Dividuality,masculine respectability and reputation: How masculinity affects men's uptake of HIV treatment in rural eastern Uganda

There is increasing evidence in SSA that once infected with HIV men are disadvantaged compared to women in terms of uptake of treatment. In Uganda fewer men are on treatment, they tend to initiate treatment later, are difficult to retain on treatment and have a higher mortality while on treatment. This article discusses how men's response to HIV infection relates to their masculinity. We conducted participant observation and in-depth interviews with 26 men from a rural setting in eastern Uganda, in 2009–2010. They comprised men receiving HIV treatment, who had dropped treatment or did not seek it despite testing HIV positive, who had not tested but suspected infection, and those with other symptoms unrelated to HIV. Thematic analysis identified recurrent themes and variations across the data. Men drew from a range of norms to fulfil the social and individual expectations of being sufficiently masculine. The study argues that there are essentially two forms of masculinity in Mam-Kiror, one based on reputation and the other on respectability, with some ideals shared by both. Respectability was endorsed by ‘the wider society’, while reputation was endorsed almost entirely by men. Men's treatment seeking behaviours corresponded with different masculine ideologies. Family and societal expectations to be a family provider and respectable role model encouraged treatment, to regain and maintain health. However, reputational concern with strength and the capacity for hard physical work, income generation and sexual achievement discouraged uptake of HIV testing and treatment since it meant acknowledging weakness and an ‘HIV patient’ identity. Men's ‘dividuality’ allowed them to express different masculinities in different social contexts. We conclude that characteristics associated with respectable masculinity tend to encourage men's uptake of HIV treatment while those associated with reputational masculinity tend to undermine it.     

HIV-negative gay men's accounts of using context-dependent sero-adaptive strategies

We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed-methods study. A subsample of participants who reported recent condomless anal sex (n = 33) were purposively recruited into an embedded qualitative study and completed two in-depth qualitative interviews. Analysis of baseline interviews elicited three narratives relevant to men's use of context- or relationally-dependent HIV-risk management strategies: (1) seroadaptive behaviours such as partner testing and negotiated safety agreements used with primary sexual partners, (2) serosorting and seroguessing when having sex with new partners and first-time hookups and (3) seroadaptive behaviours, including one or more of seropositioning/strategic positioning, condom serosorting and viral load sorting, used by participants who knowingly had sex with a serodiscordant partner. Within men's talk about sex, we found complex and frequently biomedically-informed rationale for seroadaptation in men's decisions to have what they understood to be various forms of safe or protected condomless anal sex. Our findings support the need for gay men's research and health promotion to meaningfully account for the multiple rationalities and seroadaptive strategies used for having condomless sex in order to be relevant to gay men's everyday sexual decision-making.     

Amigos and amistades: the role of men's social network ties in shaping HIV vulnerability in the Dominican Republic

While men's social networks have been identified as a source of influence on sexual behaviour, less is known about the different types of friendship ties within men's networks. We analysed data from qualitative in-depth interviews with 36 men in Santo Domingo, Dominican Republic who are current or former sexual partners of female sex workers to understand how: (1) men describe trust and communication with different types of friendship ties, (2) characteristics of trust and communication reflect norms of masculinity, and (3) these friendship ties influence HIV-related behaviours. We identified a distinction between amistades, social drinking buddies who are not trusted, and amigos, trusted friends. The majority of men lacked any amigos and some had neither amigos nor amistades. In general, men reflected traditional norms of masculinity and said they did not feel they could discuss their relationships or emotional topics with other men. Trust and communication dynamics, and how norms of masculinity shape those dynamics, should be understood and addressed in the design of HIV prevention efforts with men's social networks as they have implications for the potential effectiveness of such efforts.     

Health help‐seeking by men in Brunei Darussalam: masculinities and ‘doing’ male identities across the life course

Using data collected through semi‐structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health help‐seeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help‐seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help‐seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of ‘hegemonic masculinity’ in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei.     

