Sexual Health
EXCHANGE www.sexualhealthexchange.org
2005/2 Men, sex and power
[email protected]
Men, sex and power Engaging men in achieving gender equality and sexual and reproductive health
Alan Greig O Editorial – 1 O Reseach Notes – 3 Does men’s involvement work? Evidence from evaluated interventions
O Programme Feature – 5 Promoting gender equity among young men. Positive experiences of the Yari-dosti project in India
O Special Article – 7 Fostering alternative views of male identity among boys in Latin America and the Caribbean
O Programme Feature – 9 Using edutainment and social activities to challenge machismo in Nicaragua. The example of Somos Diferentes, Somos Iguales
O Research Notes – 10 Male identity, poverty and reproductive health in Namibia
O Special Article – 12
The 1994 International Conference on Population and Development (ICPD) in Cairo is still a rallying cry for advocates of male involvement in the struggle to achieve gender equality. ICPD was the first forum in which the international community challenged men to play their full part in the fight for gender equality. Within a year, the Beijing Platform for Action called on men to support women’s struggle for gender equality by sharing child-care and household work equally and by taking responsibility in HIV and sexually transmitted infection (STI) prevention. A decade after the ICPD, the United Nations Commission on the Status of Women met in New York City to consider, for the first time, the role of men and boys in the achievement of gender equality. In the past decade, these global policy commitments have been translated into many programmes working with men on sexual health and gender equality on all continents. According to the United Nations Population Fund (UNFPA), condom education and distribution initiatives exist in virtually every country and have led to high levels of knowledge of male condoms among men. Clinic-based efforts have sought to engage men, either in primary health care or in specialized reproductive and sexual health clinics. Links between gender inequality, sexual vulnerability and the HIV pandemic have spurred a dramatic increase in HIV prevention efforts targeting men’s sexual behaviour.
Men making a difference The “Men Make a Difference” World AIDS Campaign in 2000-2001 showcased examples of peer education efforts with male adolescents and outreach HIV education with male-dominated occupational groups. There are now projects working with men to prevent perinatal transmission, supporting men to get involved in home-based
Behind the bars of South African prisons. Gendered roles and vulnerability of male inmates to forced sex
O Special Article – 14 Men who have sex with men and disempowerment in South Asia
O Online Resources – 16
Next issue: Managing HIV/AIDS inside NGOs
Photo: USAID/Chris Thomas
2
Sexual Health Exchange 2005/2 care, and starting support groups for HIV-positive fathers to promote their own health and well-being and encourage them to support their partners and children. Fatherhood is an important theme of this work, which has included campaigns and services to encourage men to participate in childbirth and efforts to enlist male support for maternal health by educating them on warning signs of maternal complications. Mass media is being used to promote positive images of men’s participation in the lives of children. A few programmes are pioneering educational sessions, group discussions, or support groups for fathers. Violence has also become an important focus for work with men, including intervention programmes with men who have used violence against women as well as prevention initiatives. Such initiatives have either been integrated into a broader programme (as in the Stepping Stones approach to addressing violence as part of its work on HIV/AIDS) or have been stand-alone efforts (as in the White Ribbon Campaign, a movement of men working to end violence against women in more than 30 countries).
Addressing the complex realities of men’s lives But perhaps the most interesting work is being done with men on what many regard as the root of the problem; the gender socialization, pressures and norms that confine men of all ages within patterns of thinking, feeling and acting that are not only harmful to women but also to themselves. The Men as Partners (MAP) programme in South Africa offers a good example of the evolution of such work from gender awareness-raising with men to working to change individual behaviours, community norms and government policy. The programme, together with other allies, has recently secured the establishment of a cabinet-level coordinating committee on men and gender equality within the South African government’s national gender machinery. Working with men to transform the gender norms and structures (economic, social and political) that maintain gender inequality marks a significant step beyond the gender-neutral approaches (targeting men in order to improve women’s health) and gender-sensitive approaches (responding to men’s own sexual health needs and their risk-taking behaviour) that have characterized the targeting of men in sexual health work (see Box). This gender-transformative approach, as advocated by Geeta Rao Gupta of the International Center for Research on Women among others, confronts men’s complex relationship to power. Michael Kaufman speaks eloquently of men’s contradictory experiences of power:
Best practice programming for the gay/MSM community Men are targeted because they are: O Gatekeepers, who control women’s sexual and reproductive health (SRH) O Decision-makers, who decide on policies and budgets that affect SRH programmes O Clients, who are deprived of SRH services O Risk-takers, who pose a threat to the public health as well as themselves in terms of HIV and STIs O Vulnerable populations, whose human rights are denied because of their sexual or drug-using behaviour O Community members, whose harmful attitudes and behaviours are the result of the pressure to “be a man”.
“Men enjoy social power, many forms of privilege, and a sense of oftenunconscious entitlement by virtue of being male. But the way we have set up that world of power causes immense pain, isolation, and alienation not only for women, but also for men”.1
Directions for change The need to come to grips with this contradiction is Involving men in HIV/AIDS further deepened when care and support the gender framework is Photo: Edward Reilly/Lutheran World broadened to include Relief, Courtesy of Photoshare other structures of inequality within which men (and women) live. Men may have power because of their gender but may lack power because of, among others, their economic class, ethnic/racial identity, sexuality and age. These internal contradictions suggest two important directions for developing work with men in terms of their relationship to power and privilege, namely to: 1) explore men’s emotional lives and 2) address men’s political conditions. Sexual health work with men has tended to focus on the interpersonal sphere (men’s relations with women as well as with other men). But these contradictions reveal the importance of developing more work in both the internal/emotional and institutional/political spheres. This framework of the three I’s (Internal, Interpersonal and Institutional) of fighting oppression provides a useful structure for developing such work with men.2
Internal work: Exploring men’s emotional lives Rozan, a women’s empowerment NGO in Pakistan, has pioneered gender-based work with the police. In seeking to engage the police service to promote gender equality, Rozan provided gender education and a space for male police officers to talk about, and begin to heal from, the emotional harms of their masculine socialization and to see how these harms play out in their treatment of women. According to Rozan, helping men to heal must be accompanied by an equal emphasis on strengthening men’s empathy for women’s suffering from misogyny, or the hatred of women. Paying attention to masculinity and misogyny is critical in developing this “internal” work with men because it allows for a richer understanding of the complexities of male socialization and men’s sexuality.
Institutional work: Addressing men’s political conditions In its anti-sexist work with young men, the Conscientising Male Adolescents (CMA) programme in Nigeria seeks to hold its young men accountable for understanding gender oppression (in women’s and men’s lives) and working to change it. By framing their work in terms of women’s struggle for gender equality, the programme stresses young men’s role as allies to women in this struggle. Focusing on men’s role as an ally counters the
Sexual Health Exchange 2005/2 danger of reinforcing unequal power relations through men taking on the paternalistic role of protecting women from sexism or taking over women’s leadership in an effort to end sexism. This emphasis on being an ally also suggests to the young men that the programme is not just working with them on their individual attitudes and behaviours but that their personal change is part of a bigger story of social change. The bigger story moves them beyond the gender question of what it means to be a more equitable man to the broader question of what it takes for men and women to live in more equitable societies. Answering this question involves addressing the role that institutions (social, economic and political) play in creating injustice, including the gender injustice that women experience. Building men’s political consciousness in this way is critical to sexual health work. Such an approach makes clear that men’s violence against women is not simply
interpersonal but structural, and that efforts to end it must tackle the structures of male power in society which reproduce and rely on such violence. A more politicized approach to sexual health work with men would also hold specific institutions, such as religious authorities and the state, accountable for trying to limit discussion of sexuality to the realm of reproduction and “family life”. The HIV pandemic will not be controlled by preserving the stereotype of the irresponsible male who must be persuaded to remain faithful or use a condom “as a last resort”. Instead, sexual health work with men (and women) should open up discussion of sexual pleasure and sexual diversity, within the context of rights and relationships, and challenge the powerful interests that are vested in maintaining the status quo. Above all, developing this political work with men would link women’s struggle for their liberation to other struggles for justice (such as economic, racial, sexual) from which most men stand to gain. Alan Greig, Consultant, USA; e-mail:
[email protected] 1.
