Getting men in the room: perceptions of effective strategies to initiate men’s involvement in gender-based violence prevention in a global sample

Abstract

As engaging men in gender-based violence prevention efforts becomes an increasingly institutionalised component of gender equity work globally, clarity is needed about the strategies that best initiate male-identified individuals’ involvement in these efforts. The purpose of this study was to examine the perceived relevance and effectiveness of men’s engagement strategies from the perspective of men around the world who have organised or attended gender-based violence prevention events. Participants responded to an online survey (available in English, French and Spanish) and rated the effectiveness of 15 discrete engagement strategies derived from earlier qualitative work. Participants also provided suggestions regarding strategies in open-ended comments. Listed strategies cut across the social ecological spectrum and represented both venues in which to reach men, and the content of violence prevention messaging. Results suggest that all strategies, on average, were perceived as effective across regions of the world, with strategies that tailor messaging to topics of particular concern to men (such as fatherhood and healthy relationships) rated most highly. Open-ended comments also surfaced tensions, particularly related to the role of a gender analysis in initial men’s engagement efforts. Findings suggest the promise of cross-regional adaptation and information sharing regarding successful approaches to initiating men’s anti-violence involvement.     

Patterns of sexual arousal and history in a “normal” sample of young men

Sexual histories and arousal patterns of 60 college men were sampled in a rural area to better evaluate the role of sexual arousal in males typically used as nonoffender controls in sex research. Nearly two-thirds of the sample (65%) had engaged in some form of sexual misconduct in the past, ranging from sexual contacts with children and coercive sex with women to voyeurism and frottage. Even more subjects expressed a desire for such activities. Previous experience with frottage, obscene phone calls, and pedophilic contacts was associated with higher subjective arousal to depictions of these activities. Previous experience with coercive sex or voyeurism did not appear to be associated with greater arousal to these activities. There was considerable variability in the arousability of subjects to the variety of deviant stimuli presented, thus blurring the distinction between pathological and normal arousal patterns. These results suggest that young men are easily aroused sexually by a variety of stimuli, and seek out a variety of sexual experiences, some of which are punishable by law.     

Increasing hepatitis A immunity in men who have sex with men in Sydney, 1996–2012

We examined the hepatitis A virus status of all MSM seen at a large sexual health clinic in inner Sydney between 1996 and 2012. Overall, the proportion of MSM susceptible to hepatitis A decreased from 68.1% in 1996 to 36.2% in 2012; most of this reduction was attributable to vaccination.     

Determinants of serum calcium in men and women. The Tromsø Study

The level of serum calcium appears to be associated with blood pressure and metabolic risk factors for cardiovascular disease. Determinants of serum calcium may therefore be of interest. In a health survey in Tromsø in 1994–1995, 27,159 subjects were examined. The survey included measurements of serum calcium and questionnaires on diet and lifestyle factors. In males mean serum calcium declined from 2.41 mmol/l for those in their 20s to 2.34 mmol/l for those in their 80s. In females mean serum calcium was stable at a level of 2.35 mmol/l before the menopause, and thereafter reached a plateau of 2.39 mmol/l. In both sexes serum calcium showed a positive association with body mass index (BMI) and coffee consumption that persisted after correcting for other variables in a multiple regression model (p < 0.05). Physical activity had no significant association with serum calcium. In females alcohol consumption was negatively, and cigarette smoking positively associated with serum calcium (p < 0.01). No significant effect on the serum calcium levels was found for the intake of calcium or vitamin D, except for males with a calcium intake below 200 mg/day. Some of the observed effects, like the variation with age, may partly be explained by alterations in levels of serum albumin to which approximately 40% of circulating calcium is bound and which was not adjusted for in this study, whereas that is hardly the case for the association with BMI and coffee consumption. However, none of these factors could affect the serum calcium level more than 0.02 mmol/l, and the biological significance of the observed associations questionable.     

Why include men? Establishing sexual health clinics for men in rural Bangladesh

Subsequent to recommendations from the 1994 United Nations International Conference on Population and Development, and given recent findings outlining the links between control of sexually transmitted infections (STIs) and a reduction in HIV incidence, many countries are now seeking to establish STI control programmes. In many cases this is through a policy of providing comprehensive reproductive health care through the maternal and child health/family planning (MCH-FP) system. This involves management of all reproductive tract infections including STIs. This paper demonstrates how such an approach may miss one of the largest target groups--men. In general, men are at higher risk of initially contracting STIs, but, once infected, their clinical management is usually simpler than treating equivalent infections in women. It is argued that these two factors alone make the inclusion of men in STI control programmes critical. The paper outlines the experiences of one programme in rural Bangladesh in establishing sexual health clinics for men within the existing service structure. In response to client demand, the clinics moved beyond simple STI care towards provision of comprehensive sexual health services. Finally, the paper argues that whilst including men in sexual health programmes should never be at the expense of providing services for women, excluding them from service provision may make the objectives of STI control programmes unattainable.     