‘The study has taught me to be supportive of her’: empowering women and involving men in microbicide research

Recognising that women often have little control over most HIV-prevention methods, including condoms, researchers have made efforts to develop new bio-technological interventions, such as microbicides, that could allow women greater autonomy in HIV-prevention decision making. In many situations, women are unable to negotiate condom use with their partners, meaning that they could be better protected through the use of an effective microbicide. This paper uses qualitative data from the Microbicide Development Programme 301 (MDP301) microbicide trial in Johannesburg, South Africa. Data is taken from in-depth interviews with male partners of female trial participants (n = 28), six focus-group discussions involving male partners of trial participants (n = 4) and female participants (n = 2). Data show that men's involvement in microbicide research ranges from a disinterest in trials to the desire to actively take part in and promote research that affects the health of themselves and their partners. Results showed that some participants were reluctant to disclose trial involvement and product use to their partners, making identifying men as potential research participants problematic. This paper considers how to involve men in microbicide research without undermining women's sense of empowerment and ownership of the trial and the product that is being tested.     

Men who have sex with men in Kisumu,Kenya: support group membership and knowledge of HIV-risk factors

Men who have sex with men are an important yet marginalised population for HIV prevention in Africa. We conducted a two-phase study (individual qualitative interviews and a survey) of men who have sex with men, aged 18–34 years of age and living in Kisumu, Kenya. Approximately half (27/51) of survey respondents reported belonging to a support group. The odds of belonging to support groups were greater for older men (aged 24–34 versus 18–23 years [OR = 5.20; 95%CI = 1.27–26.66]). More than two-thirds (68.6%) of survey respondents were categorised as having high knowledge of HIV-risk factors. Most respondents (94.1%) correctly reported lack of condom use during vaginal sex as a risk factor for HIV, but slightly fewer (82.4%) recognised lack of condom use during anal sex as an HIV risk factor. Among the 15 interviewees, the following were included as greatest needs: health information (n = 5), safe lubricants (n = 5), condoms (n = 4), healthcare facility or men-who-have-sex-with-men-friendly health services (n = 3) and advocacy (n = 2). Kenyan men who have sex with men have developed support groups and have unmet needs for information, lubricants and condoms and services. Partnering with support groups offers an opportunity for organisations to reach men who have sex with men with accurate health information, provision of safe sexual lubricants, condoms and other health and social services.     

Gender,masculinity and migration: Mexican men and reproductive health in the Californian context

An appreciation of the social, cultural and economic dimensions of gender and sexuality is important in increasing reproductive health service utilisation. This analysis of recent Mexican male immigrants in Southern California focuses on changing views of gender roles, masculinity and relationship dynamics in the context of migration in order to explain low levels of reproductive healthcare utilisation. Semi-structured, in-depth interviews were conducted with 23 men who had migrated from Mexico. Some men saw their migratory experience as empowering, both individually and within the couple context. Migration reinforced positive male qualities, such as being a good provider. However, for others, the levelling of economic power between immigrant couples challenged traditional male gender roles and threatened men's identities. Maintaining control and decision-making power, especially in reproduction, remained tenacious, especially among older men. In response to immigration, however, men's views of ideal family size and contraceptive method preferences had evolved. The migration process caused some divisions in family networks and aspirations of fatherhood as an expression of masculinity contributed to varying levels of contraceptive use. Recommendations are made on factors that may empower male clients more actively to seek reproductive healthcare in the context of more equitable couple decision-making.     

‘But I'm not like that’: young men's navigation of normative masculinities in a marginalised urban community in Paraguay

Young men often define themselves and their masculine identity through romantic and sexual relationships, and their resulting sexual decisions can affect their successful transition into adulthood, as well as STI, HIV and pregnancy rates. This paper looks at how young Paraguayan men's peer groups, family and masculine identity formation influence their behaviours in sexual and romantic relationships. In Asunción, Paraguay, we conducted five focus-group discussions (FGDs) examining neighbourhood norms in 2010, with male peer groups ranging in age from 14 to 19 years. We then interviewed half the members from each peer group to examine their relationships with friends, family and young women and their beliefs about existing gender norms. Young men described two types of masculine norms, ‘partner/provider’ and macho, and two types of romantic relationships, ‘casual’ and ‘formal’. The language used to describe each spectrum of behaviours was often concordant and highlights the connection between masculine norms and romantic relationships. The perceived norms for the neighbourhood were more macho than the young men's reported behaviours. Norms cannot change unless young men speak out about their non-normative behaviours. This provides evidence for more research on the formation, meaning and transformation of male gender norms.     