2.
Men receiving counseling on contraception offered by the CASA programme in San Miguel de Allende, Mexico Photo: Rick Maiman/David and Lucile Packard Foundation, Courtesy of Photoshare
M. Kaufman. Men, feminism and men's contradictory experiences of power, www.europrofem.org/02.info/22contri/2.04.en/1en.gend/ 02en_gen.htm. A school to build a movement: Political education workshop manual, School of Unity and Liberation, Oakland, California, USA, 2000.
More information about the programmes mentioned in this article: O Stepping Stones: www.steppingstonesfeedback.org O White Ribbon Campaign: www.whiteribbon.ca O Men as Partners (MAP), South Africa: www.engenderhealth.org/ia/wwm O Rozan: www.rozan.org O Conscientising Male Adolescents (CMA) programme, Nigeria: “My father didn't think this way" – Nigerian boys contemplate gender equality, F. Girard, Population Council 2003, www.synergyaids.com/documents/ Nigeria_GenderEquality.pdf
Research Notes
Does men’s involvement work? Evidence from evaluated interventions Peter Sternberg & John Hubley Against a backdrop of rapidly increasing HIV infection rates, widespread reports of violence against women and appalling statistics on maternal and infant mortality, delegates at the 1994 International Conference on Population and Development (ICPD) agreed that an international effort should be made to involve men as active participants in sexual and reproductive health promotion. A decade later, men’s involvement still attracts criticism and invites serious questions. These questions include which methods are appropriate for involving men, which strategies lead men to change their behaviour and, importantly, what effect does men’s involvement in sexual and reproductive health promotion have on women? This article is a short summary of findings from 26 evaluations of interventions that targeted adult heterosexual men which were published until July 2003.1
There is a great deal of rhetoric about men’s involvement and particularly discussion about the meaning of men’s involvement in sexual and reproductive health programmes. For health promoters, men’s involvement implies that they are involved, not just as passive recipients, but as full partners in programmes designed to meet their needs and the needs of their families. Programmes that aim to involve men encompass a wide range of activities from promoting condoms, addressing parenting issues to working to change gender norms that lead to the subordination of women and domestic violence. Early critics of men’s involvement thought that men would not be interested in participating and that involving
them would waste time and money. In reality, however, a large number of men actually want to be involved because they are genuinely interested in their own health and the health and welfare of their partners and families.
Changing men – which strategies work?
Photo: WHO/P. Virot
Evidence from many family planning services targeting men shows it is not enough just to offer a service and expect men to use it. The service must be tailored to meet their needs
3
4
Sexual Health Exchange 2005/2
Photo: WHO/P. Virot
and efforts need to be made to reach out to them. Many HIV/AIDS programmes that target adult men use their workplace as the prime site and focus for intervention. Sectors that have used workplaces to initiate interventions for men include transportation, mining, the military and fisheries. Several strategies – applied at the workplace or in other settings – seem to have promising results: Using existing non-health programmes – One way to involve men is to extend projects that already involve them, such as small business or farm projects, into the realms of sexual and reproductive health. A programme in Honduras used two strategies. One involved training agricultural extension workers to give health education sessions to their clients; the other extended an agricultural programme, the “Farm Management Plan”, into areas of family planning through the use of a “family management” booklet. Peer education – Several studies indicate that peer education may be an effective strategy to increase condom use amongst men. A truck drivers’ peer education programme in Tanzania found that reported condom use increased by nearly 20% in the two years of the maintenance phase that followed the intervention. A similar programme in Senegal found that sex workers reported a greater proportion of their clients used condoms and fewer clients offered extra money for unprotected sex after a peer education programme which targeted their clients – mostly truck drivers. Cognitive behavioural interventions – Another strategy that might hold some promise uses cognitive behaviour principles. These usually involve teaching people to overcome barriers to behaviour change and motivating change by using realistic incentives. A study of trucking company workers in Kenya found increases in condom use and a decrease in the percentage of men who had had extramarital sex as well as a decline in the numbers of men who had had sex with a sex worker following a cognitive behavioural intervention. Involving religious leaders – Some countries have successfully involved religious leaders in education on and promotion of sexual and reproductive health to men. Of particular interest are projects in Gambia and Bangladesh, which involved Muslim religious leaders in programmes to educate men on the link between family planning and Islam. Both programmes resulted in increased use of contraception amongst the men who were involved. Edutainment – This strategy uses entertainment to educate men. A good example is the Zimbabwean Family Planning Council's “Male Motivation Project”. The Project used a wide variety of media: TV, radio, newspapers advertisements, and articles as well as a television soap opera. Men exposed to the campaign were significantly more likely to use condoms than men who had not. Stages of change approach – A study involving men from rural Vietnam found that it was useful to categorize men according to their stage of change in order to tailor interventions to promote their involvement in contraceptive decisions. This strategy seems effective with many different target groups, not just men, because it allows interventions to be targeted to meet people’s real needs according to how far along they are in the process of change.
How involving men affects women Evidence from the literature on how men's involvement impacts on women is rare because few studies have examined this question. A study of Ethiopian men examined whether involving men in family planning discussions with their wives made a difference to the uptake of modern contraception methods. A year after the discussions, almost twice as many people that participated in the intervention were using a modern contraception method as people in the control group. The fact that men were participating did seem to make an important difference to contraceptive uptake by their spouses. In an Indian programme, men were given information about antenatal care services, diet, nutrition and weight gain during pregnancy as well as information about contraception. Male participants in the study had a greater knowledge of the importance of antenatal care services and their partners made more visits to antenatal care clinics. The Men's Collective of Egalitarian Relationships (CORIAC) targeted violent men in Mexico City and helped participants to examine their masculinity and to learn to express emotion in non-violent ways. A similar programme in Nicaragua that was based on the methodology of Popular Education (reflection/action) reported positive changes, which included more participation in domestic chores, fewer incidents of physical and psychological violence and more involvement with children.
Conclusion The little available literature suggests that even a decade after the ICPD, few programmes are actually targeting men. Men’s involvement seems a promising strategy, however, there is a real need for more work with men that is properly evaluated and reported on. Although men may no longer be seen as just part of the problem, as they were in the 1980s, they have yet to be taken seriously as part of the solution. Many of the studies reviewed were implemented within the narrowly conceived framework of “male motivation” and targeting men's pathological behaviour. It is important to note that men's behaviours in many countries are reinforced by cultural stereotypes, which place great value on concepts like physical strength, sexual prowess and machismo. Yet men are also victims because they can feel that they are not “real men” unless they conform to these stereotypes. Thus, an effective programme to reach men must also challenge prevailing concepts of masculinity. We were disappointed to find that none of the programmes, except CORIAC and the Nicaraguan antiviolence programme, addressed issues from the point of view of masculinity. This is a serious flaw, particularly when there is a realization that many problems in sexual and reproductive health have their roots in gender inequities between men and women. Peter Sternberg, Winona State University, USA; e-mail:
[email protected] & John Hubley, Leeds Metropolitan University, Leeds, UK; e-mail:
[email protected] 1.
