The Trouble with "MSM" and "WSW": Erasure of the sexual-minority person in public health discourse

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449332/

nlm.nih.gov

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.

This piece has been floating around in tabs for so long that I honestly forget the context in which I initially grabbed it. Oops. It probably initially fascinated me in part because I picked up Young's Brain Storm: The Flaws in the Science of Sex Differences earlier this summer and completely lost my mind in delight at the thoroughness of her analysis, but it might have come up when I was wallowing around in trying to figure out what 'queer' really means and how we label human sexual and social variation in respect to cultural norms.

As I read this piece, I'm of two minds: I agree that we need to be careful about the terminology we use and to include as much context as we can which is necessary to the points we're trying to make as writers. When we develop new terms, it's very important to keep in mind the context that each potential word we use brings to the table and figure out what

But I also see the need for terms that group people according to the salient characteristic we're trying to use to talk about things! If you're looking at epidemic spread of a STI, you don't really have to care why a given person has sexual contact of the type you're studying as potentially a risk factor, and for those analyses MSM and WSW are valid--after all, you're primarily interested in the infectious impacts of the particular behavior you're grouping people by. On the other hand, sometimes I want to group people by the cultural experiences they have, or by the way their relationships are evaluated by the mainstream culture they live in, or whatever. Just as it's important to have specific identity terms that carry the baggage and all the context for the people you're discussing, sometimes you need to be able to pull a salient aspect of a group of identities out and study that instead. And terms like MSM are absolutely crucial for that--there is a baby in that bathwater!

Of course, there's also a lot of filthy bathwater in there, and it looks like the problem is that researchers have been just.... habitually using the term to mean "gay enough, as viewed from an outside lens, for my analysis." Like an academic-coded dialect variant on a word like queer. And that's bad for academia, it's bad for research, and it's just generally bad for communication--you wind up saying that you're lumping people by one thing and you wind up actually sampling from a totally different (but related!) group. Which was exactly the problem that MSM the term was initially developed to respond to!

I don't think the authors that Young and Meyer are criticizing here are necessarily using the best term to lump exactly the groups they mean. For example, in a study about the health services accessibility among black gay/bi/queer men recruited from venues where these men socialize, you're talking about gay/bi/queer men. You're talking about the way that these men's experience as self-identified gay/bi/queer men impacts their access and their ability to interact with health care, not the direct results of having sex with other men.

But I think it's striking that even as Young and Meyer write, they're.... using a very similar lumping term, 'sexual-minority', to try and get across the category of people they're talking about while also not using the lumping term they're criticizing. Would everyone in the group of people we're talking about categorize themselves as a sexual minority? What about people who think that 'everyone is a little bit bi'? What about people who assume that everyone has the same sexual feelings they do, but are keeping quiet about it because society is oppressive or that's what the polite thing to do is or because they perceive the social contract to require it? (I've met multiple people, with a variety of sexual orientations and, mmm, interests in having given varieties of sex who made that fundamental misattribution issue.)

That's largely semantics, though; I just don't think that you can create a wide enough umbrella term for a varied group that shares key similarities with certain members but not others that won't eventually start accruing specific connotations as a result of cognitive bias. The trick, I suspect, is to define your terms and talk about who you have in mind right before you start to write or design an experiment--making explicit who is inside the category you're targeting, and who isn't. That's the only way I can think of to at least clarify to your readers and yourself what you're thinking of instead of letting your expectations about who "counts" cloud your conceptions and bias your designs. Queerness and gender/sexual minorities are one of those topics where there are a lot of exceptions and a lot of complications, is the problem, and if you don't account for that... well, it's very easy for laziness with terminology to obscure huge methodological problems with data gathering.

I know Young is familiar with that; it's also a persistent problem in sex determination and differentiation research, and a central theme of the book I mentioned. It's generally an issue wherever humans have a lot of preconceptions about a variable group and don't think to stop and interrogate them, to be honest. That's why operational definitions and detailed methodology are so important. After all, that's the only way anyone is ever going to be able to evaluate anyone else's work.

And, well, that's Young and Meyers' whole point. Go read the paper, if you haven't already. It's got a bunch of cogent points and useful reminders about terminology and how it slips everywhere if you aren't careful. It's important to get in the habit of using words with your wits about you, and sometimes we all need a reminder about that.