Prostate cancer: embodied experience and perceptions of masculinity

Abstract While some argue that gender differences, which refer to the social classification into ‘masculine’ and ‘feminine’, have their source in ‘culture’, others argue there is no need to have an absolute dichotomy between culture and nature, or between constructionist and anti‐constructionist epistemologies. Although there has been much theorising about the body, until recently little attention has been paid to empirical evidence. This paper looks at the way in which prostate cancer and its treatment affects men's bodies, their roles and sense of masculinity. Interviews were conducted with 52 men, exploring their experiences of prostate cancer. Findings suggest that many men are reluctant to consult their doctors, because ‘men don’t cry’, thus reinforcing the notion that ‘masculinity’ is a social construction. However, while the illness and the side effects of surgical and radiotherapy treatments sometimes led to impotence and incontinence, the treatments that involved hormones were reported to have an additional, sometimes profound effect on libido, energy, ability to work, body shape and competitiveness. These side effects reduced some men's sense of masculinity. We conclude that the physical body as well as culture should be considered when trying to explain what it means to be masculine, and how illness may affect men's sense of masculinity.     

The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV

In South Africa, the frequent positioning of men's sexual behaviours as a prime driver of the HIV epidemic has generated much interest in men's sexuality. However, the relational nature of dominant male norms that exacerbate the risk of HIV transmission is inadequately understood. This study used sexual biographies to explore how men and women negotiate gendered norms and how this affects their sexual and reproductive health (SRH). A total of 50 sexual-history interviews and 10 focus group discussions were conducted with men, and 25 sexual-history interviews with women, with participants sampled from three age categories (ages 18–24, 25–55 and 55+years), a range of cultural and racial backgrounds and urban and rural sites across five provinces in South Africa. The narratives illustrate that men and women's SRH is largely dependent on the type and quality of their relationships. Men's sexuality was regularly depicted as being detached from intimacy and uncontrollable, which was premised as being opposite from and/or superior to women's sexuality and could justify men's high-risk sexual behaviours. Yet many participants also supported gender equitable relationships and endorsed accountable and healthy SRH behaviours. The narratives reveal that HIV-risky dominant male norms should be addressed relationally for the sake of better SRH outcomes.     

Intervening in masculinity: work,relationships and violence among the intimate partners of female sex workers in South India

Although health researchers have begun to examine the forms of violence and power dynamics that play out in the intimate relationships of female sex workers (FSWs) in India, this knowledge has tended to focus on the perspectives of women, leaving men’s motivations and attitudes relatively unexamined. This paper examines the contours of masculinity and gender norms from the perspective of the intimate partners of FSWs. Based on six months of ethnographic research in Northern Karnataka, the study employed two focus group discussions (FGDs) with Devadasi FSWs (N = 17), as well as four FGDs (N = 34) and 30 in-depth interviews with their intimate partners. Given the precarious labour conditions in this region, tensions developed in the participants’ relationships with FSWs, as these men were unable to meet local ideals of manhood. Violence became a way that men attempted to re-secure a sense of control in their relationships with women, and to fulfil fantasies of male power. We recommend that programs engaging men not only address intimate partner violence but also attend to the social and structural realities surrounding these men’s daily lived experiences.     

Fit to father? Online accounts of lifestyle changes and help‐seeking on a male infertility board

The reproductive realm is routinely viewed as a feminised space requiring women's commitment and labour. By contrast, men's procreative contributions and ‘reproductive masculinity’ is represented as unproblematic, with men assumed to be fertile across the lifespan. Recent scientific research has, however, cast doubt over these longstanding assumptions, suggesting that a link does exist between ‘lifestyle’ factors and male fertility. The notion that fertility can be improved with effort (for both women and men) can be located within wider cultural and political shifts which construct individuals as increasingly responsible for acting on health messages and engaging in self‐disciplining body projects. Through an exploration of ‘lifestyle changes’ within a men's online infertility discussion forum board, this paper examines how discourses of individualisation healthism and masculinity are reproduced and interlinked. Our thematic analysis indicates that ‘lifestyle work’ is construed as crucial for achieving conception ‐ and as a means to demonstrate men's commitment to the dyadic goal of parenthood, which in turn may challenge and extend previous notions of ‘reproductive masculinity’.     