For reasons of space, we have not included any references. They can be found in the online edition available at www.sexualhealth exchange.org or in the original paper on which this article was based: Evaluating men’s involvement as a strategy in sexual and reproductive health promotion, Health Promotion International, Vol. 19, No. 3, 2004: p. 389-396.
Sexual Health Exchange 2005/2
Promoting gender equity among young men Positive experiences of the Yari-dosti project in India
Ravi Verma, Julie Pulerwitz, Vaishali Sharma Mahendra, Sujata Khandekar & Gary Barker In India, the HIV epidemic is growing, and more than five million people are estimated to be living with HIV and AIDS. A key factor contributing to the increasing number of people living with HIV in the country is societal norms that keep women’s status low in the home and community and foster men’s greater control over resources and decision-making. This includes norms related to monogamy and the number of sexual partners, as well as safer sex. There is increased awareness of the role that inequitable gender norms play in HIV and violence risk, yet few studies have attempted to influence these norms and measure change in both norms and risk behaviour due to an intervention. The Horizons Program, implemented by the Population Council and partners, and local partners CORO for Literacy (India) and Instituto PROMUNDO (Brazil), have developed and implemented operations research in India to examine the role of gender equity and gender norms in HIV and violence risk and prevention.
The first step of this project was conducting formative research in 2003, with young men in low-income communities in Mumbai (formerly known as Bombay), India, on the links between gender and masculinity, sexuality, and health risk. Formative research involved qualitative methods of data gathering employing key informant and in-depth interviews, mapping exercises and focus group discussions (FGDs). Trained peer leaders from three low-income communities conducted a total of 51 interviews with young men in the age group of 16-24 years and four FGDs with community leaders and young women from the same communities. Then, intervention activities for young men were developed/adapted, including a curriculum for group education. In the second half of 2004, peer leaders were trained to implement the activities, and a group of over 100 young men participated in group education sessions over a 6-month period. Pre and post-test surveys were conducted, as well as qualitative interviews and observations, by an independent study team to determine the feasibility and acceptability, as well as the impact of the intervention. Changes in attitudes towards gender norms – using the Gender-Equitable Men (GEM) Scale developed
Yari-dosti group education for young men led by a peer leader Photo: CORO
by Horizons and Instituto PROMUNDO (see Box) – as well as changes in violence and HIV risk behaviours were measured. A gender-equitable man was defined for this project as one that: 1) supports relationships based on respect, equality and intimacy rather than sexual conquest; 2) is an involved father, both financially and in terms of care-
The Gender-Equitable Men Scale The GEM Scale was developed by the Horizons Program, Instituto PROMUNDO, and partners in Brazil. It was tested with a community-based sample of 749 men aged 15 to 60 in low- and middle-income neighbourhoods in Rio de Janeiro. The scale consists of a list of statements about attitudes regarding gender roles in domestic work and child care, sexuality and sexual relationships, reproductive health and disease prevention, and intimate partner violence, as well as attitudes toward homosexuality and close relationships with other men. In the initial testing of the GEM Scale, “traditional” attitudes were reported by some men, examples of which are: O Men are always ready to have sex O Women who carry condoms on them are “easy” O I would never have a gay friend O Changing diapers, giving the kids a bath, and feeding the kids are the mother’s responsibility O I would be outraged if my wife asked me to use a condom O A woman should tolerate violence in order to keep her family together O There are times that a woman deserves to be beaten. By documenting and analysing responses to the statements on the GEM Scale before and after an intervention, changes in gender attitudes can be measured. More information: J. Pulerwitz, G. Barker, M. Segundo, Promoting healthy relationships and HIV/STI prevention for young men: Positive findings from an intervention study in Brazil. Horizons Research Update, 2004: www.popcouncil.org/pdfs/horizons/brgndrnrmsru.pdf.
5
Programme Feature
6
Sexual Health Exchange 2005/2 giving; 3) takes responsibility for reproductive health and disease prevention; and 4) opposes intimate partner violence.
Real men and women During the formative research, young men described an asli mard (“real man” in Hindi) as someone who was physically attractive, dominant, aggressive, and sexually powerful. Controlling women and violent behaviour were important parts of the definition of a real man. Young men also thought that young women sought this type of real man. They stated that it was important to prove one’s manhood, and that proving manliness was characterised by violence against women, risky sexual behaviour, and alcohol and drug use. According to some of the young men interviewed, a real man: “should be a body builder… He must have physical strength and must take a lead in physical fights. A real man has to provide proof of his mardangi (manliness).” The concept of an asli nari or an “ideal woman” was also explored. She was shy and did not respond to men’s sexual advances. These women were considered “marriageable”. In contrast, girls who did not match these ideals “deserved” (and often were subject to) sexual harassment.
Yari-dosti – Tapping alternative voices Based on the results from the formative study, the team developed an intervention called Yari-dosti, which means friendship or bonding among men. The intervention was adapted from Program H, a groupbased project working with young men that was developed and tested by Instituto PROMUNDO and partners in Brazil.1 Both Program H and the Yari-dosti project seek to tap into “alternative” voices of young men that promote more gender-equitable norms and behaviours. During a weeklong workshop, followed by two months of community consultations, the team adapted 20 group educational exercises for the Indian context. Among the main themes covered in the exercises were STI/HIV risk and prevention, partner, family and community violence, gender and sexuality, and the reproductive system. These exercises were then piloted and tested with a group of young men from low-income communities in Mumbai. Selected peer leaders underwent an intensive two-week training programme to strengthen their knowledge and facilitation skills. Peer leaders then recruited young men from the community to participate in the intervention. The 126 participants thus recruited were divided into four groups of 30-35 participants each. The pilot started with an intensive week of group educational activities, facilitated by peer leaders and gender specialists and was followed by two to three-hour sessions every week, led by peer leaders only, for a duration of six months.
Results from the intervention Process data indicate that almost all of the young men recruited for the project consistently participated in activities. Also, most were greatly interested in the topic areas addressed, as it was their first opportunity to discuss these issues with other men. Participants were initially most interested in factual/biological information (e.g., on the human body, sex, HIV), but over time they found sessions on gender-related attitudes, sexual
Percentage of young men harassing girls reduced almost half after attending the Yari-dosti programme
violence, and power dynamics between men and women very engaging. The peer leaders observed that the process of change began with denial of existing norms and their links to risk, to gradual acceptance that these norms existed, and that change would be worthwhile, and then to exploring ways to challenge these norms and behaviours. The researchers were able to collect pre-test surveys from 107 young men, and post-test surveys from 92 young men. GEM Scale responses during pre and posttests indicated that a significant proportion of young men moved away from more inequitable attitudes to more egalitarian attitudes towards gender. For example, the proportion of men who said that “it is okay for a man to hit his wife if she refuses sex with him” declined from 28% during the pre-test to 3% during the post-test. Similarly, the proportion of young men who believed that “a man should have the final word about decisions in his home” declined from 34% to 11%. Self-reported harassment of girls over the last three months (referred to as “eve teasing” in India) significantly declined from 80% during the pre-test to 43% during the post-test. A trend towards increasing condom use with casual sex partners and sex workers was observed.
