(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore, India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

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.     

Men's contribution to the food and nutritional situation in the Tanzanian household

More is presently known about women's than men's role in food production and nutrition in Africa. The present article is an attempt to remedy this shortcoming. A special focus is put on the influence men exert through their labour and decision‐making on the household food situation. Findings from a study in a subsistence agricultural community in Tanzania give a differentiated picture compared to current literature. Most men put a substantial amount of labour into food production, but not as much as their wives, while a minority did almost nothing. When men worked hard in the fields, their wives worked hard too. Both men's and women's labour input in the field was important for household food availability. However, no direct relationship was found between men's work and child nutrition. In decision‐making women had a subordinate position and men were apt to favour cash above food. However, women usually had their way with men to insure that family food needs were met. The potential for improving women's situation by increasing men's contribution is discussed.     

Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam

Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.     

Health and Sexual Outcomes of Women Who Have Experienced Forced or Coercive Sex

Previous research has linked women's history of experiencing sexual assault with negative health outcomes; however, much of this research is over a decade old. Furthermore, little research has examined the relationship between sexual assault and women's sexuality. In the current study the authors aimed to assess the relation of experiencing sexual assault to women's health and sexuality and the relation of repeat victimization by multiple different perpetrators to such outcomes. Data were collected from a convenience sample of 2,915 women using an online questionnaire. Nearly half (n = 1,394, 47.8%) indicated having experienced forced or coercive sex. Women who had experienced forced or coercive sex were more likely to report negative health outcomes (Adj. OR = 1.56; 95% CI: 1.35–1.82, p < .001) and some negative sexual outcomes compared to women without a history of forced or coercive sex. Similarly, women who experienced repeat victimizations by multiple different perpetrators were even more likely to report negative health outcomes (Adj. OR = 1.43; 95% CI: 1.28–1.59, p < .001) as well as some negative sexual outcomes. Healthcare providers should be aware of the relation of sexual assault to health and sexuality and continue to address health and sexuality issues associated with sexual assault for their patients.     

Improvement of Older Women's Sexuality Through Emancipatory Education

The purpose of this action research (AR) was to explore the ways in which sexuality is experienced daily and to improve the expression of older women's sexuality. The pedagogy of autonomy as proposed by the Brazilian educator Paulo Freire theoretically supported this AR, with the participation of six older adult women living in a rural setting in southwest Brazil. The older women's experiences regarding sexuality, their concerns, and their educational demands could be summarized through five phrases: the improvement of self-esteem as a way to promote sexuality; sexuality impaired by loneliness and lack of affection; men's sexual satisfaction seen as a woman's obligation; women's sexuality controlled by the society; and relinquishment of the companion to attend to the expectations of family members. Dialogical and participative educational approaches and continuous observation–participation strategies were performed to support the women's care and educational requirements.     

College Students' Sexual Consent Communication And Perceptions of Sexual Double Standards: A Qualitative Investigation

CONTEXT

Affirmative consent standards adopted by colleges and universities are meant to decrease miscommunication that may lead to sexual assault. However, they may not take into account sociocultural factors that influence consent. In particular, the role of gender norms needs to be better understood.

METHODS

In‐depth interviews about college students’ sexual activity, including sexual consent communication, were conducted with 17 female and 13 male students at a large southern university during the spring 2013 semester. The interview protocol and analyses were guided by Carspecken's critical qualitative methodology, which seeks to understand both participants’ explicit statements and implied underlying meanings and values. Themes and subthemes were identified through inductive analyses.

RESULTS

Two overarching themes emerged: Students perceived a sexual double standard, and males viewed obtaining sex as a conquest. Subthemes related to the first theme reflected endorsement of traditional views of women's sexuality (the notions that “good girls” do not have sex, that women should privilege men's sexual needs over their own and that women “owe” men sex once men have “worked” for it). Subthemes related to the second theme reflected males’ beliefs that sex is a commodity that pits women and men against one another, and that women can be “convinced” to have sex if they initially refuse.

CONCLUSIONS

College students’ consent communication may be influenced by gender norms that challenge assumptions of affirmative consent standards. Cultural shifts in students’ views of sexuality may be necessary for affirmative consent policies to be effective.     

Men's experiences of sexuality after cancer: a material discursive intra-psychic approach

Men can experience significant changes to their sexuality following the onset of cancer. However, research on men's sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on men's sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, men's intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of ‘normal’ masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Men's relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.     