Men's Use of an Internet-Based Decision Aid for Prostate Cancer Screening

Most medical organizations recommend informed decision making before undergoing prostate cancer screening. The authors conducted a detailed evaluation of men's use of an interactive, Web-based prostate cancer screening decision aid. Participants (N = 531) were 57 years old (SD = 6.8), 37% were African American, and 92% had Internet access. Men completed 2 telephone interviews, pre- and 1-month post–Web site availability. Half of the sample (n = 256) accessed the Web site. Multivariate analysis revealed that users were more likely than nonusers to be White (OR = 2.37, CI 1.6–3.6), previously screened (OR = 2.13, CI 1.07–4.26), have Internet access (OR = 3.66, CI 1.15–11.58), and to report daily Internet use (OR = 2.58, CI 1.47–4.55). Agreement between self-reported and actual Web site use was moderate (κ = .67). Tracking software revealed a mean of 1.3 (SD = 0.5) log-ons and a median of 38 min per log-on. Of participants, 84% used the values clarification tool, and more than 50% viewed each video testimonial. Baseline screening preference was associated with values clarification tool responses and Web site feedback. This study revealed that, beyond the digital divide, Web site use depended on more than Internet access. Further, electronic tracking of Web site use demonstrated overestimation of self-reported use, high use of interactive features, and effect of baseline screening preference on men's response to the Web site.     

‘It's like taking a bit of masculinity away from you’: towards a theoretical understanding of men's experiences of infertility

In the UK, nearly half of all cases of infertility involve a ‘male‐factor’. Yet, little empirical work has explored how men as men negotiate this terrain. Three interrelated concepts; ‘hegemonic masculinity’, ‘embodied masculinity’ and the linkages between ‘masculinities’ and male help‐seeking, provide the theoretical framework that guided a qualitative study conducted with 22 men experiencing infertility. The paper explores men's propensity to delay their help‐seeking in relation to infertility despite their desire for children. It also demonstrates how, in the context of infertility, the male body can be defined as both a failed entity in itself (unable to father a child) and a subordinated social entity (unable to measure up to hegemonic ideals) that characterises men's masculine identities. The paper also illustrates how men appear willing to accept responsibility for their infertility and adopt aspects of hitherto subordinate masculine practice. This does not, however, constitute the total unravelling of well understood and accepted expressions of masculinity. Finally, the paper demonstrates how infertility is perceived as having the potential to fracture current and even future relationships. Moreover, regardless of how well men measured up to other hegemonic ideals, ultimately they can do little to counteract the threat of other (fertile) men.     

Integrating male sexual diversity into violence prevention efforts with men and boys: evidence from the Asia-Pacific Region

Evidence shows the importance of working with men to reduce intimate partner violence and HIV-risk. Two claims dominate this work. The first is that interventions ‘reconstruct’ masculinities – these new formations of masculinity exist in opposition to existing ones and are healthier for men and less harmful for women. The second is that to be successful, such interventions need to address men's exclusion from the economy. Using a qualitative longitudinal cohort study of young men who participated in a gender transformative and livelihood strengthening intervention, as well as dyadic interviews with men's main female partners, we explore these claims. Data suggests men saw some improvements in livelihoods and relationships. However, challenging social contexts, including high rates of unemployment, peer networks and a dominant youth masculinity, limited change. Rather than reconstructing masculinity, a more subtle shift was seen with men moving away from ‘harmful’ aspects of a dominant youth masculinity towards a form of masculinity whereby male power is buttressed by economic provision and attempting to form and support ‘households’. Working with men on their livelihoods at an instrumental level encouraged participation in the intervention. Beyond encouragement, men's improving livelihoods afforded men the opportunity to materially demonstrate the social changes – in the form of shifts in masculinity – they were seeking to enact.     

