Western perception of homosexuality

The population that has come to be referred to as "gay" in the West is not a descriptive term that would be recognized by all men who have sex with men (MSM) as known in the rest of the world. While gay culture is increasingly open and discussed, the world of MSM consists of a diverse population that often may respond differently depending on how communications in clinical settings are framed. "Gay" is generally used to describe a sexual orientation, while "MSM" describes a behavior.^[3]
Some men who have sex with other men will not relate to the term "gay" or homosexual, and do not regard sex with other men as sexual activity, a term they reserve for sexual relations with women. This is particularly true among individuals from non-Western cultures. Nevertheless, it is common in the US. Terms such as MSM or "same gender loving" are often used in place of the word gay. Men in Africa and Latin America engage in sexual relationships with other men while still referring to themselves as "heterosexual", which is known as being on the "down-low".^[4] The same is true of men who engage in homosexual activities in the military, gender-segregated schools and universities, or prison; most of them do not consider themselves gay but still engage sexually with members of their own sex in order to fulfill their desires.^[5]
There is a lack of information on sexual behaviour in most developing countries. The limited sources that are available indicate that although homosexual self-identification might occur relatively infrequently, the prevalence of homosexual behaviour is higher. These men are not taken into consideration in some sexual identity surveys which may lead to under-reporting and inaccuracies