Constructions and experiences of sexual health among young,heterosexual, unmarried Muslim women immigrants in Australia

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified ‘purity versus corruption’ as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes ‘maintaining ignorance and naivety’, ‘remaining virginal’, ‘sex segregation’ and ‘the fallen woman’ capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.     

African American women's perspectives on ‘down low/DL’ men: implications for HIV prevention

African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women contribute to women's HIV risk. Popular media discourse tends to refer to these men as ‘down low’ or ‘DL’. Six focus groups were conducted with 36 African American women in Washington, DC, to examine their knowledge, attitudes, beliefs and behaviours regarding DL men. Three of the focus groups were composed of HIV-positive women and three groups were composed of HIV-negative women. Data analysis reveals six central subcategories related to women's perspectives on the DL: awareness, suspicion, coping with partner infidelity (male versus female), sexual health communication, empathy and religion. No major differences were identified between the HIV-positive and HIV-negative focus groups. Findings from this study provide insight into African American women's perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women's exposure to HIV risk.     

Heteronormativity and ‘troubled’ masculinities among men who have sex with men in Addis Ababa

In most societies, heterosexuality is the dominant way of expressing sexuality and masculinity and those men outside of it are stigmatised and discriminated against. This paper explores the sexual lives of men who have sex with men and the personal and social conflicts that arise as they attempt to both live up to societal expectations and manage their sexual desires. It critically explores how an overriding heteronormativity structures and influences men's perception and understanding of sexuality and masculinity/femininity. The paper draws on data from 24 in-depth/life history interviews, one focus group discussion and ethnographic observation conducted between July 2006 and June 2007. The study reveals that powerful and dominating beliefs about heteronormativity and masculinity result in men who have sex with men dealing with a number of issues of personal conflict and contradiction resulting in uncertainty, resentment, ambivalence, worry and discomfort. Heteronormativity or the expectations of parents, community and society at large is far more influential on the sexuality of men who have sex with men than their own individual desires and needs. The paper concludes that there is little room for individuality for Ethiopian men who have sex with men with their sexual bodies ‘belonging’ to parents, families and to society at large.     

Older Chinese men and women's experiences and understanding of sexuality

This study explored the meaning of sexuality for older Chinese people from diverse backgrounds and the role of traditional Chinese cultural values in shaping sexual expression. A total of 20 Hong Chinese elders were interviewed. Most reported a rigid definition of sexual behaviour, confining it to heterosexual sexual intercourse. Kissing, hugging and caressing were not considered ‘sexual’, and same-sex relationships were virtually absent from respondents' conceptions of sexuality. Traditional patriarchal values in relation to sexuality prevailed. Men and women attached different meanings to sexuality. Neither believed that sex was enjoyable for women or that women needed sex in the same way as men. Female participants saw sex as part of their responsibility to procreate and to fulfill their husband's needs. Male participants considered sex to be important for fulfilling their physical drives. The lack of an appropriate partner due to widowhood, the partner's physical condition or a poor spousal relationship apparently accounted for the low levels of sexual activity reported by informants.     

Men's Perspectives on Their Role in Family Planning in Nyanza Province,Kenya

Research has indicated that gender dynamics—and in particular men's disapproval of family planning—have had an influence on the low levels of contraceptive use in sub‐Saharan Africa. Limited evidence exists, however, on effective strategies to increase male approval. We conducted 12 focus group discussions with married men aged 20–66 (N = 106) in Kenya to explore FP perceptions. Men's disapproval of FP was associated with anxieties regarding male identity and gender roles. Men often distrusted FP information provided by their wives because they suspected infidelity or feared being viewed as “herded.” Men also feared that providers might pressure them into vasectomies or into disclosing extramarital sexual activity or HIV diagnoses to their wives. Suggested strategies include programs targeting couples jointly and FP education for men provided by male outreach workers. To encourage men's acceptance, community‐based programs directly targeting men are needed to reduce stigma and misconceptions and to increase awareness of the benefits of FP.     

Who decides? Women's status and negotiation of sex in Uganda

Women's ability to negotiate the timing and conditions of sex with their partners is central to their ability to control a variety of reproductive health outcomes. Focus group discussions and survey data from 1356 women and their regular male partners in two districts in Uganda were analysed to explore the nature of sexual negotiation and to test hypotheses about the influence of women's work and marriage institutions on norms and behaviour regarding sexual decision making. Sexual negotiation is characterized by four stages starting with normative precedent for decision making about sex and progressing to communication, disagreement, and conflict resolution. Men are generally reported to have more influence over sex in these settings, but women can and do refuse sex under a variety of circumstances. Education and urban residence consistently enhance women's ability to negotiate sex. The effect of marriage and women's work characteristics depends strongly on district context. We speculate that certain types of bridewealth agreement inhibit a woman's ability to influence timing and conditions of sex independently of other 'bargaining' resources she may control.     

