Public health research utilizes a number of terms that may be confusing to those who aren’t familiar with the literature. These words can also be used as short-hand and, as a result, conflate or obscure the meaning originally intended by use of the term. In this post, I will talk about two terms that are widely used throughout SexLab’s work and research: WSW/MSM and sexual minority.
The terms ‘women who have sex with women’ (or WSW) and ‘men who have sex with men’ (written as MSM) are used widely throughout public health literature. The integration of these terms can be traced to a de-stigmatization of HIV and AIDS (Young and Meyer 2005). While HIV/AIDS had been associated with gay identity in the early period of the epidemic, activists wanted to shift the focus to specific behaviors that put one at risk for contracting the virus, rather than sexuality or community. These terms were designed to be more inclusive, as they allow for the targeting of individuals who are engaged in same-sex behavior but do not identify with a queer sexuality (Bauer and Jairam 2008). Sexual behavior often relates to health outcomes of interest, and so specifying ‘WSW’/’MSM’ rather than LGBTQ+ allows researchers to study the ways that sexual behavior, independent of identity, relates to people’s wellbeing.
In some cases, however, these behavioral terms have become stand-ins for identity, albeit identities that are rarely claimed by the individuals they describe. Rather than describing the intricacies of sexuality, ‘MSM’/’WSW’ often replace other terms that speak directly to one’s sexual identity. Labeling people who clearly use and identify with other terms (such as lesbian, bisexual, gay, queer, or same-gender loving) as ‘MSM’ or ‘WSW’ can perpetuate the erasure of queer culture and history. ‘MSM’/‘WSW’ also reduce the complex meanings of terms like lesbian, gay, and bisexual to a strictly sex-based definition. Such a reduction in scope may serve to perpetuate the belief that queer individuals are sexual deviants, or that acts of sex are the only thing to differentiate LGBTQ+ people from heterosexuals. Using ‘MSM’/’WSW’ when exploring topics other than sexual behavior, as is often seen in health research, is inaccurate and adds unanswered complexity to researcher’s agendas.
Utilizing the term ‘sexual minority’ can be more accessible and broad (Ghaziani 2011). It is inclusive of individuals who may not identify with a queer identity, or are fluid in their identifications. For example, researchers have shown a considered amount of fluidity over time in the terms that women use to describe their sexual identity (Diamond, 2008). Ostensibly “stable” terms such as lesbian and bisexual are suddenly on shaky ground when usage of the terms themselves becomes the central focus.
While acknowledging that “sexual minority” can account for such fluidity, there are also significant drawbacks to researching with an umbrella term. Each identity within the LGBTQ+ population lives through a variety of experiences, and work that is geared towards one section may be inappropriate for the others. For example, women who identify as lesbian often face different issues and have different health outcomes than those who identify as bisexual (Fredriksen-Goldsen et al. 2010). Grouping them together does not acknowledge how interactions within queer communities and in the world at large may differ depending on one’s specific sexual minority identity.
Unlike ‘MSM’/’WSW’, the term ‘sexual minority’ has been expanded into social science consciousness through research that explores attraction in addition to identity and behavior. As prior SexLab research has shown, it is important to consider these different aspects of a person’s being when observing psychosocial outcomes (Johns, Zimmerman, and Bauermeister 2013). Yet research on this population rarely includes questions of attraction, nor does it consistently address changes to identity over time.
Additionally, norms of sexuality and gender are enforced when everyone who operates outside a standard is classified as a ‘sexual minority.’ This labels any slight variation to fiercely heterosexual, cisgender performance as divergent.
These critiques do not suggest the abolition of certain terms, but show the need for nuanced perspectives. that encourage people’s critical, strategic use of words. Rather than capitulating to academic norms, practitioners and researchers should carefully consider the groups they are addressing and use terms that: are most appropriate for that audience, accurately reflect the groups with which they are working, and are respectful to participants’ own definitions.
In the realm of research, identity terms – claimed or imposed – should not necessarily take precedence over lived experiences of discrimination, relationships, and norms that emerge from the intersections of sexuality, race, ethnicity, age, class, ability and gender. Such considerations provide researchers the opportunity to truly work for the benefit of queer individuals and acknowledge the cultural beauty and strength of diverse communities.
Bauer, G. R., & Jairam, J. A. (2008). Are lesbians really women who have sex with women (WSW)? Methodological concerns in measuring sexual orientation in health research. Women & health, 48(4), 383-408.
Fredriksen-Goldsen, K., Kim, H., Barkan, S., Balsam, K., & Mincer, S. (2010). Disparities in health-related quality of life: a comparison of lesbians and bisexual women. American Journal Of Public Health, 100(11), 2255-2261.
Ghaziani, A. (2011). Post-gay collective identity construction. Social Problems, 51(1), 99-125.
Johns, M. M., Zimmerman, M., & Bauermeister, J. A. (2013). Sexual attraction, sexual identity, and psychosocial wellbeing in a national sample of young women during emerging adulthood. Journal of youth and adolescence, 42(1), 82-95.
Young, Rebecca M., and Ilan H. Meyer. “The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse.” American journal of public health 95, no. 7 (2005): 1144.