Talk:Men who have sex with men/Archive 7

Amsterdam Cohort Studies
The Amsterdam Cohort Studies have been used in several studies published in several professional, peer-reviewed journals. However, one study that used information from them was removed from the article with the justification that the Amsterdam Cohort Study is unreliable. If it so unreliable, why do so many professional, peer-reviewed papers use it? Joshuajohanson (talk) 18:58, 5 September 2008 (UTC)


 * The study was removed because it made claims about number of partners of MSM in general, whereas, according to the ACS themselves, on page 2, the studies only include MSM who, at the beginning of their inclusion of the study, had had more than 2 partners in the last 6 months. What the ACS says about risk behaviour amongst MSM may be reliable, which would explain why it is used in so many studies about HIV infection, but not about average number of partners of MSM as a whole.


 * We also discussed this at Talk:Homosexuality/Archive_11, towards the bottom. Darimoma (talk) 02:23, 6 September 2008 (UTC)


 * OK. Thank you for rewording that to make it clearer.  What about this study?   It has statistics on whether MSM have anal intercourse with just their regular partner, regular partner and casual partners, or just casual partners.  It does not have other forms of non-monogamous behavior, such as kissing another man on the lips, but that would be hard to find in medical studies. Joshuajohanson (talk) 22:03, 8 September 2008 (UTC)


 * Some of the stats seem high, but I can't find a problem with methodology. Should be usable, although it seems to be cited disproportionately much on anti-gay-marriage websites (possibly indicating its data leans more to the promiscuous side than other studies - something to be cautious about, but not a reason to keep it out). Incidentally - the 1990 study (according to an acquaintance of mine) uses data from the GSS, which is done every other year, meaning that data up to 2006 should be available, but I can't find its claims on numbers of partners available anywhere. Might be worth looking into, though. Darimoma (talk) 17:47, 12 September 2008 (UTC)

Let's improve this article up to featured status.
Let's improve this article up to featured status. It is a very welll researched an has lots of proper citations. Let's try to get it up to featured status. William Ortiz (talk) 13:02, 12 September 2008 (UTC)

Anal sex and MSM (Josh's blanked section)
Hfarmer recently took out a section on intestinal parasites amongst MSM that Josh had put in. Her justification was that it was to do with anal sex, and not MSM. I don't agree with that; anal sex is a significantly higher practise amongst MSM than non-MSM, and, as it is a sexual practise, and MSM is a concept based on sexual practises (although not necessarily anal sex), I think the dangers of anal sex can be included in this article (although they'd feel more at home on Anal Sex).

Having said that, the section Josh included 5 references, supporting (what I'm going to treat as) 5 claims:


 * "Anal sex can be an important risk factor for intestinal parasitism." - The source is slightly dodgy, in that English is clearly not the author's first language, and may not have full control over its nuances (e.g. calling anal sex an "important sexual practise" amongst MSM), but I think the source is good enough to let it through. Somewhat concerned that the author's email is not an academic address, but a yahoo.com address...


 * "High rates of intestinal parasitism are found in MSM throughout the world." - seems fine, although, as it's a direct quote, should be presented as such to avoid plagiarism.


 * "The prevalence of amebiasis is approximately 4% overall in the United States, however the prevalence of E. historylitica or E. dispar in the gay population of New York City and San Francisco approached 40-50%." - Now, this is an odd one. While Josh's presentation of this claim stays true to the article he quotes, the article (and consequently this claim here) is very misleading. Amebiasis is caused by E. hystolitica, NOT by E. dispar. According to Amoebiasis, E. dispar is 9 times more prevalent than E. hystolitica (although this is unsourced). As E. dispar is apparrently much more common than E. hystolitica, it's misleading to compare the general population's prevalence of a disease with a specific sub-population's prevalence of the microbe that causes that disease in addition to another microbe. This claim should, I think, go.


 * "Guardia lamblia and Entamoeba histolytica have long been regarded as 'exotic' organisms, but are 'hyperendemic' among gay men attending STD clinics with up to 20 excreting cysts." - can't find this in the source. I might not be looking hard enough.


 * "In a controlled study 67.5% of 200 homosexual men but only sixteen percent of 100 heterosexual men were found to be infected with intestinal parasites"...These findings suggest that the male homosexual community may be an important reservoir of potentially pathogenic protozoa." - again, can't find this in the source. Also, this paper is from 1962, and may well not reflect current trends (although this shouldn't make it unusable in the article - just should have a disclaimer - that's all).

Removing the last three claims (based on misleading-ness and seemingly unsourced-ness - although I'm happy to be corrected), we're left with: "Anal sex can be an important risk factor for intestinal parasitism. High rates of intestinal parasitism are found in MSM throughout the world." This sounds very weak, and I don't think should be in the explanations section (as it's not been brought up in the preceding section). As a result, I agree with taking the section out. Darimoma (talk) 03:10, 23 September 2008 (UTC)


 * I did not write this, but moved it here from the homosexuality article as a result of this conversation. I don't know about the last three claims, but I think the fact that high rates of intestinal parasitism are found in MSM throughout the world is significant to this article.  This was originally in the STD section, not the explanations section.  I think the "Anal sex can be an important risk factor for intestinal parasitism" should be in the explanations section. Joshuajohanson (talk) 23:14, 23 September 2008 (UTC)


 * Sorry - my mistakes. I'm happy for the first two claims to be included, but I think some users may not be. At any rate, if we can get sources with more specific claims (e.g. MSM are x% more likely to get intestinal parasites) we should replace the ones we currently have. Darimoma (talk) 05:17, 24 September 2008 (UTC)