The next steps Based on the experiences generated during the pilot intervention, a large evaluation of the group education intervention – with over 1000 young men – has begun in the city of Mumbai and the states of Goa and Uttar Pradesh. In addition, a community-based “lifestyle” social marketing campaign, consisting of activities such as street theatre and poster distribution, is under development. The campaign will act to reinforce the gender equitable and HIV prevention messages from the group education sessions. With the tag line Soch sahi mard vahi (“A real man has the right attitude”), the campaign is being designed and executed by young men from the community. Ravi K. Verma (
[email protected]) & Vaishali Sharma Mahendra (
[email protected]), Horizons Program/ Population Council; Julie Pulerwitz (
[email protected]), Horizons Program/PATH; Sujata Khandekar (sujata55 @hotmail.com), CORO for Literacy, India; & Gary Barker, Instituto PROMUNDO, Brazil (
[email protected]). Contact person: Ravi K. Verma, Population Council India, 53 Lodhi Estate, New Delhi, 110003, India; tel.: +91-11-246.109.13, e-mail;
[email protected] 1.
More information about both the Yari-dosti intervention and Program H: Young Men and HIV Prevention, Horizons Report, December 2004: www.popcouncil.org/horizons/newsletter/horizons(9).html.
Sexual Health Exchange 2005/2
Fostering alternative views of male identity among boys in Latin America and the Caribbean Matilde Maddaleno, Francisca Infante, Rodrigo Aguirre, Pedro Güell & Sarah White Young men in Latin America and the Caribbean tend to engage in high-risk behaviours such as drug abuse, unprotected sex and violence that can have long-term consequences for themselves and others. Approximately 50% of young men aged 17 and under are sexually active, but do not practise safe sex. In Brazil, though 96% of adolescents know that condom use prevents HIV infection, only 60% report using them. Twenty percent of sexually active young males in El Salvador report condom use, while only 11% of sexually active adolescents in Nicaragua report regularly using any type of contraception. In many countries in the region, up to one third of babies are born to young women aged 10-19. Young people are particularly affected by the AIDS epidemic, as around half of new HIV infections occur among youth aged 15-24. Violence – especially related to drug trafficking and gang membership – is a serious problem that can lead to death among male adolescents.1
However, males are not born with an inherent desire to take risks. Rather, they are socialized to take on masculine characteristics early in life, which are later reproduced in an effort to exhibit manhood. As part of an effort to address the threats to adolescent male health, the World Health Organization (WHO)/Pan American Health Organization (PAHO), in collaboration with other agencies, undertook a multi-country, qualitative study to understand the relationship between high-risk behaviours and the construction of male identity.2 Focus groups and interviews were conducted with young male participants aged 10-24 from rural and marginalized urban areas in Brazil, Costa Rica, El Salvador, Guatemala, Honduras, Jamaica, Mexico and Nicaragua. Focus groups were used to shed light on the idealized common views of youth, while interviews were used to gather information about their real behaviours. Topics of discussion varied by age group, and included the meaning of manhood, development of sexuality, sources of information, and relationships with family, female partners and peers. Results were compiled and from them were derived participants’ views on characteristics that define masculinity as well as their ideas about “mandates” (ideas, norms and rules) that govern actions and relationships with others.
subordinating them sexually, and seducing them with intent to deceive them. Men were described as the hunter, unfaithful partner and the sexual satisfier. They felt that use of contraception was not their responsibility. Men, they added, use any opportunity to engage in sexual intercourse. The above descriptions provide a clear context for high-risk behaviours. Such behaviours serve the dual purposes of demonstrating manhood and thereby gaining acceptance and respect from peers, confirming the need for adolescent males to detach themselves from their intimate selves, their homes and families.
Alternative views In individual interviews, participants were more likely to suggest a certain struggle to achieve these ideas of manhood, and “confess” gender-equitable characteristics that in the group they would most likely deny. For instance, they recognized the contradiction in upholding
The construction of the male identity The central male characteristic emerging from the study was strength through physical capacity, aggressiveness and competitiveness. The youth stated that men are strong by nature and that this is reflected in their bodily strength. Strength of character, they said, could be exhibited through resistance to challenges, control of emotions and the capacity to take on responsibilities. Mandates identified through the study tend to focus on the requirements for the transition that adolescent males make from the home to the outside world, particularly the “street”. The street world is the domain of violence and other risk behaviours such as drug and alcohol abuse. It is rife with challenges and it is where peers meet and manhood is constructed. Participants stated that men are of the street and women and children are of the family. They said that men accepted the challenges posed by others and were therefore fighters, risk-takers and imitators of group behaviours. Their relations with women helped in the definition of masculinity. Mandates included possessing women,
There is a need to promote alternative views of male identity which will be beneficial to men and women Photo: Nel van Beelen
Special Article
7
8
Sexual Health Exchange 2005/2 both risk behaviour and responsibility as key masculine characteristics. It was mentioned that an overemphasis on the world of peers could lead one to neglect work and family responsibilities. The alternative view regarding relations with women placed a higher value on sentiment and legitimizes the emotional aspects of masculinity. Without denying the role of men as conquerors, participants also suggested that it was best for sexual relations to occur within the context of a committed and loving relationship. Programmes promoting action or attitudes that threaten the hegemonic model and the process of masculinity construction are likely to fail. However, there is a need to promote alternative views of male identity which will be beneficial to men and women. Such views, which are being espoused by some male youth are useful in the negotiation of daily life. Educational programmes should build upon them. Interventions targeting young males should take place in environments that are important for youth, take into account their treacherous path to constructing themselves as men, and work within this framework with the aim of finding ways to reinforce healthy and gender-equitable attitudes and behaviours.
The Football, Health and Gender programme Based on the results of the study, PAHO/WHO and the Johan Cruyff Foundation developed a strategy to use soccer to reach and educate young males. The programme, entitled “Football, Health and Gender: A New Approach to Health in Pre-Adolescent Males”, is underway in six Latin American countries and utilizes soccer coaches to promote gender-equitable health behaviours and relationships among pre-adolescent boys aged 8-12. Soccer plays a role in the lives of many young males, and the game embodies values promoted by dominant ideas of masculinity (see Box), as well as offering a fertile environment for enhancing alternative views of how to become a man. The programme requires soccer coaches to integrate health and gender education into soccer practice. Coaches are trained in: O Gender awareness and sensitivity to improve perceptions of masculinity O Sexual and reproductive health education, including HIV/AIDS and prevention of unwanted pregnancy
O Conflict resolution, anger management, and life skills development O Prevention of substance abuse through the promotion of good nutrition and well-being. After the training, coaches conduct “soccer schools” sessions for consecutive days. The soccer schools are open to local youth and held in public areas of lowincome neighbourhoods. The project has already been implemented in Argentina, Brazil, Chile, Paraguay, Mexico and Venezuela and has involved over 1000 adolescents. The project is an example of how programmes can reach young men by working at the level of their daily world. The risks that concern public health officials are rarely a concern of young people themselves. From the point of view of boys, what is at risk is their own identity and their transition to manhood. The successful and healthy completion of this transition can be a common objective of both health policies and the youth they target. By understanding the fragile nature of masculinity construction and working with emerging alternative masculinities, health officials can help adolescent males grow into the best men they can be. Matilde Maddaleno, Francisca Infante, Rodrigo Aguirre, Pedro Güell & Sarah White, Child and Adolescent Health department PAHO/WHO, Washington, USA; tel.: +1-202-974.35.23, fax: +1-202-974.36.31/3640; e-mail:
[email protected], web: www.paho.org/adolescence, www.adolec.org (Adolescent Virtual Health Library) 1. 2.
