Abstract
Introduction:
Heterosexual-identified men who have sex with men (H-MSM) experience sexual identity and behavior discordance. H-MSM may comprise 0.5–3.5% of adult heterosexual men. Understanding and accepting H-MSM as they self-identify may be necessary to implement effective public health and psychosocial interventions. This scoping review synthesizes research on H-MSM’s identity development, attraction, and behavior. Methods: Thirteen databases were searched and, using Covidence software, two independent reviewers screened 3617 titles and abstracts and 269 full texts to arrive at 124 articles meeting entry criteria. Ten independent reviewers then conducted thematic content analysis. Results:
H-MSM either expressed sexual identity uncertainty or justified maintaining heterosexual identity, due to fear of discrimination and little or no social support. H-MSM compartmentalized sexual behaviors as isolated events unrepresentative of their sexual identity. H-MSM further minimized same-sex behaviors to infrequent, recreational/sport, or economic coincidences with little partner communication regarding HIV and sexual health. Many H-MSM depersonalized male sex partners, denied same-sex attraction, and avoided gay-identified venues. Reviewed articles further reported H-MSM had negative emotional responses to sex with men (e.g., guilt, shame, disgust). Conclusion: H-MSM are unlike other heterosexual men and other MSM and require unique considerations for social policy and approaches for care. Policy Implications: Findings suggest H-MSM are mislabeled as “behaviorally bisexual” in sexual health screening, which may cause inaccurate epidemiology of sexually transmitted and blood borne infections.
Heterosexual-identified men who have sex with men (H-MSM) experience sexual identity and behavior discordance. H-MSM may comprise 0.5–3.5% of adult heterosexual men. Understanding and accepting H-MSM as they self-identify may be necessary to implement effective public health and psychosocial interventions. This scoping review synthesizes research on H-MSM’s identity development, attraction, and behavior. Methods: Thirteen databases were searched and, using Covidence software, two independent reviewers screened 3617 titles and abstracts and 269 full texts to arrive at 124 articles meeting entry criteria. Ten independent reviewers then conducted thematic content analysis. Results:
H-MSM either expressed sexual identity uncertainty or justified maintaining heterosexual identity, due to fear of discrimination and little or no social support. H-MSM compartmentalized sexual behaviors as isolated events unrepresentative of their sexual identity. H-MSM further minimized same-sex behaviors to infrequent, recreational/sport, or economic coincidences with little partner communication regarding HIV and sexual health. Many H-MSM depersonalized male sex partners, denied same-sex attraction, and avoided gay-identified venues. Reviewed articles further reported H-MSM had negative emotional responses to sex with men (e.g., guilt, shame, disgust). Conclusion: H-MSM are unlike other heterosexual men and other MSM and require unique considerations for social policy and approaches for care. Policy Implications: Findings suggest H-MSM are mislabeled as “behaviorally bisexual” in sexual health screening, which may cause inaccurate epidemiology of sexually transmitted and blood borne infections.
| Original language | English |
|---|---|
| Journal | Sexuality Research and Social Policy |
| DOIs | |
| Publication status | Published - 15 Jul 2025 |
ASJC Scopus subject areas
- Gender Studies
- Health (social science)
- Sociology and Political Science
Keywords
- Heterosexual men who have sex with men
- Identity
- Scoping review
- Sexual identity-behavior discordance
- Social work
