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Overlooked Populations and HIV Prevention

Summer 2001

Since the beginning of the AIDS epidemic the world has been quick to throw labels on persons who are infected with or at risk of contracting HIV. "Gay . . . IDU . . . Bi . . . Straight." Although it's easier for statistical purposes to lop everyone into one of these groups, unfortunately it doesn't work in the real world. Not everyone fits so easily into the little boxes that the CDC has set up for them.


The term MSM (men who have sex with men) is a category created by the governments and funders to describe homosexual men. Some of the logic behind the MSM label is to not discourage HIV positive men who do not identify themselves as being homosexual nor being "gay" from accessing care and services for HIV/AIDS. In addition, not all homosexual men identify with the term "gay." Because of the social stigma that is attached to it, some men prefer to call themselves "same gender-loving," for example.

Although many gay rights activists fought over the years (and continue to fight) for equal rights and the ability to embrace their sexuality, there are still many men who have not quite come to terms with it.


This brings us to another acronym that the governments have created: "MSM/W," which stands for (men who have sex with men and women). The governments try to attach labels to every single behavior that is humanly possible. There are some people who believe that the governments have missed their mark in terms of (for lack of a better term) bisexuality. However, it is known that there are many men who live a "heterosexual life-style" yet still engage in same-gender sex. For governmental granting purposes these men would most likely be called "MSW/M."

As we attempt to find a better and broader range of boxes to place people in, we are finding that among our original risk groups, there are many, many sub-populations that have been overlooked. One of these groups who have yet to receive their official box to check is "men who have sex with women (and occasionally men)" . . . MSW/Ms. More specifically, we are discussing men who identify as heterosexuals, but have had prior sexual experiences or even on-going affairs with other men.

Not fitting the traditional picture of bisexuality, and not absolute heterosexuals by definition, this population has been largely overlooked when it comes to prevention. Many of them have wives, girlfriends, or children but are the least likely to get tested for HIV. If they do get tested, they sometimes list their risk category as "heterosexual contact," which may not be totally accurate.

Disclosure for them, means acknowledging a behavior that may be unacceptable in their family or culture. For some men who are in institutions like prisons, male-to-male sex happens while in that situation, but does not normally occur on the outside. If these men do disclose that they have ever had sex with another man, they are automatically categorized as being "gay."


Fear of such stigmatization and the denial that surrounds it, often prevents them from accessing services, seeking treatment, and/or using a condom with their female partners. Though many of these men self-identify as being completely heterosexual, they truly demonstrate the difference between sexual identity and sexual behavior. In a study conducted by the CDC from 1994 to 2000 entitled "The Young Men's Survey," results showed that 117 out of the 1,224 men who were interviewed identified as being heterosexual. In their self-reported sexual behavior, about 15% of these men had engaged in anal sex with males, 3% had unprotected sex with men, and 12% had unprotected sex with females in the 6 months prior to the interview.

It is widely known that young MSMs of color are particularly at risk for HIV infection. It is widely known that women of color are at disproportionate risk for HIV infection. It is only logical that MSW/Ms are probably not far behind. In The Young Men's Survey, black males had the highest rates of seroprevalence (HIV-positive) of all races.

In an effort to find interventions that will work with MSW/Ms, The City of Los Angeles AIDS Coordinators Office is developing a new study. The main focus of this new study will be MSW/Ms of color. Traditionally marginalized, and completely overlooked throughout the epidemic, the City hopes to find out what some of the gaps are in reaching this group, while also learning from them what strategies may assist in breaking down some of the social barriers that perpetuate the epidemic. From this, it is hoped that new and effective interventions will be developed to encourage testing and treatment for this population. The study will interview men throughout the community. Interviews will be completely confidential, open-ended, and unstructured. In addition, the City would like to interview women who are involved with the men in this target population in hopes of helping the women reach their partners to encourage HIV testing and treatment.


If you have a friend or partner who may be a good candidate for this study, or if you would just like to receive more information, please contact Jacqui Khorasanee at the LA City AIDS Coordinator's Office, 215 W. 6th St. Los Angeles, CA 90012. Alternately, call 213.847.3359 or send E-mail to You can also contact Khatija Noorullah at the Women Alive offices by calling 323.965.1564 or 800.554.4876.

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This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.