Health in the Americas. Volume II. PAHO, 2002 R. Aguirre & P. Güell. Hacerse hombres: La construcción de la masculinidad en los adolescentes y sus riesgos (“Becoming men: masculinity construction in adolescents and its risks”. PAHO, 2002 (Spanish only)
Adolescence, soccer and masculinity At present, soccer is the most popular sport with masculinity nuances. It is a masculine game par excellence. The masculinity ideal that soccer espouses strikes a chord with the youth. The values associated with the soccer practice are similar to those inherent in masculinity. Soccer condenses, produces and reproduces the masculinity hegemonic (superiority) model. It helps reaffirm the masculine subjectivity, the bonds between men, the exercise of paternity, the bonds with women and how tasks can be organized. Soccer connects directly with the masculine competitive side. When playing it, one feels that it is possible to exert power on other equals. Soccer generates much passion that can transform into fanaticism. This can be explained by soccer personalities or idols being admired by adolescents. The soccer player is the epitome of masculinity, recreating the idea of the superman: tough, brave, competitive, loyal to the group, successful and recognized by peers. Passion for soccer is inherited very early in life from fathers to children. Thus, the boy learns that soccer is a virile sport – it nurtures the masculine body and it is a measure of one’s strength. Finally, soccer builds affection and allows expression of bonds. It triggers diverse emotions and feelings, among them joy when men are playing it and, especially, when they win. Percy Fernández Dávila, PhD student of psychology at the Ramon Llull University of Barcelona
Sexual Health Exchange 2005/2
Using edutainment and social activities to challenge machismo in Nicaragua The example of Somos Diferentes, Somos Iguales
Henry Espinoza “Somos Diferentes, Somos Iguales” (SDSI), Spanish for “We’re Different, We’re Equal”, is a communication for social change strategy to promote the empowerment of young men and women and prevent HIV infection in Nicaragua. The strategy focuses on the social and cultural issues that hinder prevention of HIV by promoting the transformation of social norms towards greater gender equity and sexual responsibility. Furthermore, SDSI places HIV transmission in the context of daily life issues such as “machismo” (roughly translated as sexism or a system of subordination of women by men), gender-based violence, and drug and alcohol abuse, among others. The elements of the strategy have been developed by the Nicaraguan feminist organization Puntos de Encuentro (“Meeting Points” or “Common Ground”) since the late 1990s, but the HIV prevention project begun in 2002 and will end in 2005.
According to the 2004 UNAIDS report on the global AIDS epidemic, it is estimated that 0.2% of Nicaraguans between 15-49 years of age are infected with HIV. This prevalence is much lower than figures for the region as a whole and neighbouring Honduras (0.5% and 1.8%, respectively). Despite having one of the lowest HIVinfection rates in Latin America and the Caribbean, social, political, demographic and cultural factors make prevention difficult and could lead to a rapid spread of HIV. Sexual activity begins at an early age and the effect of machismo on both men’s and women’s sexuality is significant. Unprotected sex is the most common form of transmission. This puts the future of the next adult generation at risk. Cultural norms in Nicaragua encourage male sexual irresponsibility and efforts to prevent the spread of HIV/AIDS, through the promotion of condom use and the reduction of stigma, are hampered by custodians of tradition, especially the Catholic Church. In 2003, these sectors forced the government to withdraw a manual on comprehensive sex education for schools. In this context, mass media becomes a useful tool to fight HIV/AIDS, and using mass media in Nicaragua has at least two main advantages. Television and radio are by far the main forms of entertainment for Nicaraguans and almost all households have them. Furthermore, men and women seem to have equal access to them.
Mass media and social action Between 2002 and 2005, SDSI has taken on HIV prevention. The programme aims to increase young people’s perception and personalization of risk of infection; encourage them to develop or adopt more equitable gender norms and behaviours; and promote an environment where young people can engage in prevention actions, individually and collectively. SDSI combines two components that complement each other: mass media and social action.1 Mass media – The strategy promotes favourable conditions at the level of public opinion and social support to facilitate prevention and non-discrimination. More than half a million young people between ages 13 and 24 in Nicaragua are targeted by the mass media component through the weekly drama TV series Sexto Sentido (“Sixth Sense”) and Sexto Sentido Radio, both educational entertainment (“Edutainment”) programmes. Sexto Sentido Radio is a call-in debate programme hosted by young presenters. Sexto Sentido Television
“It is your life... Be bold!” Sexto Sentido’s affiche
weekly soap opera is about the daily lives of a group of youth, and is broadcast on the largest commercial TV station and re-broadcast on 11 local cable channels. Social action – Through agreements with more than 80 local service providers, Puntos seeks to increase access to quality SRH services for young people, and together with some 200 collaborating organizations, it hopes to create a more favourable environment for young people to develop their own initiatives.
Challenging machismo to prevent HIV Under the campaign slogan “We need to be able to talk”, there is an argument that machismo is a risk factor that increases the chances of contracting HIV. The TV series approaches this issue from various angles. For example, one of the main characters becomes infected and confronts the prejudices – including his own – about forms of transmission and what kinds of people get HIV. A young woman living with HIV shows the difference in men’s and women’s experiences with HIV/AIDS. The show also demonstrates the accumulated effects of gender-based bias and stigma towards women, homosexuals and sex workers. The series conveys the message that with awareness, open communication and equitable decision-making processes between men and women, HIV can be prevented.
Monitoring and evaluation The current focus on HIV/AIDS responds, to a large extent, to the needs expressed by young people in the previous period. The evaluation of the programme consists of a sequential approach of quantitative and qualitative research. For the 2002-2005 HIV/AIDS project, the effects are being measured in a cohort of 4,800 young people (13-24 years old) randomly selected in three cities in Nicaragua who will be interviewed three times: for
9
Programme Feature
10
Sexual Health Exchange 2005/2 baseline, for mid-term evaluation and several months after the project activities end. About 200 young people will be enrolled into the two qualitative measures, which comprise focus groups and individual interviews with young participants and non-participants of social action activities (workshop, camps, etc.). The evaluation is being conducted by a multi-agency team comprised by Horizons/Population Council, Program for Appropriate Technology (PATH), Centro de Investigación de Demografía y Salud (CIDS) and local consultants.
Collaboration – Working in an alliance provides another opportunity to sustain the programme. Collaborating organizations have already developed some ownership of approaches, themes and methods. In interviews with representatives from organizations, service providers and local media outlets with whom Puntos de Encuentro works, it was clear that SDSI is seen to have supported their own organizational work on these issues.
Challenges Lessons learned The findings of the baseline survey were not surprising: while there is good knowledge about HIV/AIDS, AIDSrelated stigma is prevalent, and safer sex is not practised very often. There is already some evidence to suggest that the strategy may play a helpful role to prevent HIV. Several factors can be seen as windows of opportunity for a sustainable strategy: Questioning cultural norms – Challenging machismo is a long-term process. SDSI is contributing to young men and women beginning to question, among other things, the social norms that govern their interpersonal relations and sex lives, and which negatively affect their quality of life. Integrated approach – The integration of different themes plays an important role in the sustainability of the SDSI strategy. HIV/AIDS and machismo are linked to a range of relevant themes: drug and alcohol abuse, physical, psychological, and sexual violence against women and girls, and early pregnancy, which are serious problems in Nicaragua. Capitalizing on popularity – In the four years since Sexto Sentido began national broadcasts, the series has become a source of national pride, especially when relatives in the United States reported seeing the show on TV “up there”.2 The popularity of the TV programme and its cast has helped reduce opposition from some conservative sectors, especially at the Ministry of Education, since actors are allowed to go to local high schools and talk with students about topics and perspectives that are usually not allowed in the curriculum.