 * I could agree to the one sentence "Anal sex can be an important risk factor for intestinal parasitism." with it's reference being included. That's all.  What was there which I removed was a whole paragraph about anal sex and parasitism that seemed to me to be OT.  Those facts are in my opinion, more appropriately put in articles on anal sex, or parasitism. That's where I was coming from on deleting that.  I must also say that the way it was written before, and added without prior discussions, had the flavor of clever vandalism.  The most sinister wiki vandalism is that which could plausibly be in an encyclopedia.  That is why I used my rollbacker power to expunge that. --Hfarmer (talk) 16:20, 24 September 2008 (UTC)


 * MSM have higher rates of intestinal parasitism. I'm sure the exact number varies from region to region.  It may be because of higher rates of anal sex, which is an important, but not the only risk factor, so to conclude it belongs on the anal sex page or parasitism page seems premature. It belongs here. Joshuajohanson (talk) 18:48, 24 September 2008 (UTC)


 * That MSM have higher rates of intestinal parasitism is a related, and proper point to make. Indicating that Anal sex is one of the possible risk factors to explain this is not invalid.  I think the problem is that breaking it down to simply two sentences with no prosaic cement makes them seem more or less pointless.  I think that it's valid information to indicate in the STD section.  If there is complaint about it being "sexually" transmitted, then the title could or should be changed from "STDs" to "specific health risks in MSM".  I actually like that title much better.  There are specific health risks in being a woman, a man, black, or white.  There are more issues to MSM health than simply and plainly STDs. --Puellanivis (talk) 02:41, 25 September 2008 (UTC)


 * Comment. I'm more than a bit disturbed by what seems to me to be a campaign to perpetuate the stereotypes that LGB people are more prone to diseases. That this information is routinely and prominently placed (and replaced) in LGBT articles seems quite distasteful and shows a lack of POV. No one disputes that people who have sex are exposed to diseases but the statements are presented as LGB people are more likely to be diseased without contextualizing that it has nothing to do with their sexuality as much as the activities and the treatment LGB people get as sexuality minorities. ie, less culturally specific and adequate health care. Information about anal parasites should certainly not go in this article as this is about a cultural difference from the heteronormative mainstream, not about the increased health risks of one activity. That's terribly undue. Similar content about women who have sex with women is also undue and simply needs to be moved to articles about sexual health. -- Banj e  b oi   23:36, 15 October 2008 (UTC)


 * Wikipedia's job is to present the facts. As the article points out "the persistence of disparities in HIV between heterosexual individuals and MSM in the United States cannot be explained solely by differences in risky sexual behavior between these two populations; it is also contributed to by both the lack of "sexual role segregation" between male sex partners and "the differential anal/vaginal transmission probabilities."  This is specific to the nature of men who have sex with men and have nothing to do with cultural differences, adequate health care or the treatment MSM get as sexuality minorities. Joshuajohanson (talk) 23:43, 15 October 2008 (UTC)

Unbalanced "Health concerns" section - not surprised actually
Really? The lede sentence of the section regarding Health concerns is MSM are more likely to get HIV in the modern West,[1] Japan,[2] India,[3] and Taiwan,[4] as well as other developed countries than among the general population.? Yikes. Howabout we get a bit real here and explain first that all sexual activities have some risks and with an increase in the number of partners those risks, including contracting a STD, increase. Instead of the tabloidy scare allegation of MSMs spreading AIDS we seem to currently have. I cleaned up everything before this section but it's such a mess I thought I should post here as it's so POV and unbalanced. I think the entire section should be trimmed per WP:Undue and WP:NPOV then merged to Safe sex. Anyone else see this section as somewhat flawed? -- Banj e b oi   11:00, 12 March 2009 (UTC)


 * I agree that as written it suffers from a confusion between correlation and causation (i.e. it should be "is associated with" rather than "is caused by"), but deleting it isn't the solution. The problem is that the entire reason the classification exists is because it is associated with higher disease risk.  Talking about MSM without talking about disease risk is like talking about needle exchange programs without talking about disease risk.  The section could be toned down and more context could be provided (e.g. that other categories that overlap with MSM are part of why this group is at higher risk), but removing it rather kills the point of the article.  SDY (talk) 18:31, 12 March 2009 (UTC)


 * The whole article was a mess but I just was stunned when I got to this section. Perhaps there is something salvagable if rewritten and contextualized. Let's see if anyone else pipes up and then we can look to reworking it and then bring in some folks from the medical project to add perspective. -- Banj e  b oi   10:52, 13 March 2009 (UTC)


 * I would be willing to help. I see what you are all talking about.  My interpretation of the literature is that the way MSM have sex increases the risk of transmission of HIV and certain other diseases.  That is worlds different than "causes" hiv, a virus does that.  The article should, if I am not totally off, reflect that basic idea. Right now it really does not.--Hfarmer (talk) 01:05, 14 March 2009 (UTC)

Incorrect Statistics
I find the Health Issues section a little concerning over the statistics we are giving. As far as I can see, they are incorrect and should be changed to represent more correctly. Not to mention as stated above, I don't think it is presented very well in general much like the WSW section.

"In the U.S., their HIV prevalence is 60 times higher than the general population.[14] An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men. This compares to an estimated 13% of American males who get HIV from sexual contact with a female who is known to have, or is at high risk for, HIV infection."

