definitions and descriptions of men who have sex with men

definitions and descriptions of men who have sex with men
and transgender people
The definition of MSM encompasses both specific behaviours and multiple identities. As a consequence of the
complexity of attempting to categorize the numerous individuals and communities of MSM, there exists a plethora
of definitions, often even within the same country. From the perspective of the health sector, definitions are
important for programmatic focus. The lack of standardized definitions and measurements complicates the task of
surveillance programmes, which attempt to understand what the problem is, where and among whom it is located,
and whether there are identifiable trends within the population in question over time. For epidemiological purposes,
it is important to ensure that the key focus remains those behaviours which are known to directly increase the risk
of HIV infection – notably, unprotected anal sex.
Over time, the development of the term “MSM” has evolved from an attempt to define clearly the key behaviours,
or the group of specific behaviours, that characterize this risk group. Most data drawn from epidemiological studies
use the simple metric of “men who have sex with men”. However, the reality is that, in some countries at least, even
this seemingly simple category may not be so easy to measure. For example, in societies that are strongly
influenced by “machismo”, it has been observed that same-sex interactions may be structured, in principle, in
terms of a gender hierarchy, along active–passive lines.
The broad definition of MSM as any man who has sex with another man, regardless of sexual orientation or gender
identity, and whether or not he also has sex with women, is in use by some programmes at the national level. In
India, for example, a time period of the past one year is placed on self-reported behaviour. A time frame attempts
to overcome a further complication associated with measurement; that is, the ability to discern current compared
with lifetime MSM behaviours. Where data quality is good and data are readily available, it is possible to distinguish
between those men who have ever had sex with men and those men for whom the behaviour is more recent and
recurring. Where data are limited and no time frame has been applied to reported behaviours, it may be difficult to
distinguish between those men who have explored or experimented with same-sex behaviours at some point in
their lives and those who have recently been or currently are sexually active with men. Table 1 presents data from
surveys reporting on behaviours across a range of countries, according to whether the behaviour was in the past
year or at some point in the lifetime of the respondent.