MSM

[Arnold M. Zwicky]

On Dec 19, 2004, at 7:08 AM, James A. Landau wrote:

> from The Body, a Web site about HIV and AIDS
> http://www.thebody.com/siecus/msm.html
>
> ...Since the 1980s, when CDC investigated the first cases of AIDS
> among men who
> have sex with men (MSM),

"MSM" has been in use for some time; i noted the expression in a
posting some months ago in a posting here about guys on the down low
(roughly = african american MSMs), though i made no attempt to find
early uses.

the morphology of "MSM" varies, depending on whether you say/read it as
"em ess em", in which case its plural is "MSMs" (as above), or whether
you say/read it out in full as "men who have sex with men", in which
case it *is* plural as it stands, takes plural agreement, and is
written without the plural suffix (as below).

> the agency has worked closely with state and local
> partners and affected communities to develop, implement, and evaluate
> HIV-prevention programs for those at greatest risk. Today, although
> HIV has affected
> men, women, and children of all ages, races, ethnicities, and
> demographic
> categories, MSM are still disproportionately affected, accounting for
> an estimated 42
> percent of new HIV infections each year.

the semantics of "MSM" is also of interest.  to start with, MSMs are
not, literally, men who have sex with men, since that would include
most of what i called, in my earlier posting, "frankly gay men".  in
fact "MSM" gets its meaning from its *opposition* to "gay men" (much as
the ordinary use of "animal" gets its meaning from its opposition to
"human being").  MSMs reject labels like "gay" and "homosexual" for
themselves.  (think Roy Cohn as depicted in Angels in America.  to his
doctor: "Roy Cohn is not a homosexual.  Roy Cohn is a heterosexual man,
Henry, who fucks around with guys.")

"MSM" also differs from "gay men" in that what makes you an MSM is what
you do -- behavior -- while what makes you a gay man is what's in your
head -- what arouses you, what incites desire.  boys and men can be
clear that they are gay long before they actually have sex with another
male, or during long periods when they aren't sexually active, but you
aren't an MSM unless you're actually doing it, at least occasionally,
so that if you stop doing it, you're not an MSM any more.

(i put aside the vexed question of what counts as doing it, what counts
as having sex with someone.)

> <end quote>
>
> This is the earliest cite I could find in a quickie search.  The Body's
> search engine lists 585 pages using "MSM".

well, 2001 is *way* too recent.  i believe that the expression was
already being used as a term of art by public health professionals in
1989 (when a boyfriend and i were deeply puzzled about how to fill out
a columbus department of health questionnaire about our sexual
practices).  i'd look back earlier than that, to the early days of the
AIDS epidemic at least, possibly even before 1984, when HIV-1 was
identified as the cause of this epidemic.

> Note the derivative phrase "MSM of color".

interesting.  this is certainly broader than than "men on the down
low", since it takes in at least hispanics/latinos as well as african
americans.  depending on how you use "of color", it might also take in
people of south asian, southeast asian, east asian, arab, pacific
island, and/or native american descent.

> Another note:  several years ago (probably before I joined ADS-L) I
> read in a
> nursing trade journal the prediction that in 5? 10? years the acronym
> "AIDS"
> would be replaced by "HIV".  No way, I said, such a well-established
> term
> isn't going to vanish.  Well, perhaps I was wrong.  In the quote
> above, "HIV" is
> sometimes used to mean the disease rather than the virus which causes
> the
> disease (note "HIV and STDs" above. where "STD" means "Sexually
> Transmitted
> Diseases".

the usage of "HIV" above -- to refer to not only the virus but also the
infection caused by that virus -- is very common.  (the shift in the
quotation above between "HIV-prevention" and the like vs. "HIV
infection" isn't unusual.)

meanwhile, "AIDS" as a technical term continues to be used to refer to
severe immunosuppression caused by HIV; the 1993 CDC definition (which
i lift from my 1999 Merck Manual) distinguishes asymptomatic infection,
symptomatic infection "with conditions attributable to HIV" (things
like thrush and shingles; there's a list), and "true AIDS" (there's
another, longer and even more distressing, list of AIDS-indicator
conditions).  (these distinctions are roughly correlated with CD4
lymphocyte counts and viral loads.)  by and large, in my experience,
people who have reason to talk about these things continue to make a
distinction between HIV and AIDS, based roughly on the current medical
definitions.  one odd consequence of this is that it's possible to
suffer from AIDS at one time but not at a later time (though you'll
still have HIV); a number of my friends are in this state, thanks to
the development of antiviral cocktails.

in very simple terms, if you have HIV you're in danger, but if you have
AIDS you're in serious trouble.  that is, the distinction isn't merely
theoretical line-drawing but has important consequences in people's
lives, so the terminological distinction isn't likely to disappear.

in the literature on HIV infections, their treatment, their spread,
etc., it's common to lump HIV and AIDS together under the ungainly
label "HIV/AIDS".  in any case, "HIV" doesn't seem to be replacing
"AIDS", or the reverse.

arnold (zwicky at csli.stanford.edu), still sorrowful after all these years