I can find several sources that don't agree with that such as "MSM (47%) and persons exposed through heterosexual contact (33%) accounted for 80% of all HIV/AIDS cases diagnosed in 2004." . The study IS correct, HOWEVER we have paraphrased it incorrectly and are giving incorrect facts -- the facts that the CDC are actually giving are much more closer to the demographics I just noted. "For the study, CDC analyzed data from 33 states but did not include statistics from states with large minority and MSM populations, including California, Illinois and Georgia (Tuller, New York Times, 6/27). The study found that of the 214,379 HIV diagnoses recorded during the study period, 46% were among MSM." and "During 2001--2006, an estimated 214,379 persons had HIV/AIDS diagnosed in the 33 states. Of these diagnoses, 46% were in MSM, and 4% were in MSM who engaged in illicit injection-drug use (IDU)" from the CDC themselves The CDC study where that information was given does not say that "an estimated 62% of adult and adolescent American males[....]" as well, because not all of America was included, only 33 states were, and I also believe the 13% of heterosexual contact may have included females.

One thing the CDC also notes is that they compared "high-risk heterosexual contact" which was later defined as "heterosexual contact with a person known to be HIV-infected or at high risk" with "male-to-male sexual contact" instead of simply "male to male" and "heterosexual". Many people are going to look at it and see "62%" of homosexual contact and "13%" of heterosexual contact instead of notice that the study only included high-risk heterosexual contact which would greatly change the statistics in favour of heterosexuals.

In addition lets go back to the "In the U.S., their HIV prevalence is 60 times higher than the general population." which I assume was taken from the "Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population" quote from the FDA. FDA gets their information from CDC (or so it seems) and CDC defines HIV prevalence as:

"HIV Prevalence: The number of people living with HIV/AIDS in a given year." .... and CDC's demographics which for some reason FDA cites does not show a prevalence 60x higher than the general population to me. It would have to be 1 HIV+ person (female or male, as that is "general population") out of every 60 HIV+ MSM to make their statement true, and I don't think there are enough men let alone MSM people to make that true. If you continue to read the source given on FDA you'll see a few contradictions and uncited facts -- or cited facts that lead to CDC which doesn't support their fact at all -- such as MSM are at higher risk for transmitting HIV than any other category which is not supported by CDC.

"Infection with the Hepatitis B virus is about 5-6 times more common, and Hepatitis C virus infections are about 2 times more common, in men who have sex with men than in the general population. They also have an increased incidence and prevalence of Kaposi's sarcoma-associated herpesvirus, which causes a cancer called Kaposi's sarcoma in immunocompromised individuals." is another thing we say in the article, also from the same site that says it is 60x more prevalent. I cannot find this information anywhere else, CDC or otherwise, and if needed I am sure I can find several studies that do not agree. Considering the majority of the information on that cite is unreliable, I think it should be taken down.

In conclusion, I think we need to correct the % statistics and completely take out anything cited from http://www.fda.gov/Cber/faq/msmdonor.htm as it is just not reliable information. CDC gives various other information if we want to use it, or we can go with the "MSM (47%) and persons exposed through heterosexual contact (33%)" which is only 1% off CDCs. CDC gives other charts that compares MSM... such as http://www.cdc.gov/hiv/topics/surveillance/images/Transmission-all-2006.gif (2006, this one includes females in their study for heterosexual) or http://www.cdc.gov/hiv/topics/surveillance/images/Transmission-males-2006.gif (2006, which include only males). I think, just for neutrality, it would be better to compare heterosexual contact in general to MSM instead of male heterosexual high risk behaviour to MSM.

I will be back, as I notice other inconsistencies, but for now I am done. Avalik (talk) 09:43, 20 March 2009 (UTC)


 * Please pull these out to the talk page, we have a lot of statistics being used but I'm utterly unconvinced they are cleaning comparing what we infer they do. Also most of them are unqualified how limited the study is or the time period covered. Also many of these would be immediately refuted by ... another study. -- Banj e  b oi   05:35, 29 March 2009 (UTC)

Removed
An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men. This compares to an estimated 13% of American males who get HIV from sexual contact with a female who is known to have, or is at high risk for, HIV infection.

I've removed this as the data doesn't seem to be qualified well nor account for that lack of full reporting. It would likely be better to use more generalized and longer term studies - "over a ten-year period", etc. -- Banj e  b oi   05:29, 29 March 2009 (UTC)

clean-up of Health section
I boldly re-organized this section to separate the main content into AIDS, Hep and Intestinal diseases (which may need to change to other STDs); I've put all these under Anal sex which seems to be the main issue here and moved the few bits of content to the top that discuss overall activity. I think the next steps are to verify what we are stating as true is in fact accurate. Also expanding the intro of the section to address why anal sex and other salient issues for rates of activity, etc. -- Banj e  b oi   19:11, 29 March 2009 (UTC)


 * I'm not sure that's really such a good idea, since it really isn't all about anal sex (even though that's been demonstrated to be a higher risk activity). The impression I've gotten from reading the relevant literature is that the main reason it's so prevalent in MSM is because it's so prevalent in MSM.  If we treat the social environment in the same way we would treat geography, you could say that it's endemic in that sub-population in that the rate of spread is faster than the rate of cure (or death).  SDY (talk) 19:41, 29 March 2009 (UTC)


