Safety in Numbers

Chapter 5

'Men who have sex with men' versus gay men (113)

By the late 1980s, very little educational work for gay men was being undertaken in either the voluntary or the statutory sectors, the emphasis having shifted either to the general public at large, or to discrete sub-populations such as young people or women, all of which are usually assumed to be entirely heterosexual. (114) When sex between men was addressed as a risk activity by AIDS educators, it was increasingly likely that its practitioners would be described as 'men who have sex with men' rather than 'gay men' or 'gay and bisexual men'. While there appear to have been a number of well-intentioned motives for the adoption of 'men who have sex with men' terminology (MWHSWM), in practice the term reflected a rather subtle form of de-gaying.

The term MWHSWM was embraced particularly enthusiastically by statutory sector authorities involved in HIV prevention work, such as the Health Education Authority in its MESMAC project described earlier, and numerous smaller, local initiatives. In some local government bureaucracies, the very idea of promoting safer gay sex encountered a number of obstacles: political sensitivities and a concern to avoid controversy, especially in relation to the notion of 'promoting homosexuality'; the mistaken view that gay men were no longer particularly at risk from HIV; and in some cases, the straightforward prejudiced view that the health of gay men was of little importance. In these circumstances, the use of MWHSWM terminology offered "a way of getting resources which might otherwise have been felt to have been unavailable for explicitly gay and bisexual work". (115)

MWHSWM terminology was also intended to focus attention on the disjunctions between behaviour and identity. At a time when there was a common misapprehension that safer sex campaigns among men who self-identified as gay had been successfully completed, the next priority in preventing homosexual transmission of HIV seemed to be among 'hard-to-reach' men who occasionally had sex with other men, but who did not consider themselves to be gay.

Unfortunately, MWHSWM can be a profoundly alienating term for men who are confident and proud in their gay or bisexual identity. For gay men, the term 'gay' is something we choose to use to describe ourselves and our sense of shared identity and interests with other gay men, rather than being a label which is attached to use by others from outside or above. By contrast, MWHSWM is not a term of self-identification, but rather a pseudo-scientific classification applied by others to homosexually active men, and thereby creating and perpetuating a gulf between the 'professional' educator and the 'subject'. Health education messages based on MWHSWM terminology are thus likely to meet with quite avoidable resistance from gay men, simply because they clearly originate outside the community and are imposed upon it, rather than being generated from within.

The inappropriateness of MWHSWM in work for confident gay men means that its use in health education appears to prioritise the needs of heterosexually identified 'men who have sex with men' above or instead of those of gay men. Not only is work with homosexually-active men accorded at best a low priority in the overall scheme of HIV prevention initiatives; even where MWHSWM are targeted, the needs of those most at risk B namely, 'out' gay men on the commercial scene B are neglected. To this extent, use of the term MWHSWM frequently characterises work which remains complacent or indifferent to the ongoing needs of gay men at the core of their communities. (116)

Moreover, the use of MWHSWM may ironically also obscure a proper recognition of and effective response to the needs of those men who do not identify as gay. In the first place, this is because research has shown that men who do have a strong gay identity are more likely to be able to adopt and sustain the practice of safer sex. (117) A valid aim of HIV education would therefore be to help so-called 'men who have sex with men' to develop a confident gay identity. Instead, MWHSWM focuses exclusively and mechanistically on their sexual activity, and thence simply labels them with a term around which they are highly unlikely to mobilise.

Secondly, the term MWHSWM "gives the misleading impression that this is a homogenous group with the same needs, obstacles and potential" (118), when in reality gay men, bisexual men and heterosexual men who sometimes have sex with other men may well have dramatically different needs. In particular, the term 'bisexual men' draws attention to the fact that these men may have sex with both men and women in a way that MWHSWM does not.

Thirdly, as Peter Scott has pointed out, the MWHSWM terminology may also prevent what is likely to be the most cost-effective and efficient form of safer sex peer education, by alienating gay men:


It is important to understand that even those MWHSWM who identify themselves as heterosexual will, in practice, have sexual encounters with confident gay and bisexual men. The advantage of a clear focus upon gay and bisexual men [as opposed to the MWHSWM model] is that they are themselves relatively easy to reach... whilst at the same time they are most capable of reaching the hardest to reach, by dint of having sexual and social encounters with them. There is no evidence to suggest that anyone else can influence these men 'on the margins' any more effectively. (119)