Identity development, attraction, and behaviour of heterosexually-identified men who have sex with men: A scoping review

Abstract Heterosexually identified men who have sex with men (H-MSM) experience discordance between their sexual identity and behaviours. Studies with large, mixed samples suggest that H-MSM may comprise 4–7% of the sexually active adult male population. Understanding and accepting H-MSM as they self-identify may be necessary to implement effective public health and psychosocial interventions. There is no known knowledge synthesis of H-MSM. This scoping review synthesizes primary studies about H-MSM identity development, attraction, and behaviour. Thirteen databases were searched, and two independent reviewers screened 3,617 titles and abstracts and 269 full-texts to arrive at 120 articles meeting inclusion criteria. Ten independent reviewers then conducted thematic content analysis. 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 same-sex sexual behaviours as isolated events unrepresentative of their sexual identity. H-MSM further minimized these behaviours to infrequent, recreational/sport, or economic coincidences with little partner communication regarding HIV and sexual health. Many H-MSM also 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). Findings also suggest H-MSM are mislabeled in sexual health screening. H-MSM are unlike other heterosexual men and other MSM, and require unique considerations and approaches to sexual and mental health care.