 * Huh, the main reason it's so prevalent in MSM is because it's so prevalent in MSM, I think you dropped a phrase from there? The whole section is a mess and needs work, that much is clear. In general, we have oral and anal sex issues. I think we should lead with sexually activity has risks and if there are any reliable sources to show men have more sex than women and if MSM have more sex than self-identified heterosexual people. All if this is somewhat subjective as the underlying issue is that even MSM's are counted in various statistics including as heterosexuals. So we need to go conservatively and ensure that we are being accurate to studies and in comparing statistics. From what I've read men generally are somewhat more sexually active when they engage in any non-heterosexual activities, likely do to more opportunities. But among sexually active people, all groups seem to be having sex at roughly similar rates. Then we need to focus on any reliable sourcing comparing various STDs. -- Banj e  b oi   21:49, 29 March 2009 (UTC)


 * As I said, it sounds circular, but that's more or less the way disease transmission works once it's established.  How it got that way in the first place is probably due to things like number of partners or higher risk types of sex, but now that the disease is established in that "island" (a social rather than geographical division in this case) it persists.  It's not really men having sex with men that are at high risk, it's men who are being exposed to an established high risk group (MSM).  Now that it's established, everyone on that "island" is much more likely to be exposed to someone with disease than people living on the "continent" even if the disease originated on the "continent" and the "island" people had nothing to do with it.  SDY (talk) 23:47, 29 March 2009 (UTC)


 * I see what you mean. Suppose we weren't talking about HIV/AIDS and a whole politicised identity group MSM (which in the USA is almost a synonym for the gay community)...suppose we were talking about the epidiemology of the hanta vrius.  Looking at that article it is seen to be endemic to certain geographical regions. So basically if you live in one of those places your risk is greated just because you live there.  The virus is much more prevalent there, and therefore your likelyhood of exposure is greater. {sracasm}It's not because you are bad people cursed by god for sinning.{/sarcasm}  Saying that the virus is endemic to certain area's and people who live there are more likely to have it is not phobic or discriminatory it's just a statistical fact.
 * HIV Aids among MSM in most of the world (except Sub Saharan Arfica) is particularly endemic in that group. That's not homo or transphobic it's true, and a horrible fact.  Just as HIV/AIDS being endemic in South Africa is a true and horrible fact. Not a South Africanaphobic slur.
 * That said SDY I would agree with Banjeboi that we have to be careful on how we word these things. IMHO being very specific about the types of sex that MSM are known to engage in which are risky... namely anal sex.--Hfarmer (talk) 01:27, 30 March 2009 (UTC)


 * Yep, just don't want everything as a subtopic since while it's related, it's not the whole story. SDY (talk) 04:58, 30 March 2009 (UTC)


 * I think we all basically agree; I had reorganized based on the content that was there and incorrectly attributed it all to anal sex which was silly. Hopefully we're on a better path. -- Banj e  b oi   03:14, 31 March 2009 (UTC)

Benefits of sex section
Has anyone noticed how bady this article is written? —Preceding unsigned comment added by 202.78.165.3 (talk) 17:01, 3 September 2009 (UTC)

I removed all that information because it does not belong here. 1.) all of those references refer to heterosexual sex. While I am sure that most of those benefits apply to sex of any kind. My personal security does not comprise evidence.  2.) If that is to be readded without violation of WP:V OR, and SYTNH then a source which mentions homosexual sex somewhere should be found. My personal feeling is that the one on one act of homosexual sex likely gives the same benefit as heterosexual sex. The difference is what happens 9 months latter in the case of heterosexual sex is something that, unless the kid is another hitler, will bring greater joy than pain for the rest of their lives. Like it or not nature has a bias for heterosexual sex, it is the way 99.999999999% of people came into this world. Who ever reads this should not be totally surprised I would write such a thing since when you come down to brass tax I think myself a hetrosexual woman. --Hfarmer (talk) 18:40, 30 March 2009 (UTC)


 * Sorry, but there is no reason to delete a passage rich with well-sourced material. I read the Reliable Sources carefully and i found they made absolutely no distinction in their reports and statististics concerning the supposed sexual orientation of the people studied, and there is absolutely no reason (given the careful reading of the sources) to dismiss them merely because they don't explicitly describe specific sex-acts of MSM. On the contrary, their reports were very generalized and non-specific for a reason-- to be as broad as possible while avoiding erroneous summarization-- and we can use these Sources for any WP articles about sexual health because these Sources are valid for men, women, men having sex with men, men having sex with women, and any other gender/orientation permutation. The only way it would be SYNTH would be if we made some conclusions or analysis about MSM which were unsupported by those Sources; this is not the case. Thank you ~Teledildonix314~Talk~4-1-1~ 20:41, 30 March 2009 (UTC)


 * Comments FWIW you're both right. Hfarmer has a valid point there that even if we have no problem accepting those statements as applying here we're likely better off finding ones that speak specifically about MSM sex benefits. There's been quite a few books written on the subject and plenty of studies so I've simply cleaned this up and added sources. The article is improving and that's what ultimately counts. Thank you both for watching out for this. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   20:54, 30 March 2009 (UTC)


 * Question It's accurate and reliably sourced, but my question is whether or not it's actually relevant to the topic. It's information that is adequately covered in other articles on Wikipedia on human sexual relations.  I agree that we can cover the material, but I see no reason why we should.  SDY (talk) 21:03, 30 March 2009 (UTC)


