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LETTER |
Shivananda Khan is with Naz Foundation International (NFI), London, England. Omar Khan is with the Department of Family Medicine, University of Vermont, Burlington, and serves on the US board of NFI.
Correspondence: Requests for reprints should be sent to Shivananda Khan, OBE, Naz Foundation International, Palingswick House, 241 King St, London W6 9LP, United Kingdom (e-mail: shiv{at}nfi.net).
Young and Meyer recently considered the ubiquitous use of the term men who have sex with men (MSM).1 We respond with our experience in this area, with special attention to HIV/AIDS.
We agree with many of the points made by Young and Meyer. We advocate the appropriate use of the term MSM, which has achieved (over)usage in a variety of contexts. Subsequently, its utility as an authentic term for settings where behavior and identity remain separate has been diminished. For example, in much of South Asia, male-to-male sex as a behavior does not equate with behaviorally or socially being homosexual or desiring men in a nonsexual context. The complex reasons for this duality of behavior and identity are explored elsewhere.2–4
The generalization of the term MSM has implications for studying HIV risks as well. This behavior-oriented term has effectively masked the sexual identity of men who engage in same-sex behavior, potentially impairing long-term goals of self-actualization and social justice. Because it is a reductionist term, it can also have the unintended effect of causing those outside the community of MSM to view those men as "issues" rather than as human beings whose life choices include a set of behaviors.
Naz Foundation International (http://www.nfi.net) is a foundation that assists with developing networks for advocacy and self-help to MSM, provides technical assistance to health organizations with an MSM focus, and provides public health information and advice to improve the health of MSM (largely within South Asia). The foundation uses the term males rather than men because the latter term can be problematic itself. Sexual activity may occur between older and younger males, and differentiating between men and boys here is not particularly useful.
The term MSM defined as males who have sex with males also has problems, albeit more subtle ones. For instance, for some participants, penetrated versus penetrative sex differentiates one’s sexual identity as male versus not male. In this situation there will be, by definition, only one male, and the term MSM will be inaccurate. The terminology also does not include nonpenetrative sexual behavior (masti) or men having sex with transvestites or castrati (hijras). For political and social reasons, we have used alternate terminology for MSM, using terms that refer to men in the context of their sexual behaviors (e.g., kothis—men who sometimes feminize their behavior and state that they prefer the receptive role in anal or oral sex). The trouble remains with the characterization of sexual practices versus identities, which potentially limits the development of an empowering environment to reduce risk and vulnerability.
We strongly believe that we need a shared vocabulary that is both specific to the needs of those with whom we work and accessible to health and advocacy professionals. We appreciate the points raised by Young and Meyer and look forward to a continuing discussion.
Acknowledgments
We acknowledge the work and support of our colleagues, including the local partners of the Naz Foundation, who carry out challenging tasks on a daily basis in a frequently stigmatized and dangerous environment.
References
1. Young RM, Meyer IH. The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse. Am J Public Health. 2005; 95(7):1144–1149.
2. Jenkins C. Varieties of homosexuality in Bangladesh. Paper presented at: 12th World AIDS Conference; June 28–July 3, 1998; Geneva, Switzerland.
3. Khan S. Under the blanket: bisexualities and AIDS. In: Khan S, ed. Bisexualities and AIDS. London, United Kingdom: Taylor & Francis; 1998.
4. Pappas G, Khan OA, Wright J, Khan S, O’Neill J. Males who have sex with males (MSM) and HIV/AIDS in India: the hidden epidemic. AIDS Public Policy J. 2001;16(1):4–17.
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