MSM: The low-down on the down-low


The term “men who have sex with men,” or MSM, can be confusing, as is the idea that a man can identify as straight yet still have sexual contact with other men. So, what does it mean and why is it used?

The term MSM originated in the 1980s in the context of efforts to understand men’s sexual behaviour as it relates to HIV transmission and prevention.

Experts in the HIV field recognised that not all men who engage sexually with other men identify as gay or bisexual. This made it difficult for their HIV prevention and treatment messaging to reach all those men who may be at higher risk of HIV.

Because some MSM don’t identify as gay they might not read or watch sexual health material about safer sexual practices between gay men because they don’t think it’s for them.

Another concern was that some MSM who are married to women have unprotected sex with men in secret and then also have unprotected sex with their wives, which puts those women at high risk of getting infected with HIV.

So, it’s important to reach all MSM because the risk of HIV during unprotected anal sex is as much as 18 times greater than vaginal intercourse. The reasons for the increased risk include factors such as:

  • The fragility of rectal tissues, which allow the virus direct access into the bloodstream through tiny tears or abrasions
  • The porousness of rectal tissues, providing access even when undamaged
  • The high concentration of HIV in semen and pre-seminal fluid if someone is not on HIV treatment

The term MSM was thus created to encompass all men who have sex with men. The idea was to separate sexual behaviour from sexual identity and to reduce the potential stigma that is associated with gay identity in some communities and regions.

This means that all sexually active gay or bisexual men are MSM but not all MSM are gay or bisexual. MSM can refer to a wide range of groups of men that include:

  • Self-identified gay, bisexual, pansexual, queer and sexually fluid men
  • Self-identified heterosexual men who engage in voluntary sex with other men in prison
  • Self-identified heterosexual men who engage in sex with other men as a means of survival in prison
  • Men who have sex with men but have limited or no romantic feelings towards their male partners
  • Men who have sex with men for economic gains like some sex workers or porn stars
  • men who have sex with cisgender or transgender women but also have sex with men
  • Men who self-identify as “same-gender loving” and men who self-identify as “questioning”
  • Men who “experiment” sexually with other men, even if occasionally
  • Closeted men who don’t or can’t come out due to reasons like religion, culture or familial pressures, known by terms like After-9s or men on the “down-low”

Prevention strategies that target people based on “what they do” rather than “who they are” are more likely to reach more people who may be affected by a public health concern. They offer a larger number of men the opportunity to understand their risk and take the steps necessary for protection or treatment.

However, you may fit into the MSM category, it’s important to address your sexual health needs with health providers who are stigma and shame-free. Your sexual health is important, not only for you, but also for your partners and the community at large.


Engage Men’s Health offers free and confidential sexual health services to gay, bisexual and other MSM in Johannesburg, Nelson Mandela Bay and Buffalo City. They welcome all men who have sex with men – whether you are gay, bi, sexually fluid or straight, out or in the closet – without stigma or shame.  For more information, to discuss your sexual health needs or to make an appointment, call or WhatsApp 082 607 1686.

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