 * Comment @Teledildonix314 To accept your logic we have to do two things. We would have to ignore the heterosexual bias of our society (let's face it at least 90% of people are heterosexual can you really blame them?).  Studies like the ones cited previously we can assume deal with heterosexual sex between consenting adults.  The second thing we would need to do is ignore that danger that such logic, if accepted leads to say applying that positive information to articles about sexual relations which are explotative, or just taboo to our culture.  @Banjeboi Wow we actually agree.  I am trying to find the right words to google to get the sources but I am sure they exist.  It seems you already knew where to look.  @SDY Well the information as it was here before could have been moved to some other article I suppose.  But having information that talks of the fact that MSM feel the same emotional and physical benefits from sex as heterosexuals do is IMO warranted. So much of this article is filled with negativity.  Basically according to it all any biological male, who has sex with another biological male is a disease vector.--Hfarmer (talk) 21:13, 30 March 2009 (UTC)


 * I guess the question for me is: is this article about the use of this term from an epidemiological or public health standpoint (i.e. "disease"), or is it about all male-male sexual relations (i.e. "sex")? I tend to read it as the first given my biases, and I really hadn't thought about it as anything else.  It's a term that was coined by the public health community and I've really only seen it in that context, but my experience with other contexts where it might be used is limited.  SDY (talk) 22:16, 30 March 2009 (UTC)


 * I hear you and the answer, IMHO, is that it started as being about the term but then became a bit of a coatrack for how promiscuous and diseased MSM are which is rather unhelpful. FWIW the articles on anal and oral sex are for all sexes wheread this has been trimmed to focus only on context for MSM. I'm trying to also consider what serves our readers best and wonder if after cleaning up the disparity in studies leftover from the previous version if it won't make more sense? -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   03:20, 31 March 2009 (UTC)


 * I guess I'm confused. I've never heard the term "MSM" used outside of the context of epidemiology.  There's some unpleasantness to the topic, that's for sure, but I'm concerned that the article could get away from what the context where this term is usually used.  I think it makes sense to cover the epidemiology idea under the rubric of a larger discussion of male-male sexuality, but is this the most appropriate title for that article?  SDY (talk) 04:32, 31 March 2009 (UTC)
 * There's a great shift in what labels people apply to themselves and are willing to accept. We saw this with dyke vs lesbian vs SSL vs genderqueer, etc etc. The same concept is used in other fields of scientific study as well. Traditionally there has been a massive bias against studying and reporting non-heterosexual ... anything but that is starting to shift a bit as well. Compounding that was the previous rather pointy presentation. I got cleaned up a section on HPV. Our previous version stated MSM are X times more likely to get anal cancer do to HPV; this is (i) inaccurate and (ii) grossly misrepresents the sourcing which states that most all sexually active people in the US will get HPV and anal cancer is quite rare although gay, bi and immuno-suppressed men are more likely to have advancements such as anal cancer. The AIDS section is the last to be cleaned up. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   19:50, 31 March 2009 (UTC)

I have heard the term MSM used outside the context of epidemiology. When it comes to the outreach to the communities defined to be MSM. I think the answer is to trim out anything that does not deal specifically with epidemiology of HIV aids or related illnesses. Which I am afraid would make it sound like MSM's are just disease vectors. But if the article is just about the medical/preventive aspect that is unavoidable. I can only hope that it would make a reader see the need for money for outreach and prevention. But that is not the purpose of WP, just a hope.--Hfarmer (talk) 15:32, 31 March 2009 (UTC)


 * Umm, trim out anything that does not deal specifically with epidemiology of HIV aids or related illnesses? Then the article should be deleted and simply made a subsection of one of the AIDS/HIV articles. I think that approach is quite misleading. Even if the term/concept was originally in relation to HIV - which I'm not convinced of given the many decades of sex research - it is not solely related to HIV and it's a disservice to ourselves and our readers to push that. I think it's more helpful to explain this comes down to sexual behaviours vs identity - which we do seem to do. That MSM is still problematic - like with trans issues, which you are aware. What are they key sexual behaviour differences and what are soem of teh key implications for someone who identifies as a MSM. My hope is that we can either answer there questions of what this is about and refer them to good articles elsewhere for more information. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   18:38, 31 March 2009 (UTC)


 * If you read through our current sixth reference, I think we can find quite a bit of good information about the struggles over this issue. It does specifically reference 1994 as the first use of the MSM initialism as a term in the context of public health.  The concept existed long before the public health usage, but this article was previously about the use of MSM in the specific epidemiological sense, a "term of art" (basically jargon), that is specifically related to communicable disease.  If the epidemiological use of the initialism is an insensitive or inaccurate view of reality we should find reliable secondary sources that say that and include that context.  We don't want to confuse MSM (jargon) with Men who have sex with men (the broader universe of sexual activity between men), and in many cases I think we're talking about two related but distinct articles.  SDY (talk) 19:50, 31 March 2009 (UTC)
 * That may be true. I guess my first goal is to clean up the incorrect stuff but sorting out how to structure also makes sense. We also have at least one drive-by helper who is terribly interested in sex between men so I'm OK if we aren't in a rush to fix it all immediately. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   23:43, 31 March 2009 (UTC)