Homosexuality,seropositivity, and family obligations: Perspectives of HIV‐infected men who have sex with men in China

The HIV epidemic has had major impact on men who have sex with men in China. Most current studies view male‐to‐male sex as a behavioural dimension or variable affecting HIV infection, paying little attention to the socio‐cultural meanings of homosexuality and their impacts on men's experiences with HIV/AIDS. This oversight has impeded understanding of the health practices of this population. Based on a qualitative study of experiences of Chinese people living with HIV/AIDS, this paper explores the complex processes in which men who have sex with men struggle and negotiate with their sexuality, family obligations, and this disease. To facilitate Chinese men who have sex with men in responding effectively to HIV and AIDS, researchers and practitioners should take into account a wide range of contextual factors including desired gender roles, family obligations, homophobia, and HIV‐related stigma that contribute to current constructions of ‘homosexuality’ in China.

Résumé

En Chine, l'épidémie de sida a eu un impact majeur sur les hommes qui ont des rapports sexuels avec des hommes. Actuellement, la plupart des recherches envisagent les rapports sexuels entre hommes comme une dimension ou une variable comportementale qui a des conséquences sur l'épidémie, en prêtant peu d'attention aux significations socio‐culturelles de l'homosexualité et à leur impact sur les expériences des hommes vivant avec le VIH/sida. Cette négligence entrave la compréhension des pratiques de santé dans cette population et l'élaboration d'interventions qui lui soient plus spécifiques. En se basant sur une étude qualitative des expériences des Chinois vivant avec le VIH/sida, cet article explore les processus complexes selon lesquels les hommes qui ont des rapports avec des hommes luttent et négocient avec leur sexualité, leurs obligations familiales et cette maladie. Pour aider les hommes qui ont des rapports avec des hommes à apporter des réponses efficaces au VIH/sida, les chercheurs et les praticiens devraient prendre en considération un large éventail de facteurs contextuels comprenant les rôles de genre désirés, les obligations familiales, l'homophobie et le stigma dÛ au VIH, qui contribuent aux constructions actuelles de «l'homosexualité» en Chine.

Resumen

La epidemia del sida ha tenido un fuerte impacto en los hombres que tienen relaciones homosexuales en China. En la mayoría de estudios actuales se consideran las relaciones homosexuales como una dimensión de conducta o variable que afecta a la infección del VIH. Se presta poca atención a los significados socioculturales de la homosexualidad y al impacto que tiene en las experiencias de los hombres afectados con el VIH/sida. Esta negligencia ha impedido conocer las practicas sanitarias en esta población y la posibilidad de desarrollar intervenciones más sensibles. A partir de un estudio cualitativo sobre las experiencias de chinos afectados con el VIH/sida, en este artículo se exploran los complejos procesos en que los hombres con relaciones heterosexuales negocian y luchan por su sexualidad, las obligaciones familiares y la enfermedad. Para ofrecer una respuesta eficaz al VIH y el sida a esta población con relaciones homosexuales, los investigadores y profesionales de la salud deberían tener en cuenta toda una serie de factores contextuales, por ejemplo los roles sexuales deseados, las obligaciones familiares, la homofobia y el estigma relacionado con el VIH que contribuyen a crear el concepto actual de la ‘homosexualidad’ en China.     

Is intake of breakfast cereals related to total and cause-specific mortality in men?

BACKGROUND: Prospective studies suggested that substituting whole-grain products for refined-grain products lowers the risks of type 2 diabetes and cardiovascular disease (CVD) in women. Although breakfast cereals are a major source of whole and refined grains, little is known about their direct association with the risk of premature mortality. OBJECTIVE: We prospectively evaluated the association between whole- and refined-grain breakfast cereal intakes and total and CVD-specific mortality in a cohort of US men. DESIGN: We examined 86,190 US male physicians aged 40-84 y in 1982 who were free of known CVD and cancer at baseline. RESULTS: During 5.5 y, we documented 3114 deaths from all causes, including 1381 due to CVD (488 myocardial infarctions and 146 strokes). Whole-grain breakfast cereal intake was inversely associated with total and CVD-specific mortality, independent of age; body mass index; smoking; alcohol intake; physical activity; history of diabetes, hypertension, or high cholesterol; and use of multivitamins. Compared with men who rarely or never consumed whole-grain cereal, men in the highest category of whole-grain cereal intake (> or = 1 serving/d) had multivariate-estimated relative risks of total and CVD-specific mortality of 0.83 (95% CI: 0.73, 0.94; P for trend < 0.001) and 0.80 (0.66, 0.97; P for trend < 0.001), respectively. In contrast, total and refined-grain breakfast cereal intakes were not significantly associated with total and CVD-specific mortality. These findings persisted in analyses stratified by history of type 2 diabetes, hypertension, and high cholesterol. CONCLUSIONS: Both total mortality and CVD-specific mortality were inversely associated with whole-grain but not refined-grain breakfast cereal intake. These prospective data highlight the importance of distinguishing whole-grain from refined-grain cereals in the prevention of chronic diseases.     

