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Men who have sex with men (MSM) and women who have sex with women (WSW) are purportedly neutral terms commonly used in public health discourse. However, they are problematic because they obscure social dimensions of sexuality; undermine the self-labeling of lesbian, gay, and bisexual people; and do not sufficiently describe variations in sexual behavior. MSM and WSW often imply a lack of lesbian or gay identity and an absence of community, networks, and relationships in which same-gender pairings mean more than merely sexual behavior. Overuse of the terms MSM and WSW adds to a history of scientific labeling of sexual minorities that reflects, and inadvertently advances, heterosexist notions. Public health professionals should adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups.
(Am J Public Health, 2005;95:1144-1149. doi:10. 2105/AJPH.2004.046714)
THE BEHAVIORAL CATEGORY men who have sex with men has been used in HIV literature since at least 1990. The acronym MSM, coined in 1994, signaled the crystallization of a new concept.1,2 MSM and, more recently, WSW (women who have sex with women) have since moved beyond the HIV literature to become established in both research and health programming for sexual-minority people. In part because the terms held the promise of reducing AIDS stigma, which has been irrationally attached to gay men and lesbians, we, the authors, helped to promulgate these nowfamiliar acronyms.3 But we have become increasingly troubled with the way these terms are used, especially when they displace rather than coincide with information about sexual identity. The 10th anniversary of these terms provides a good occasion to reflect on their meaning, utility, and limitations.
The argument for MSM and WSW seems to be driven by the convergence of 2 perspectives. The first is an epidemiological perspective: by using identity-free terms, epidemiologists sought to avoid complex social and cultural connotations that, according to a strict biomedical view, have little to do with epidemiological investigation of dis eases. Accordingly, MSM was introduced to reflect the idea that behaviors, not identities, place individuals at risk for HIV infection, a particularly important distinction given that scientific and medical experts had initially identified gay identity as a risk for HIV/AIDS, a characterization that stigmatized lesbian, gay, and bisexual (LGB) populations and confounded efforts to prevent...