I agree with the original poster that the section on health issues should only contain aspects of sex that specifically pertain to men who have sex with men. The descriptions of oral sex and the benefits of sex in general are out of place, though they should be referenced in conjunction with MSM. Otherwise, these inclusions are nothing but a Coatrack. The introduction in particular seems to be arguing that MSM are no more likely to face health risks than any other group, all before such a statement is even made. EJNOGARB 20:46, 31 March 2009 (UTC)
 * We all agree with you and each other, to a point, that's why it was re-written and resourced. And Coatrack usually applies to BLPs but since there is ongoing discussion about content issues here on men having sex with each other you could explain how you see it applying? -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   23:23, 31 March 2009 (UTC)
 * Looking back over it, I think this problem can be somewhat solved by moving the sexual content out of "Health issues" and into a new section under "Sexuality". Next, I propose deleting the paragraphs that being with "Sex has many health benefits," "Anal sex most often refers," "Oral sex refers to," and "Some receivers regard" since none of these sections are exclusive to MSM. The new section would read as follows:
 * Men who have sex with men are sexually active with each other for a variety of reasons. When two males have sexual intercourse, there is not a possibility of reproduction. Historically, anal sex has been popularly associated with male homosexuality and MSM, though many MSM do not engage in anal sex. Among those who do, the insertive partner is referred to as the top or active partner. The man being penetrated is referred to as the bottom or passive partner. Preference for either is referred to as versatile. Another popular form of sexual behavior between MSM is oral sex.
 * The introduction of "Health issues" should then read as follows:
 * All human sexual behavior that involves contact with the bodily fluids of another person presents some risk of transmitting sexually transmitted infection (STI)s. Some health issues concern MSM in particular.
 * Opinions? EJNOGARB  00:38, 1 April 2009 (UTC)


 * At this point I would be opposed to those changes as all the articles we send the reader to are not about MSM and, as was pointed out above, we can't automatically translate research from one group to the next; that's the same issue with many of the disease statements. We comparing different things so the data is at odds with each other. That in itself might be worth reporting - the disparity in studies extrapolating data regarding men who have sex with men verses study protocols where men identified as gay or straight vs. gay, bi or straight vs. other options. Also the issues of social researching using quantitative and qualitative research. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   01:48, 1 April 2009 (UTC)
 * Any problems with moving the information about sex away from "Health issues" and into a new "Sexuality" section? EJNOGARB  08:25, 1 April 2009 (UTC)
 * I don't want to naysay before i see your proposal for how you would actually rewrite those paragraphs with an additional new section, if you propose a draft here, i'll consider what you're suggesting. However, i'm skeptical; because when i read the first two sentences of the lede, it describes the topic in terms of sexual activity research plus epidemiology research, so i don't exactly see why sexuality needs to be separated from health issues... the topic is basically an intersection of those two fields (specifically regarding men, of course) so i'm not clear why it would help the readers to have it bisected. Maybe you could write those paragraphs here, and we could see why you think it's a possible improvement? If it accomplishes better understanding, i could be persuaded to accept your rewrite. Thanks for offering to help make it more lucid. ~Teledildonix314~Talk~4-1-1~ 12:31, 1 April 2009 (UTC)
 * I'm going to boldly make the edit, which will only be a rearrangement of material. If anyone opposes such a change, I wouldn't fight the revert. EJNOGARB  15:57, 1 April 2009 (UTC)

Intestinal section?
MSM also have high rates of intestinal parasitism throughout the world.

According to one study's abstract, MSM can be an important risk factor for intestinal parasitism, although another study found no correlation between "detection of E. histolytica [the parasite which causes amoebiasis] and sexual practices".

I've removed the above because to me it's not clear how this should be tied into actual sex acts between men. The first ref is a massive PDF so if no one is willing I can see if the ref desk will help look at it. The other two seem to contradict each other. Any ideas? -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   19:13, 31 March 2009 (UTC)

Young and Meyer also misrepresented?
Currently we have - Young and Meyer (2005) note that the term has been in use within the public health discourse since 1990 or earlier (sentence goes onto different point).

This is a bit misleading, although Young and Meyer may have also stated that, their main point is that the term is problematic which we never seem to mention. From their "The Trouble With “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse" abstract;

[MSM and 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.

"The Trouble With “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse" is fully online and annotated and should help inform overhauling things a bit. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   21:29, 1 April 2009 (UTC)
 * I see no reason this cannot be added. I had never noticed. --Hfarmer (talk) 21:47, 1 April 2009 (UTC)
 * Thinking back I believe that was added back when i and another editor were clashing over weather the term MSM included transgender women. That may be what I was looking for when I first looked at this source....  Yeah I see no reason this problem could not be mentioned.  No terminology is perfect. --Hfarmer (talk) 21:50, 1 April 2009 (UTC)

Instructions section
The "how to have safe sex" section is clearly inappropriate under WP:NOTGUIDE. It's important information, sure, but it's not content for an encyclopedia article. It would be relevant as an external link, surely, but it should not be in the article proper. SDY (talk) 18:34, 19 April 2009 (UTC)


 * You are being ridiculous. Are you gonna delete Safe sex too? Phoenix of9 (talk) 18:36, 19 April 2009 (UTC)