Sexual desire among Mexican-American older women: a qualitative study

Although researchers have related sexual desire in older women to quality-of-life variables such as overall physical health, well-being, and life satisfaction, little is known about the socio-cultural mechanisms that shape sexual desire in minority ethnic older women. We investigated this sexual variable among Mexican-American older women in a qualitative fashion. Data were collected from 25 community-dwelling women of Mexican descent (aged 59–89 years) using a semi-structured interview protocol and a grounded theory approach. We inquired about dimensions of sexual desire including sexual fantasies and the desire to engage in sexual activity within the context of several socio-cultural and health-related factors. Using content analysis, we were able to identify key themes differentiating among respondents’ levels of sexual desire and fantasies. These included the availability of a suitable partner, cultural and religious norms pertinent to women's sexuality, stigma related to sexuality in older age, and health status. Traditional socio-cultural restrictions coupled with unmarried status and physical health problems emerged as critical issues associated with limited or no sexual fantasies and desire in our sample. Many respondents indicated that their sexual needs were unmet.     

‘Women now wear trousers’: men's perceptions of family planning in the context of changing gender relations in western Kenya

Gender inequity has been closely linked with unmet need for family planning among women in sub-Saharan Africa but the factors related to male family planning disapproval are not well-understood. This qualitative study explored men's perspectives of gender roles and cultural norms as they pertain to family planning. Twelve small group meetings were held with 106 married men in Nyanza Province, Kenya. Shifting gender relations made the definitions of manhood more tenuous than ever. Men's previous identities as sole breadwinners, which gave them significant control over decision-making, were being undermined by women's increasing labour force participation. While many men viewed family planning positively, fears that family planning would lead to more female sexual agency and promiscuity or that male roles would be further jeopardised were widespread and were major deterrents to male family planning approval. By addressing such fears, gender-sensitive programmes could help more men to accept family planning. Increased family planning education for men is needed to dispel misconceptions regarding family planning side-effects. Focusing on the advantages of family planning, namely financial benefits and reduced conflict among couples, could resonate with men. Community leaders, outreach workers and healthcare providers could help shift men's approval of joint decision-making around family size to other reproductive domains, such as family planning use.     

Gender relations,sexual communication and the female condom

An exploratory multi-site study supported by the World Health Organisation and UNAIDS was conducted in Costa Rica, Indonesia, Mexico and Senegal to examine the extent to which women's capacity to negotiate safer sex might be enhanced by the introduction of the female condom. Data were first collected on prevailing gender relations, sexual communication and negotiation. This was followed by the distribution of the female condom and a locally designed intervention devised to develop women's knowledge and confidence in relation to their bodies, health and sexuality. In each of the four research sites, two groups of women were involved: one consisted of women engaged in sex work, the other of women from a range of backgrounds which varied across the sites. The introduction of the female condom was particularly successful in enhancing sexual communication between sex workers and clients, in couples where the man was already supportive of family planning, in a context where men were reassured that acceptance was high among peers, where the male condom was already in use but unpopular, and where the female condom was able to be eroticized and introduced into sex play.     

Switching on After Nine: Black gay-identified men's perceptions of sexual identities and partnerships in South African towns

ABSTRACT

There is considerable diversity, fluidity and complexity in the expressions of sexuality and gender among men who have sex with men (MSM). Some non-gay identified MSM are known colloquially by gay-identified men in Mpumalanga, Province, South Africa, as ‘After-Nines’ because they do not identify as gay and present as straight during the day but also have sex with other men at night. Based on, key informant interviews and focus group discussions in two districts in Mpumalanga, we explored Black gay-identified men's perceptions of and relationships with After-Nine men, focusing on sexual and gender identities and their social consequences. Gay-identified men expressed ambivalence about their After-Nine partners, desiring them for their masculinity, yet often feeling dissatisfied and exploited in their relationships with them. The exchange of sex for commodities, especially alcohol, was common. Gay men's characterisation of After-Nines as men who ignore them during the day but have sex with them at night highlights the diversity of how same-sex practicing men perceive themselves and their sexual partners. Sexual health promotion programmes targeting ‘MSM’ must understand this diversity to effectively support the community in developing strategies for reaching and engaging different groups of gay and non-gay identified men.