“Straight-Acting Gays”: The Relationship Between Masculine Consciousness, Anti-Effeminacy, and Negative Gay Identity

Some gay men are preoccupied with traditional notions of masculinity and express negative feelings towards effeminate behavior in gay men. Various scholars have speculated that such attitudes by gay men reflect internalized negative feelings about being gay. Thus, we sought to assess the importance of masculinity among gay men, to compare their ideal versus perceived masculinity–femininity, to ask how gay men assess masculinity, and to test whether masculine consciousness and anti-effeminacy could predict negative feelings about being gay. Results from an online survey of 751 gay men in the United States (M _Age = 32.64 years, SD = 11.94) showed that the majority rated masculinity for themselves and in a same-sex partner as important, and they ideally wished that their behavior was more masculine (Cohen’s d = .42) and less feminine (d = .42) than they perceived it to be. Furthermore, one’s behavior was more important than how one looks when assessing masculinity. A multiple regression analysis showed that the degree to which they were preoccupied with masculinity and expressed anti-effeminacy accounted for 30% of the variance in negative feelings about being gay. These finding further support the idea that masculinity is an important construct for gay men and that masculine consciousness and anti-effeminacy are related to negative feelings about being gay.     

Male preschool teacher students negotiating masculinities: a qualitative study with men who are studying to become preschool teachers

The overall interest is to understand how men who study preschool teaching negotiate masculinities. Earlier research shows how male teachers negotiate masculinities when being in and entering a predominantly feminine work area, such as early childhood education [see, for example, Brody, D. L. (2015). The construction of masculine identity among men who work with young children, an international perspective. European Early Childhood Education Research Journal, 23(3), 351–361; Pirard, F., Schoenmaeckers, P., & Camus, P. (2015). Men in childcare services: From enrolment in training programmes to job retention. European Early Childhood Education Research Journal, 23(3), 362–369; Simpson, R. (2014). Doing gender differently. Men in caring occupations. In S. Kumra, R. Simpson, & R. J. Burke (Eds.), The Oxford handbook of gender in organizations (1st ed.). Oxford: Oxford University Press)]. It this article Connell's notion on hegemonic masculinity is reflected on in terms of negotiation. Semi-structured interviews were conducted with 38 men attending the preschool teacher-training programmes at three Swedish universities. The result shows two main themes for negotiation that were called ‘Becoming and being a “breaker”’ and ‘Coping with sticking out’.     

A cross-cultural examination of masculinity and health behaviour in Hong Kong: the mediating role of age and social support*

ABSTRACT

Objectives: Examine masculinity as a predictor of engagement in health behaviour, and explore the mediating effect of age and social support on the relationship between conformity to masculine norms and health behaviour among a sample of Hong Kong Chinese, mainland Chinese, Caucasian, and South Asian men living in Hong Kong.

Methods: A cross-cultural community sample of 495 men aged 18–81 years (M_age?=?39.87 years) were recruited to the study. Participants completed self-report measures of conformity to masculine norms (CMNI), social support (MSPSS), and health behaviour (HBI).

Results: Conformity to masculine norms was predictive of engagement with health behaviour, meanwhile age and social support mediated the relationship between conformity and health behaviour. Conformity was stronger among younger men, while higher levels of social support were predictive of poorer engagement in health behaviour for men in the present study. Findings from the multiple mediation revealed that social support better accounted for poorer engagement in health behaviour when compared to age.

Conclusions: While much of the literature has focused on the toxic impact of masculinity on men’s health, the present findings demonstrate that conformity to masculine norms does not necessarily equate with health risk behaviour. The association between lower levels of social support and health behaviour were interesting and demonstrate men’s autonomy in health matters; this contradicts previous findings emphasising the importance of social support in influencing men’s positive health behaviour. Findings are discussed in terms of their implications for and applications to men’s health and health promotion.     

A Qualitative Study of Homeless Fathers: Exploring Parenting and Gender Role Transitions*

Abstract: The present qualitative research focuses on homeless fathers living with their children in family shelters. Data were collected through semistructured, face‐to‐face interviews with homeless fathers (n= 9) and shelter directors (n= 3). Findings suggest that how fathers made meaning of their experiences in a homeless shelter was related to contextual factors and constructions of masculinity. Contextual constraints deriving from unemployment, behavioral and psychological restrictions of shelters, and new parenting roles led men to reassess their parental and masculine role identities. Results further suggest that homeless shelters may provide a unique point for intervention services to assist poor fathers.