 * No, because it's simply a description of the topic. The material in this article is instructions on how to do it.  There's a difference.  Wikipedia is not a health brochure.  To quote the policy, "While Wikipedia has descriptions of people, places and things, a Wikipedia article should not read like a how-to style manual of instructions, advice (legal, medical or otherwise) or suggestions, or contain how-tos."  Nothing in an encyclopedia should be written in the imperative (i.e. "Do this" "Don't do that").  SDY (talk) 19:14, 19 April 2009 (UTC)
 * You kidding me? See Safe_sex. Just description of the topic? Dont be friggin ridiculous. Phoenix of9 (talk) 19:18, 19 April 2009 (UTC)
 * That plays with fire a little bit, but it's not quite as blatant as the removed section. Also, there it is obviously relevant because the article is about safe sex.  Here it's just evangelism.  For a good cause, perhaps, but still not appropriate per policy.  SDY (talk) 19:39, 19 April 2009 (UTC)
 * What about if we drop the imperative? Phoenix of9 (talk) 19:40, 19 April 2009 (UTC)
 * Still doesn't answer the question of why safe sex is relevant to the article. The term is most commonly used to describe a set of individuals, and should be focused on the broader meaning and implication of the term, mainly the difference between activity and identification and characteristics associated with the group.  Information that isn't specific to MSM and is just about sex in general should be covered only in passing with an obvious link to the relevant article.  SDY (talk) 19:55, 19 April 2009 (UTC)
 * Safe sex info for MSM isnt relevant to this article? Phoenix of9 (talk) 19:58, 19 April 2009 (UTC)

(undent) If it's 1) specific to MSM and 2) isn't in the format of instructions or advice, I wouldn't object. My bone to pick with this article is that it is really two articles: one about male-male sexual relations generally and another about a classification used for research purposes (where this article began and was until very recently and where the specific phrase is almost exclusively used). It is relevant for the first, but it is totally irrelevant for the second.

Is this article about people or about sex? If it's about sex, we should give it a new title. SDY (talk) 20:12, 19 April 2009 (UTC)


 * You dont make sense. People have sex. Those are not two discrete categories. "The term was created in the 1990s by epidemiologists in order to study the spread of disease among men who have sex with men, regardless of identity.[2]" So health (and safe sex) is very related to this article. Phoenix of9 (talk) 20:54, 19 April 2009 (UTC)


 * Is there some particular reason you're being so confrontational about this? Health is, safe sex is in the context of health, but we have a whole article on it and going into detail here is really rather redundant.  As I said, I don't mind including the information within the broad version of the article, I'd just like to split out the research term from the broader universe of male-male sexuality.  It's an oft-misunderstood term and explaining why it is not simply synonymous with "gay" is good use of article space.  It's also a term that has had some controversy over whether it is an appropriate grouping.  It has an academic (literally!) relationship to sexuality, but it's not "all the same thing."  SDY (talk) 21:24, 19 April 2009 (UTC)


 * Actually this is the main article addressing specifically issues of men who have sex with men. These are hardly "how to" instructions and well within the spirit of presenting relevant information for our readers' benefit. We seem to be going to great lengths to explain how MSM are disease-prone and yet you're opposing the most basic and widely accepted safer-sex guidelines that address those issues concisely. I'm afraid I quite disagree with you on this. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   17:36, 21 April 2009 (UTC)


 * As I stated above, I'm not really all that opposed to the information, just opposed to writing it in a "how to" fashion (specifically the imperative of "do this, don't do that") and including large chunks of generic information that aren't specific to the topic at hand. As far as "great lengths" are concerned I believe it's appropriate, since it's giving organizations such as the CDC and respected academic research due weight on the topic.  It's uncomfortable information, but the idea that MSM are at high risk for a variety of diseases is more or less uncontested from a public health perspective.  SDY (talk) 23:07, 21 April 2009 (UTC)
 * We are presenting guidelines which are pretty un-howto as it gets. This is the article about sexual practices amongst men. We are presenting copious details about how MSM are walking disease vectors so relevant information outlining the most basic safe-sex guidelines is more than appropriate. It provides some balance to show that we are offering all relevant information on the subject - not just the death and disease bits. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   08:39, 22 April 2009 (UTC)
 * What you're advocating is essentially sugarcoating some rather bleak information, but I don't see any basis for doing that in the sources I've read. I can understand the desire to soften the blow, but if you can't see that "Avoid contact with a partner’s bodily fluids and with any visible genital lesions." is advice, we're going to need an RfC or at least a third opinion because that reads to me like unvarnished medical advice, which is clearly inappropriate for a variety of reasons.  It could be phrased as "such-and-such study shows that MSM who practice safe sex according to recommendations are at much lower risk etc.. .  Those recommendations include avoiding such and such, using foo when bar, etc... ."  The information can be included indirectly, but the point of this article is not to advise or educate on what they should do (especially not in highlighted bulleted lists), but rather to inform them of what is.  What is includes some very disturbing and bleak numbers, and people who would want to do further research should get real medical advice if they are concerned, rather than the fortune-cookie generalities of Dr. Google.  Wikipedia does not provide medical advice because we cannot verify that it is not bad advice, and the legal ramifications of being held responsible for providing bad medical advice are more than the foundation is comfortable with.  SDY (talk) 15:11, 22 April 2009 (UTC)
 * So just to be more clear here you think we're not only providing how to information but also doling out bad medical advice? That really seems like a lot of bad faith and misapplication of Medical disclaimer; these are pretty basic and generalized guidelines that health departments, worldwide even, apply. "Avoid contact with a partner’s bodily fluids and with any visible genital lesions" is a basic safe-sex guideline. Unclear why you think we should say in 4000 words what 400 will cover just fine. This is not disputed or controversial information, Safe sex goes into more details so I guess we could link to that as well. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   23:59, 22 April 2009 (UTC)

(undent) It's not particularly controversial, but it's still medical advice and there's a blanket ban on medical advice from the standpoint of the precautionary principle: it's unreliable, therefore it's no good. Wikipedia is by nature an unreliable source, people should get important information like that from trusted sources.