Research Notes
The use of the media in SDSI has helped reach a wider public and provide information on prevention, existing services and the rights of people living with HIV/AIDS, including the right not to be discriminated against. Nevertheless, it is a challenge to demonstrate that changes in attitudes, norms and behaviours are taking place in the target population and to disentangle the attribution of those changes to SDSI and its components. While initial cost analysis shows that the programme is very inexpensive given its reach,3 additional analyses of costs in relation to impact are warranted. Henry Espinoza, independent consultant at Puntos de Encuentro; Rotonda Güegüense 4 cuadras abajo, 1 cuadra al lago, Managua, Nicaragua; tel.: +505-268.12.27; fax: +505-266.63.05, e-mail:
[email protected], web: www. puntos.org.ni The author would like to thank Amy Bank and Irela Solorzano of Puntos de Encuentro, Julie Pulerwitz of Horizons/Population Council, and Vanessa Kurz for their valuable contributions. 1.
2.
3.
An extended description of the SDSI components can be found in an article previously published in Sexual Health Exchange (2002, No. 1): www.sexualhealthexchange.org Sexto Sentido has recently begun broadcasting in the USA to Hispanic-Central American audiences via Centroamérica TV, a satellite cable station. It will also soon begin broadcasting on Honduran and Costa Rican TV stations. Based on audience estimates, the national broadcast of Sexto Sentido costs US$0.04 per youth viewer per episode. The cost per viewer is less if adults and children are taken into account as well, and it is even less as the total audience increases as a result of broadcast in other countries and distribution of videos.
Male identity, poverty and reproductive health in Namibia Britt Pinkowski Tersbøl The link between gender-based inequalities and the spread of HIV/AIDS has been an issue in academic debates and a focus in programme efforts for more than a decade. Women’s heightened biological vulnerability coupled with socio-cultural factors, have placed girls and women at particular risk of HIV infection. As a result, HIV prevention programmes have tended to focus more on women and girls. Unfortunately, women’s vulnerability has led to a tendency to assign the responsibility for safer sexual practices to women, often leaving men out of prevention efforts. By leaving out men, opportunities are missed to address more fundamental sexual and relationship dynamics and the relational aspect of power and powerlessness.
This is a lesson that should have been learned from the early family planning programmes that targeted mainly women. In the context of gender theory and in particular within social science work on reproductive health and HIV/AIDS, there has increasingly, over the past decade, been a focus on the situations of men and constructions of masculinities in sub-
Saharan Africa. Research findings indicate that increased social and cultural disempowerment of men is detrimental to reproductive health, promotes the spread of HIV and also hampers prevention efforts.1 One of these studies was undertaken in Namibia among the Kwanyamas, the largest ethnic group among
Sexual Health Exchange 2005/2
11
A 27-year-old respondent said having many children would make him proud and that failure to have children would invite ridicule. Going out at night to drink is also perceived by some informants as”natural” behaviour of real men.
Poverty and existential crisis
For many Namibian peoples, owning cattle is of the utmost importance Photo: Maite Rodriguez
the Ovambo population.2 Kwanyama society has undergone significant transitions since the advent of Christianity and colonialism in the 19th century. Subsistence agriculture, with animal husbandry (goats and cattle), was the economic mainstay of the ethnic group. Socio-economic and political changes have caused a large of number of community members to move to urban settings in the south. Systematic exploitation and pauperization of particularly black population groups took place during the colonial era, which only ended in 1990 when the country got its independence. In this qualitative anthropological study, which was carried out in rural and urban Namibia on heterosexual relationships and their socio-cultural context, 61 men and 62 women were interviewed. The study involved interviews and participant observation among Kwanyamas living in the northern rural region of Ohangwena and in the central coastal town of Walvis Bay, a town to which many Kwanyamas move from their villages to seek economic opportunities. Constructions of masculinities are dynamic processes and possible models of masculinities exist and are constantly contested as societies change and new models emerge. Although study informants pointed to more than one valued type of masculinity, a general trend can be summarised as follows: Men are supposed to be the leaders within the family and community, and provide for members of their maternal clan, wives and children. Boys and men are expected to possess skills associated with agriculture and livestock production. The importance of cattle is underlined as young boys are frequently withdrawn from primary schools to become herdsmen. Girls are more often allowed to continue schooling until their teens when many are forced to leave due to pregnancies. With only a few years of primary education, the boys are ill equipped for the future, particularly because economic recession has resulted in fewer jobs for unskilled labourers. In the urban sphere, men must demonstrate that they are able to find and keep a job in order to invest their earnings in their rural families and livelihoods in the north. Marriage is perceived as one of the life transitions that bestow adulthood on men. To marry, men should ideally have work, millet fields and cattle. While marriage is significant, it is equally important to be pro-active in the sexual sphere and prove virility through engaging in more than one sexual relationship and fathering children.
Respondents said poverty caused them significant stress and emotional suffering as they sought for economic opportunities in vain. Poverty is mainly attributable to lack of access to fertile land, cattle, education and job opportunities. The study supports findings of similar research in other sub-Saharan African countries which concluded that poverty and lack of prospects led to confusion and loss of self esteem and meaning. Although HIV/AIDS is perceived to be a serious problem, respondents view concerns over poverty and loss of hope for the future as more acute. This study suggests that health promotion programmes should provide men with a platform for communication and education that take their urgent concerns as a starting point. Such platforms should address men’s experiences of exclusion to challenge the existing perceptions and interpretations that men have of themselves and their partners. Also, men’s conduct in the sexual sphere and how it affects their partners, children and communities should be addressed. One community-driven initiative in Namibia has focused on social relations and violence, including sexual violence, in a disadvantaged community.3 Through dialogue and reflection, the programme helped participants to analyse the ideologies and structures that oppress them and others, and devise strategies for action. There is a need to encourage social science research, particularly action research – such as the work done in Brazil, which include comprehensive transformational education on HIV/AIDS among poor youth4 – to find approaches that are effective in motivating and empowering men to take part in controlling HIV/AIDS, and in protecting the health and rights of women and young girls. Britt Pinkowski Tersbøl, Researcher, Department of Women and Gender Research in Medicine, Institute of Public Health, University of Copenhagen, Denmark; tel.: +45-353.272.82, fax: +45-353.277.36, e-mail:
[email protected] 1.
2.
3.
4.
M. Silberschmidt, Disempowerment of men in rural and urban East Africa: Implications for male identity and sexual behaviour. World Development, Vol. 29, No. 4, 2001, p. 657-671. B.P. Tersbol, How to make sense of lover telationships – Kwanyama culture and reproductive health. In: Namibia, Society, Sociology, V. Winterfeldt, T. Fox & P. Mufune (eds.), University of Namibia Press, Windhoek, 2002. N. Kandirikirira, Deconstructing domination: Gender disempowerment and the legacy of colonialism and Apartheid in Omaheka, Namibia. In: Masculinities Matter! Men, Gender and Development, F. Cleaver (ed.), Zed Books, London, 2003. V. Paiva, Gendered scripts and the sexual scene: Promoting sexual subjects among Brazilian teenagers. In: Framing the sexual subject: The politics of gender, sexuality and power. R. Parker, R. Barbosa & P. Poverty drives people from Aggleton (eds.), University of California Press, Berkeley, urban areas 2000. Photo: Gabor Zsoldos
the countryside to
12
Sexual Health Exchange 2005/2
Special Article
Behind the bars of South African prisons Gendered roles and vulnerability of male inmates to forced sex
Sasha Gear In South African prisons, different kinds of sexual interactions and relationships take place between men. The majority of these are abusive, exploitative, and involve rape and various degrees of coercion. Newcomers to prison are especially vulnerable because they are unfamiliar with the “rules” of inmate culture and are easily manipulated. Seasoned inmates regard them as sources of material goods including sex, and as potential gang members. Often, a newcomer accepts goods and services such as protection, food or cigarettes from another inmate without realizing that sex will be expected from him as payment for the unknowingly created “debt”. Rape frequently follows as a consequence.
