ABSTRACT
More than two decades ago, Herdt (1981, 1984), Parker (1985, 1991) and others (Carrier, 1985) highlighted the ethnocentricity of the Western assumption that ‘heterosexual’ and ‘homosexual’ are universally meaningful categories of sexual identity. In parallel, historians (Foucault, 1985, D’Emilio, 1998, Weeks, 1989) began to provide accounts of the emergence of sexual identities organised around same-sex or other-sex desire (also referred to as ‘object choice’). Evidence has continued to proliferate demonstrating that in many societies, at many historical moments, men and women do not necessarily perceive themselves and others as belonging to sexual identity categories that reflect the gender of their desired partners. The public health response to this insight, as others have noted and critiqued (Khan and Khan, 2006, Decena, 2008, Ford et al., 2007, Young and Meyer, 2005), has been to label groups according to practice rather than identity – e.g. ‘men who have sex with men’. Disease surveillance and prevention interventions, on the other hand, have subsequently (and ironically) treated those groups as if they were stable identities, targeting them with ‘culturally appropriate’ prevention campaigns.