It's becoming clear to me that this conversation isn't very productive and that we need further input. Do you agree? SDY (talk) 01:13, 23 April 2009 (UTC)


 * I'm re-reading this to be more clear of what you think are the issues. "Here it's just evangelism." comment above certainly doesn't help but you may have a point. First off though, this is the safe sex article for MSM - that is, non-heterosexual men - as opposed to the one general one for all sexes and genders or one just for women. So even though the foucs here has been how MSM are more prone to disease, per NPOV this information would seem certainly relevant to balance out the heatlh issue instead of only discussing how MSM are diseased. The next issue seems to be voice and tone. I may be interpreting that wrong but in essence the apprearance of us telling our readers what to do. My hunch is that a wonky but well crafted line like The following guidelines are generally agreed upon by public health officials for MSM or similar. Also that MSM are highly likely to get certain diseases is itself a sources of controversy. There have been protests and teach-ins about how health officials have caused harm by incorrectly labelling a disease outbreak as a major concern for MSM, a gay disease that is, yet further research showed it to be misleading and alarmist and more prone to other populations and those were those folks who needed to hear the info instead of characterisizng gay people, again, of being diseased which this article has been doing. So, this is the main article overviewing health concerns for MSM with concise information of relevant areas pointing to main articles. For instance, anal sex, is about all people so includes information irrelvant to MSM. So we outline the relevant issue here and they refer there. I don't see creating a whole MSM health issues article when this one can grow and split if that is actually needed. I also don't see the need to hava MSM anal sex article when we can achieve the same ends with less words or work. Given all this, does it seem to you like the issue really is the tone so maybe some disclaimerish bits would help resolve the concern? -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   10:54, 23 April 2009 (UTC)


 * We've come a long way since GRID, and including that history would be very appropriate for this article. Examples of how the association has been abused or misused would not be far off either.  That they aren't the only high risk group is probably a helpful sentiment to add as well, but for HIV in particular, especially in developed countries, this is one of the highest risk groups.  It may be a badly defined group, and that's worth covering in the article.


 * Long version From an epidemiological standpoint, the type of sex isn't a big deal. It will spread faster among groups engaged in higher risk activities (MSM/IDU being the highest risk for the US), but it's mostly a question of contact.  Risk of disease is essentially the sum of (chance of transmission)*(number of opportunities)*(chance partner is infected).  Assuming the first term is not drastically different (i.e. protected sex reduces it to a very low order of magnitude) and the second term is not drastically different (the article addresses this somewhat), then the third term is really what drives the risk.  In sub-Saharan Africa, that risk is astronomical no matter who the contact is.  Since MSM are socially and sexually isolated, they can be a "sub-Saharan Africa" even if they share the same physical boundaries as lower risk groups because of the "geography" of sex.  Short version Lots of detail about types of sex doesn't really add much to the discussion of health risks.


 * Including the information about safe sex is far from a bad thing, it just can't be in a format that tells the reader what to do. Setting it off as a "this is what reliable people say" isn't quite what I had in mind, but it gets the job done and that's what matters.  SDY (talk) 15:31, 23 April 2009 (UTC)


 * Even more valid content that deserves due consideration. I seemed to recall someone was working on a history of AIDS regarding LGBT communities which may help inform this. See if that title starts to address the issues. -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   15:48, 23 April 2009 (UTC)
 * My POV on this is, that there is no reason to exclude this type of information. The reason to include it is concern for the greater good.  Like it or not young internet generation people think of wikipedia as a source with some kind of credibility.  If even one hears themself called a MSM and reads info about safe sex here it could save their life.   However this information has to be incorporated in a encylopedic way. Not as  list of guidlines but more like.  Research by so and so and such and such found that doing XYZ reduces the chance that MSM will transmit HIV... do you feel where I'm comming from on that?  --Hfarmer (talk) 22:09, 23 April 2009 (UTC)
 * SDY is also totally correct about how the MSM groups are totally sexual isolated here. I am member of an even more isolated group, I am a pre-op transwoman, which has at times been included under MSM.  From time to time we compare notes and find that we have been with the same men.  Some of those men are known to also have sex with other men as well as transwomen.  They are the kneck of land that connects us with the larger MSM island.  Transwomen, who are sexually active with men, have a very high HIV rate.  Everyone of us knows someone who has died of HIV. Chicago used to have a triving transgender community, many bars and clubs catered to us, now not.  Let us not tap dance around this kind of information.--Hfarmer (talk) 22:16, 23 April 2009 (UTC)
 * It needs to be presented clearly though that, for the apt example of transwomen and HIV, they aren't getting HIV and other diseases because their bodies are physically more prone than non-transgender bodies to disease but because of societal and cultural discriminations and prejudices they are more likely to suffer from mental anguish, poverty, lack of opportunities for legal employemt, lack of relevant and culturally sensitive healthcare, etc etc which contributes to higher rates of diseases. The cultural spiral against all LGBT people is well documented in the medical community yet general practitioners on the "street" level are still far less likely to be sensitive to most issues and LGBT less likely to be forthcoming with relevant medical information. We should neither present the information isolated from the overall context nor sugar-coat any of it. These core issues cross many articles regarding LGBT folks so I do see us moving ina better direction.  -- <u style="font-size:14px; font-family: cursive;color:#8000FF">Banj e  <u style="font-size:14px;font-family: Zapfino, sans-serif;color:deeppink">b oi   03:27, 24 April 2009 (UTC)
 * That and anal sex is more risky. Phoenix of9 (talk) 21:39, 26 April 2009 (UTC)