However, there are no absolute prerequisites for sexual violation. Both poverty and fear, for example, can be created by fellow inmates to ensure anyone’s compliance.
Gendered roles
A qualitative study by the South African Centre for the Study of Violence and Reconciliation (CSVR) showed that the trickery frequently used to subordinate inmates relies on the exchange value that is attributed to sex.1 Because sex is embedded in the prison economy, those who are poor tend to be amongst the more vulnerable. Prisoners who do not get visitors (an important source of commodities and money) are often economically needy. As one respondent put it, “money makes prison go round” and prisoners’ basic rights – food rations, blankets, beds – become embroiled in this economy. The risks of rape are higher among those who are physically weak, not prepared to use violence or who are perceived to have committed a “sissy crime” (often those that do not involve violence or weapons). Having “good looks” also increases the likelihood of being targeted.
Beyond the trauma of unwanted sex, rape is understood to demolish the victim’s manhood and turn him into a “woman”. This is linked to the way in which dominant inmate culture perceives gender to be connected to certain sex roles: men penetrate and women are penetrated. Rape and coercion are, as a result, used to brutally impose a feminized identity on a portion of the male prisoner population. “Women” are generally stigmatized as inferior and become the sexual property of inmates identified as “men”: prison “womanhood” usually means being the constant target of harassment and abuse. In the words of one young inmate: “We are all criminals in here and if I say you are a criminal that means that I respect you. But if you have had sex done to you, even the criminal in you is now gone and you are now a woman… There is nothing we can do for you. Some people just look and some want to sleep with you and when you walk past people, they want to touch or threaten to rape you.” An initial rape often sees victims being taken by the perpetrators as prison “wives” or wyfies (in Afrikaansinfluenced prison slang) in long-term coercive
HIV/AIDS and prisons in South Africa The majority of prisoners in South Africa fall into a category at high risk for HIV infection: young, uneducated, black men. They face problems of overcrowding, violence and poor nutrition. Very little is known about HIV prevalence among inmates however. Based on the assumption that HIV prevalence in South African prisons is twice that of the prevalence amongst the same age and gender in the general population, the Institute for Security Studies (ISS) estimated in 2003 that some 40% of male and female inmates were HIV infected in the year before.1 A study among 271 male inmates of the Westville Medium Security Prison in Durban, KwaZulu-Natal Province, showed that 30% was infected with HIV.2 “Natural deaths” in prison, most of which are believed to be AIDS-related, are on the rapid increase. During the period 1995-2004 the annual death rate escalated from 1.65 per 1000 prisoners to 9.1 deaths per 1000 prisoners. In 2004, 1689 deaths were considered natural and 69 were unnatural.3 The South African Department of Correctional Services has introduced a range of policies to address HIV/AIDS in prison, based on human rights principles and international guidelines, and covering issues such as confidentiality, non-discrimination, condom provision, medical treatment etc. However, due largely to chronic overcrowding and inadequate resources, these policies are at best, unevenly implemented – more often barely so. 1. 2. 3.
K.C. Goyer. HIV/AIDS in prison. Problems, policies and potential. ISS Monograph No 79, 2003: www.iss.co.za/Pubs/Monographs/No79/ Content.html. J. Gow, G. Smith, K.C. Goyer & M. Colvin. The socio-economic characteristics of HIV in a South African prison. Abstract no. WePeD6529, XV International AIDS Conference, 2004, Bangkok. Judicial Inspectorate of Prisons. Annual Report 2004/2005. Cape Town.
Sexual Health Exchange 2005/2 relationships known as “prison marriages”. The “husband” provides material goods and consumables for his wyfie, who is required to do domestic tasks and be constantly sexually available to him. While such relationships contain differing levels of coercion and evolve differently over time, it is generally agreed that the majority of wyfies despise their positions, remaining in them only because of fear. Particularly oppressive notions of gender are at the centre of much of the sex happening in prison. To be naïve, trusting, poor, and not prepared to use violence are qualities associated with inferiority and womanliness. Manliness is equated with the use of violence and the ability to endure certain forms of it, deviousness, and participation in the prison economy (through smuggling and theft). Power lies with men. The centrality of violence to manhood is highlighted in the typical requirement that wyfies seeking promotion to manhood perform a specific violent deed in order to prove worthiness of manhood.
Homophobia and alternative sexual relations A Stop Prison Rape activist once said that in American prisons an inmate “could be fucking his cellmate every night, but will truthfully, as far as he is concerned deny that he has had a homosexual experience in prison”. It is much the same in South African prisons where the most common and sanctioned forms of sexual interaction (in marriages and the like) tend not to be connected to notions of homosexuality by many of the people involved. Indeed, some other types of sexual interaction are considered deviant precisely because they are associated with homosexuality. Ushintsha ipondo – literally meaning to “exchange a pound” – is reportedly common but also a punishable offence according to the inmate code. It is characterized by consensual sex and often spoken of as “doing each other favours” (regularly, it involves people who are simultaneously other prisoners wyfies). In these relationships, neither partner is considered to be inferior/superior, and both take turns to penetrate and receive. By doing so they are disrupting the system that demands that penetration is only for “men” and receiving only for “women”, and cannot therefore be divided into genders on the basis of a restricted sex role. This blurring of gender leads to its association with homosexuality and the threat it poses to the sexual status quo behind bars.
Institutionalization of forced sex A potentially vast range of circumstances surround prison sex. For instance, sex interactions contained in relationships defined by love feelings between partners are also reported, although less commonly. It is rape, coercion, and exploitation that have the strongest hold, and while the boundaries in prison between consent and coercion are particularly blurred, blatantly forced sex frequently escapes being viewed as such, but is rather considered normal and acceptable. Sexual abuse is embedded within inmate culture, and is most visible in the rules, rituals, and ranks employed by powerful prison gangs to organize sex along the destructive lines of “marriage”. At another level, such practices are also endorsed by the lack of attention they receive from prison officials. Important to recognize however, is that the ways that people outside of prison relate to each other play a fundamental part in these damaging prison processes. Popular beliefs around gender, for example, are behind
Image: International HIV/AIDS Alliance
the inferior way in which “prison women” are viewed, the entitlement of men to sex from them, and the powerful perception that victims of forced sex in prison, like those outside, are to blame for what has happened to them. The myth that, “real men do not get raped” has a grip in the outside world as well. Explanations from prisoners highlight the connections with broader society: “Wyfies are treated just like women outside”, said one. Or, in the words of another, “You can’t rape your wife”.
