MSM is an acronym for Men who have Sex with Men coined in 1994 by specialists in public health in the United States(1). The term was specifically invented in the wake of the HIV/AIDS epidemic(2), with the aim to ease reaching all men who have sex with men, including those who do not identify themselves as gay locally and globally. In the United States, the outbreak of the HIV and AIDS epidemic has vilified gay and queer men (and homosexuality overall) who were blamed for the spread of the virus(3) which came to be derogatorily known as the “gay disease”. Subsequently, the categories of gay and queer gained renewed stigma due to this homophobic reaction, which also included a significant negligence on the part of the government in addressing the emerging health crisis(4). In this context, the term MSM sought to somewhat delink identity from disease in order to be able to better reach those men affected by it.

Furthermore, defining the concept was necessary for public health practitioners and epidemiologists in order to study the impact of high-risk sexual behaviors on the health of men who were sexually active with men, regardless of their cultural, social and sexual identities. As such, the term was seen as an easy “neutral” concept to export abroad to African and Asian countries through transnational NGOs and public health policies (see NGOization). Further, the stigma placed on gay men as the cause for HIV/AIDS crisis and other STDs/STIs, led the UN member states to address the needs of people vulnerable to infections due to their sexual behaviors, urging local governments and civil societies to deliver prevention and health services to the newly outlined category of MSM(5). The term was adopted in Lebanon, and some Lebanese organizations have been involved in providing health care to MSM in cooperation with the Ministry of Health not only in HIV treatment and prevention but STIs and sexual health in general (see STIs).

In its emphasis on sexual acts and behavior and not on sexual identity, the use of MSM reflects an engagement with post-structuralist debates and analysis. Post-structuralist approaches to sexuality have challenged the idea that a stable and universal sexual identity exists, arguing that such a conception ignores cultural and historical differences(6) (see LGBT and Sexuality). At the same time however, U.S. practitioners have critiqued the term precisely for avoiding “identities”, arguing that the term minimizes the importance of self-identification and rather alienates gay men who see that the term ignores their surrounding social lives and networks that form an inseparable part of their sexual lives and practices(7).

In Lebanon, the term’s perceived apolitical neutrality offered a convenient way for the Ministry of Health to avoid working publicly with self-identified gay men and avoid acknowledging them beyond their sexual practices, which remain punishable under law. Thus, for local activists and NGOs who work on raising the visibility of LGBT-identifying persons, using the term MSM appears as a contradiction in political strategies.

Although MSM sexual activities include anal sex, oral sex or mutual masturbation, an emphasis on anal penetration (with an emphasis on the health risks of being penetrated as opposed to penetrating – see Sex Roles) has dominated the medical and public health field. This led to often ignoring the multiplicity of sexual interactions and identifications. Yet, despite the strong emphasis on men who are penetrated rather than penetrators, MSM can still miss many communities and categories. For example, kothis(8), who are a community of feminine men in India and who do not identify as men or as trans, but rather as women (and take the gender role of women, which to them includes being penetrated by a man), would not necessarily be included under the term MSM as field practitioners noted(9). At the same time however, in the U.S. context, MSM can and does include some transwomen as a subset category given that transwomen can still “share some biological risk factors with MSM”(10), including for example prostate cancer, and breast cancer in transmen’s case. What this multiplicity of the uses of the MSM term demonstrates is its specificity to a U.S. context and non-neutrality.