may be disempowering, by zooming in on just one aspect of their personhood—the fact that they have sex with men.
Unfortunately, this clinical classification would also include transgender women as the practice in Malaysia is to still classify transgender women according to the sex listed on their identity card. This is not ideal as transgender women do not have the same type of risk factors given their different gender identity from gay, bisexual and other MSM.
Some progress has been made in Malaysia where transgender women are treated as a separate key population for survey purposes; whereby they are surveyed separately for estimating HIV prevalence. Also, in terms of HIV programming, HIV interventions designed and implemented by all NGOs and CBOs in Malaysia consider transgender women as a separate key population, distinct from MSM.
Do all men who have sex with men identify as gay or bisexual?
The term “men who have sex with men” refers to a sexual behaviour, and hence is not about sexual orientation. Gay or bisexual men who are sexually active are of course MSM, but there are other MSM who do not call themselves gay or bisexual but prefer to label themselves as heterosexual, but who still engage in the sexual behaviour of having sex with other men.
For that reason, it is important not to package all HIV services for MSM as services for “gay or bisexual men” as this might not appeal to these other MSM who are more hidden and discreet, often having a family (marriage to a woman) and children.
Why do some men have sex with men even if they do not identify as gay or bisexual?
Some men simply enjoy the sexual behaviour; for example, they like to penetrate, and they do not care whether they penetrate a woman or another man. Some men have sex with men in all-male environments only, like jails, marine/fishing ships, armed forces (army, navy, air force), factory/construction hostels or boarding schools, because there are no women available there. Such men may prefer women, but they do not have a girlfriend or have no access to women, so they have sex with men instead. Some heterosexual men may also have sex with other men as a form or sex work, simply to earn money.
Some adolescent boys have sex with each other to learn about their bodies and explore their emerging sexual sensations, especially in societies where they cannot experiment freely with girls. Once they are adults and/or have access to women, they may (or may not) stop having sex with other men.
Are MSM more at risk for HIV than heterosexual men who do not engage in MSM behaviour?
Yes. Globally, MSM are 28 times more likely to acquire HIV than the general population, due to various risk factors.
What are the reasons MSM are so heavily affected by HIV?
This is due to various factors which increase HIV risk for MSM compared to heterosexual men as listed and briefly addressed below: