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MSM as a Behavioral Category

Main article: Men who have sex with men

Men who have sex with men (abbreviated as MSM, also known as males who have sex with males) are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves; many men choose not to (or cannot for other reasons) accept sexual identities of homosexual or bisexual.[1] MSM is often used in medical literature and social research to describe such men as a group for research studies without considering issues of self-identification. MSM and women who have sex with women "WSW" have been used in medical literature since at least 1990. [2]

Demographics

The United Nations estimates that 6-20% of men worldwide have sex with other men at some point during their lifetime. [3]The Center for Disease Control estimates that men who have sex with men represent about 2% of the American population. [4] A 2007 study estimated that they are 7.1 million men who have sex with men (MSM) in the United States, or 6.4% of the overall population. Of these men, 71% are White, 15.9% are Hispanic, and 8.9% are black. The percentage of men who were MSM varied by state, with the lowest percentage in South Dakota (3.3%) and the highest in the District of Columbia (13.2%). However, the same study found that 57% of men who have sex with men identify as bisexual or straight [5] A 2010 Study estimated that 2.6% had engaged in same-sex behavior in the past year, 4.0% in the past five years, and 7.0% at any point in their lifetime. [6]

HIV Infection Rates

Although men who have sex with men are only a small proportion of the U.S. population, they are consistently the population most affected by the HIV/AIDS virus and are the largest percentage of persons with an AIDS diagnosis who have died. The CDC reports that in 2009, MSM accounted for 61% of all new HIV infections and that MSM who had a history of injection drug use accounted for an additional 3% of new infections. Among the approximately 784,701 people living with an HIV diagnosis, 396,810 (51%) were MSM. About 48% of MSM living with an HIV diagnosis were white, 30% were black/African American, and 19% were Hispanic or Latino. Although the majority of MSM are white, non-whites accounted for 54% of new infections HIV related MSM infections in 2008. [7] A recent study estimated that for every 100,000 MSM, 692 will be diagnosed will HIV. This makes MSM 60 times more likely to contract the virus than other men and 54 times more likely than women. [8]

Risk Factors

A 2008 CDC study found that one in five (19%) of MSM in major U.S. cities were infected with HIV and almost half (44%) were unaware of their infection. [9]

The HIV virus is more easily transmitted through unprotected anal sex than through unprotected vaginal sex.[10] A 2004 study of HIV positive men found men who had unprotected anal intercourse (UAI) in the past year were put at risk for contracting the virus. The study found that men who reported engaging in UAI had increased from 30% in 1996 to 42% in 2000. Almost half of all men who participated in UAI in 1996-1997 said that they had not known the HIV status of their partner [11] Studies have found that risk factors for HIV infection are anal intercourse with a man in the past 12 months, having unstable housing, and having inhaled alkyl nitrites (“poppers.”) [12] A 2009 study on the prevalence of unprotected anal intercourse among HIV-diagnosed MSM found that majority protected their partners during sexual activity, but a sizeable number of men continue to engage in sexual behaviors that place themselves and others at risk for HIV infections. [13]

Condom fatigue

Main article: Condom fatigue

Although HIV transmission rates fell throughout the 1990's, they hit a plateau at the end of the decade. The increasing rates of sexually transmitted diseases in major cities in the United States, Canada, and the United Kingdom led to reports in the gay and mainstream media of "condom fatigue" and "AIDS optimism" as causes of the new "laxness" in safe sex practices. [14] This is supported by research on the tendency of couples (heterosexual or homosexual) to use condoms less over time. [15] [16] [17] [18] [19] [20] A 2010 study found that gay and bisexual men choose to have unprotected sex for a variety of reasons and cannot be generalized. Erectile dysfunction, mental health problems and depression, lack of communication or intimacy, and a subculture of unprotected sex were all listed as reasons why men had sex without condoms voluntarily. [21]

A Kaiser Family Foundation study indicated that fewer Americans view HIV as a top health priority today compared to ten years ago. In 1996, 25% of Americans viewed HIV as an “urgent problem” to their community but in 2009, only 17% listed it as “urgent.” The percentage of 18-29 year olds that were personally concerned about contracting the virus dropped from 28% in 1995 to 17% in 2009 [22] A study conducted in 6 major U.S. cities found that only one in 4 teenage men who have sex with men believed they were personally at risk for contracting the HIV virus. [23]

Prevention

The Joint United Nations Program on HIV/AIDS published a paper in 2005 offering specific policy solutions for alleviating the spread of the HIV virus in the MSM population for specific regions around the world. They pointed to “a profound lack of knowledge” and stigma about sexual identity as worldwide barriers to preventing transmission and encouraging those infection to seek treatment. The UNAIDS program has recommended that the South African government implement “sex positive” policies to reduce societal stigma around homosexuality and promote the use of water-based lubricants. Particularly in Morocco, the program has advocated distributing condoms in prisons. In recent years, the Chinese government has begun to acknowledge the sexuality of its constituents. According to UNAIDS, the “Government has made significant progress in recognizing the issue of male-to-male sexual health and HIV.” [24]


References

  1. ^ "UNAIDS: Men who have sex with men" (PDF). UNAIDS. Retrieved October 24, 2012.
  2. ^ Young, Rebecca M. and Ilan H. Meyer. “The Trouble With “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse.” Am J Public Health. (2005) 95: 1144–1149.
  3. ^ “Men who have sex with men, HIV prevention and care” Geneva, November 2005. UNAIDS. http://data.unaids.org/pub/Report/2006/jc1233-msm-meetingreport_en.pdf
  4. ^ Center for Disease Control. “HIV among gay, bisexual, and other men who have sex with men (MSM)” (2010). Department of Health and Human Services.
  5. ^ Lieb, S., Fallon, S., Friedman, S., Thompson, D., Gates, G., Liberti, T., & Malow, R. (2011). Statewide estimation of racial/ethnic populations of men who have sex with men in the U.S. PubMed, 126(1), 60-72.
  6. ^ Purcell, D.W., C Johnson, A Lansky, J Prejean, R Stein, P Denning, Z Gaul, H Weinstock, J Su, & N Crepaz. “Calculating HIV and Syphilis Rates for Risk Groups: Estimating the National Population Size of Men Who Have Sex with Men” Latebreaker #22896 Presented March 10, 2010. 2010 National STD Prevention Conference; Atlanta, GA.
  7. ^ Center for Disease Control. “HIV among gay, bisexual, and other men who have sex with men (MSM)” (2010). Department of Health and Human Services.
  8. ^ Purcell, D.W., C Johnson, A Lansky, J Prejean, R Stein, P Denning, Z Gaul, H Weinstock, J Su, & N Crepaz. Latebreaker #22896 Presented March 10, 2010. “Calculating HIV and Syphilis Rates for Risk Groups: Estimating the National Population Size of Men Who Have Sex with Men” 2010 National STD Prevention Conference; Atlanta, GA.
  9. ^ Center for Disease Control. “HIV among gay, bisexual, and other men who have sex with men (MSM)” (2010). Department of Health and Human Services.
  10. ^ http://www.avert.org/men-sex-men.htm
  11. ^ Dodds, J.P., D.E. Mercey, J.V. Parry & A.M. Johnson. (2004) Increasing risk behaviour and high levels of undiagnosed HIV infection in a community sample of homosexual men. Sex Transm Infect; 80:236-240
  12. ^ Mimiaga, M., Reisner, S., Cranston, K., Isenberg, D., Bright, D., Daffin, G., Bland, S., & Driscoll, M. (2009). Sexual mixing patterns and partner characteristics of black msm in Massachusetts at increased risk for HIV infection and transmission. Journal of Urban Health, 86(4), 602-623.
  13. ^ Crepaz, Nicole, Marks, Gary; Liau, Adrian; Mullins, Mary M; Aupont, Latrina W; Marshall, Khiya J; Jacobs, Elizabeth D; Wolitski, Richard J; (2009) “Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis”, AIDS, 80, 23:1617-1629
  14. ^ Adam, Barry D., Winston Husbands, James Murray, and John Maxwell. (2005): AIDS optimism, condom fatigue, or self‐esteem? Explaining unsafe sex among gay and bisexual men, Journal of Sex Research, 42:3, 238-248
  15. ^ Appleby, P., Miller, L., & Rothspan, S. (1999). The paradox of trust for male couples. Personal Relationships, 6, 81-93.
  16. ^ Bochow, M. (1998). The importance of contextualizing research. In M.Wright, B. R. S. Rosser, & O. de Zwart (Eds.), New international direc- tionsinHIVpreventionfor gayandbisexualmen.NewYork:Harrington Park Press.
  17. ^ Cusick, L., & Rhodes, T. (2000). Sustaining sexual safety in relationships. Culture, Health & Sexuality, 2(4), 473-487
  18. ^ Diaz, R., & Ayala, G. (1999). Love, passion and rebellion. Culture, Health &Sexuality, 1(3),277-293
  19. ^ Hays, R., Kegeles, S., & Coates, T. (1997). Unprotected sex and HIV risk- taking among young gay men within boyfriend relationships. AIDS Educationand Prevention, 9(4), 314-329.
  20. ^ Middelthon, A. L. (2001). Interpretations of condom use and nonuse among young Norwegian gay men. Medical Anthropology Quarterly, 15(1), 58-83.
  21. ^ Adam, Barry D., Winston Husbands, James Murray, and John Maxwell. (2005): AIDS optimism, condom fatigue, or self‐esteem? Explaining unsafe sex among gay and bisexual men, Journal of Sex Research, 42:3, 238-248
  22. ^ Kaiser Family Foundation. (2009) “2009 Survey of Americans on HIV/AIDS: summary of findings on the domestic epidemic.”
  23. ^ MacKellar DA, Valleroy LA, Secura GM, et al. (2007) Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS Behav:263-270.
  24. ^ “Men who have sex with men, HIV prevention and care” Geneva, November 2005. UNAIDS. http://data.unaids.org/pub/Report/2006/jc1233-msm-meetingreport_en.pdf
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