What is in a label? Multiple meanings of ‘MSM’ among same-gender-loving Black men in Mississippi

ABSTRACT

Men who have sex with men (MSM) and other same-gender-loving (SGL) men continue to be disproportionately affected by HIV and AIDS, particularly among the Black population. Innovative strategies are needed to support the health of this community; however, public health efforts primarily approach MSM as a monolithic population erasing the diverse identities, practices, and sexualities within and beyond this category. To better understand diversity within MSM in a geographic region with the largest proportion of Black Americans in the U.S.A. and among the most heavily affected by the epidemic, the Deep South, we conducted four focus groups (n?=?29) with Black men who reported having sex with other men residing in Jackson, Mississippi. Results suggest multiple overlapping usages of MSM as identity and behaviour, reflecting internalisation of behavioural categories and co-creation of identities unique to the Black community. These narratives contribute to the literature by documenting the evolving understandings of the category ‘MSM’ among Black men to reflect intersections between race, socioeconomic status, sexual behaviour, sexuality, subjectivities, and social context. Findings suggest the current monolithic approach to treating MSM may limit public health efforts in developing effective HIV prevention and promotion programmes targeting SGL Black men in the Deep South.     

Increasing sexually transmitted infection rates in young men having sex with men in the Netherlands, 2006–2012

Background

Men having sex with men (MSM) remain the largest high-risk group involved in on-going transmission of sexually transmitted infections (STI), including HIV, in the Netherlands. As risk behaviour may change with age, it is important to explore potential heterogeneity in risks by age. To improve our understanding of this epidemic, we analysed the prevalence of and risk factors for selected STI in MSM attending STI clinics in the Netherlands by age group.

Methods

Analysis of data from the national STI surveillance system for the period 2006–2012. Selected STI were chlamydia, gonorrhoea, infectious syphilis and/or a new HIV infection. Logistic regression was used to identify factors associated with these selected STI and with overall STI positivity. Analyses were done separately for MSM aged younger than 25 years and MSM aged 25 years and older.

Results

In young MSM a significant increase in positivity rate was seen over time (p?<?0.01), mainly driven by increasing gonorrhoea diagnoses, while in MSM aged 25 and older a significant decrease was observed (p?<?0.01). In multivariate analyses for young MSM, those who were involved in commercial sex were at higher risk (OR: 1.5, 95% CI: 1.2-1.9). For MSM aged 25 years and older this was not the case. Having a previous negative HIV test was protective among older MSM compared to those not tested for HIV before (OR: 0.8, 95% CI: 0.8-0.8), but not among younger MSM.

Conclusions

MSM visiting STI clinics remain a high-risk group for STI infections and transmission, but are not a homogenous group. While in MSM aged older than 25 years, STI positivity rate is decreasing, positivity rate in young MSM increased over time. Therefore specific attention needs to be paid towards targeted counselling and reaching particular MSM sub-groups, taken into account different behavioural profiles.

     

Consumption of alcohol and risk of cancer among men: a 30 year cohort study in Lithuania

Studies have indicated hazardous consumption of large quantities of alcohol among adults in Lithuania. We assessed the associations of alcohol consumption at baseline with cancer incidence among men in a population-based cohort study, using Cox models adjusted for smoking, education and body mass index. Attained age was used as a time-scale. During follow-up (1978–2008) 1,698 men developed cancer. A higher amount of alcohol consumption (≥140.1 g/week vs. 0.1–10.0 g/week) was positively associated with increased risk of total cancer [hazard ratio (HR) = 1.36, 95 % confidence interval (95 % CI) 1.11, 1.65], upper aerodigestive tract cancer (HR = 2.79, 95 % CI 1.23, 6.34) and alcohol-related cancers (i.e. oral cavity, pharynx, larynx, oesophagus, colorectal and liver cancer) (HR = 1.88, 95 % CI 1.25, 2.85). Compared to occasional drinkers (a few times/year), drinkers 2–7 times/week showed an increased risk of total (HR = 1.45, 95 % CI 1.16, 1.83), alcohol-related (HR = 1.83 95 % CI 1.14, 2.93) and other cancers (HR = 1.35, 95 % CI 1.04, 1.76). Our results showed no statistically significant associations between quantity of alcohol intake per one occasion and risk of cancer. About 13 % of total, 35 % of upper aerodigestive tract, 22 % of alcohol-related and 10 % of other cancer cases were due to alcohol consumption in this cohort of men.     

Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Münster Study (PROCAM) using neural networks

BACKGROUND: Logistic regression (LR) is commonly used to estimate risk of coronary heart disease. We investigated if neural networks improved on the risk estimate of LR by analysing data from the Prospective Cardiovascular Münster Study (PROCAM), a large prospective epidemiological study of risk factors for coronary heart disease among men and women at work in northern Germany. METHODS: We used a multi-layer perceptron (MLP) and probabilistic neural networks (PNN) to estimate the risk of myocardial infarction or acute coronary death (coronary events) during 10 years' follow-up among 5159 men aged 35-65 years at recruitment into PROCAM. In all, 325 coronary events occurred in this group. We assessed the performance of each procedure by measuring the area under the receiver-operating characteristics curve (AUROC). RESULTS: The AUROC of the MLP was greater than that of the PNN (0.897 versus 0.872), and both exceeded the AUROC for LR of 0.840. If 'high risk' is defined as an event risk >20% in 10 years, LR classified 8.4% of men as high risk, 36.7% of whom suffered an event in 10 years (45.8% of all events). The MLP classified 7.9% as high risk, 64.0% of whom suffered an event (74.5% of all events), while with the PNN, only 3.9% were at high risk, 58.6% of whom suffered an event (33.5% of all events). CONCLUSION: Intervention trials indicate that about one in three coronary events can be prevented by 5 years of lipid-lowering treatment. Our analysis suggests that use of the MLP to identify high-risk individuals as candidates for drug treatment would allow prevention of 25% of coronary events in middle-aged men, compared to 15% and 11% with LR and the PNN, respectively.     

In fitness and health? A prospective study of changes in marital status and fitness in men and women

The authors examined the prospective associations between marital status transitions and changes in fitness in men and women. Between 1987 and 2005, a total of 8,871 adults (6,900 men) aged 45.6 (standard deviation, 9.1) years were examined at the Cooper Clinic, Dallas, Texas; the median follow-up was ～3 years. Marital transition categories (from single to married, married to divorced, divorced to remarried) were derived from self-reported marital status at baseline and follow-up. Fitness (maximal oxygen consumption) was assessed by a maximal treadmill test. Analyses were adjusted for baseline levels and changes in body mass index, physical activity, smoking, alcohol consumption, and major chronic diseases. Compared with the corresponding "control" groups (remaining single, married, or divorced), transitioning from being single to married was associated with a reduction in fitness in women (P = 0.03); divorce was associated with an increase in fitness in men (P = 0.04); and remarriage was associated with a reduction in fitness in men (P = 0.05). The authors conclude that the transitions to being married (from single to married or from divorced to remarried) are associated with a modest reduction, while divorce is associated with a modest increase in fitness levels in men. Study results suggest that these patterns may be different in women, but further research is required to confirm this.     

Why men experiencing deep poverty in Montréal avoid using health and social services in times of crisis

This article describes the experiences of men living in deep poverty regarding their decision not to seek out health and social services in moments of crisis, even when they recognized needing help. It presents results from a qualitative research project done in collaboration with a community center in a disadvantaged neighborhood of Montreal, Canada. It was designed to increase understanding of men's experiences of poverty and the role played by health and social services in their lives. Data were collected through 80 days of participant observation, 22 semi-directed interviews, and six group discussions with men living in poverty. The results show that these men are reluctant to use health and social services for three main reasons: 1) the nature of their problems; 2) their difficulty in seeking help; 3) the nature of services offered. The paper concludes with implications of the findings for future research and interventions.     

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.     

Role of men in promoting the uptake of HPV vaccinations: focus groups’ finding from a developing country

Objectives

Better outcomes of human papillomavirus (HPV) vaccination would be expected if men become full partners and advocates in vaccination initiative. Men involvement has important implication especially within the context that they are equally responsible for spreading the virus.

Methods

Twenty-seven men took part in four focus group discussions carried out to assess men’s attitudes toward the HPV vaccine between October and November 2007.

Results

The results revealed that men have low awareness about the newly release vaccine and minimal knowledge of HPV and its association with cervical cancer. When provided with information, most men were in favor of protecting their spouses, partners, or daughters from cervical cancer using the vaccine. They were aware of the effects of men’s risk behavioral patterns on women’s risk for acquiring HPV infections. Many needed assurance about the vaccine’s long-term safety and efficacy. They also expressed concern over the high cost of the vaccine. Men in this study played an influential role in the vaccination decision of their child and sexual partners. Many were in favor of male vaccination for cervical cancer prevention of their spouse or partner.

Conclusions

Vaccine advocacy should put special emphasis on men as sexual partners, husbands, and fathers from a gender equality and partnership perspective. The findings are useful in facilitating the development of strategies for effective immunization initiatives.