Damaging and damaged identities Particularly destructive notions of what it means to be a man or woman are intensified and entrenched in prison. Intolerances are fuelled, abusive and dangerous behaviours learnt and trauma caused. Prison is likely to provide young inmates with some of their most decisive views on sexuality and gender, ones on which they will base future relationships. Further, sexual violence has severe consequences for the spread of HIV and STIs and the health of prisoners. Amidst high crime levels, punitive public attitudes prevail and the health and well-being of inmates are not of popular concern. If the realities of life behind bars continue to be ignored, many men exposed to life in prison will be condemned to living out damaging and damaged identities. But while the area is starved of the attention it so urgently requires, a sprinkling of individuals and groups have made a vital start: like the successful committee of inmates and staff in one KwaZulu-Natal prison that works to manage and prevent HIV/AIDS there, or another, set up in the notorious Cape Pollsmoor prison, to support victims of prison rape; or the drama performances by a Gauteng NGO that challenge the oppressive and gendered inmate power relations at the same time as they raise awareness of HIV risk. The learnings and experiences provided in initiatives like these need to be shared and drawn on to focus a broad and concerted strategy to prevent the violence and safe-guard prisoners’ health. Sasha Gear, Researcher Centre for the Study of Violence and Reconciliation; PO Box 30778, Braamfontein, South Africa, 2017; tel.: +27-11-403.56.50 ext 141, fax: +27-11-339.67.85, e-mail:
[email protected], web: www.csvr.org.za 1.
S. Gear & K. Ngubeni. Daai ding: Sex, sexual violence and coercion in men’s prisons. Centre for the Study of Violence and Reconciliation, 2002: www.csvr.org.za/papers/papsgkn.htm.
13
14
Sexual Health Exchange 2005/2
Special Article
Men who have sex with men and disempowerment in South Asia Shivananda Khan Men in South Asia dominate public spaces and the affinity male members of the society have for other men is central to this. This affinity, which is openly displayed in public, is one of the facilitating factors in male-to-male sexual relationships in the region. Most male-to-male sexual relationships in South Asia are based on gendered self-identities and sex roles. The most visible of these male-to-male sex frameworks involve feminized males who identify themselves as kothis, a term used across Bangladesh, India and Pakistan. Their partners, who generally sexually penetrate them, are males who are referred to as giryas or panthis – meaning “real men”. Males who are penetrated are usually perceived to be “not-men”. This labelling plays a role in enabling the penetrating males to consider themselves superior to the penetrated in terms of power relations.
who could be categorised as MSM would not define themselves as such because they perceive themselves as normative penetrative males or as penetrated “not-men”. Categorization is further complicated by the traditional demand that every man marries a woman. Many MSM, of whatever gender identification or sexual orientation, are either married or planning to marry, even kothis. Many MSM have concurrent relationships – with men and women at the same time.
Male to male sex and HIV/AIDS
Kothis at a drop-in center
For self-identified kothis then, the distinction between themselves and their male partners is based on gender identity and not sexual identity. Kothis identify more with females as attested to by a kothi who said: “Why do men have sex with men? This is not normal. We kothis are here for them.” Another stated: “When my parik (husband) beats me, I feel as helpless as a woman. Since I want to be a woman, it actually makes me feel good.” This gendered identity framework of male-to-male sex is mainly common among low-income populations, both rural and urban, which are plagued by poverty, low levels of literacy and economic disempowerment. Another category of men who have sex with men (MSM) involves English-speaking, middle and upper class males who identify themselves as gay. Then there are hijras, biological males who cross-dress regularly. They are often castrated and belong to a socio-religious community with its own rules and regulations. They draw their sexual partners from the general male population. Finally, there are men and boys who approach other males to relieve their sexual urge (referred to as “reducing body heat”) and may include friends having sex with friends for mutual pleasure and males in all-male institutions such as boarding schools. In the South Asian context, male-to-male sex is seen primarily within a gendered dynamic, rather than in terms of sexual orientation or identity. This means that many
Very little is known about HIV prevalence among MSM in the region. The National AIDS Control Organisation (NACO) in India has several sentinel sites which target MSM separately. In 2002, NACO reported a 23.6% rate of HIV infection among MSM in Mumbai. However, two sentinel sites located in rural areas in Tamil Nadu State reported much lower figures, that is 1.2 and 3.6% respectively. The exact contribution of male-to-male sex to HIV infection is unknown, as no studies have been undertaken on the subject. From the observed high-risk behaviour and vulnerability of the kothis, it can be assumed that the impact is significant. The various situational assessments conducted by the Naz Foundation International indicate the following risk and vulnerability factors: O Feminization within a dominant masculinity that sees such males as less than men, and thus susceptible to abuse, violence and rape O Receptive anal sex and low levels of condom and lubricant use O High levels of multiple partners and sex work O Significant levels of reported STIs and low levels of treatment.
Stigmatization and disempowerment The Naz Foundation International (NFI) is an international NGO, whose primary aim is to improve the sexual health and human rights of marginalized males who have sex with males, and their partners and families in South Asia. Research conducted by NFI shows that men who are anally penetrated by other men are highly stigmatized, both by penetrators, as well as the general society.1 Those who are perceived to be recipients of penetration are usually treated with contempt. Such stigmatization leads to human rights abuses, blackmail, violence, and male-on-male rape by local men, thugs and even the local police. As reported by several members of the
Sexual Health Exchange 2005/2 Network of Indian People with Alternate Sexualities living with HIV/AIDS (NIPASHA), MSM living with HIV/AIDS are stigmatized by other men who are also living with HIV/AIDS because men in heterosexual relationships deem their routes of HIV infection “normal”. Many kothis also face harassment, sexual violence and rape from former friends in schools and colleges, and from those in positions of trust such as relatives, neighbourhood elders and teachers. Gang rape is common, along with violence and abuse from sexual partners. Such forced sex is always unsafe and often results in serious physical injury such as a ruptured rectum, internal haemorrhage and even HIV infection. One of the central issues that have arisen from NFI research is that often it is effeminacy (acting or looking like a woman) and not the factual knowledge of male-tomale sexual behaviour that leads to harassment and violence. This effeminacy is expressed through body language, and at times, through cross-dressing, wearing make-up and use of effeminate language. Harassment and sexual violence result from the fact that many kothis do not live up to the expected normative standards of masculine behaviour. It is this belief that leads to the notion that those who are feminized can be exploited and abused and that being feminized somehow weakens the person, a notion often harboured by the kothis themselves. The disempowerment of kothis has been found to create significant levels of suicidal impulses and selfdamage, an expression of self-hatred and despair. This increases their vulnerability to STI/HIV as well as impeding successful implementation of risk-reduction strategies.
What needs to be done Accepted notions around effeminacy are, therefore, one of the major factors that lead to disempowerment and opens kothis to abuse and assault. The fact that kothis themselves have internalized these notions so strongly, means that specific tools need to be developed for them to enable them to value their lives, enhance their selfrespect and reduce their risks of contracting HIV. These tools would include gender-sensitivity training programmes that address differing sexualities, targeting the judiciary and law enforcement agencies2 and education and vocational training programmes for kothis, to make them less economically dependent on their partners. Examples drawn from female sex workers projects, such as the Sonagachi Project in Calcutta, India, indicates this could be a viable process for enhancing selfesteem, increasing other sources of income, and more effective risk management. Also, the legal, sociocultural and economic impediments to MSM sexual health interventions urgently need to be understood and addressed. An NFI study in Bangladesh (Against the odds, 2002, 2004) clearly identifies this as a
major concern. Empowering MSM to develop their own self-help services will be central because communitybased organizing is often the best approach to sustaining behaviour change. NFI has assisted in the development of 28 such community-based service providers in Bangladesh, India, Nepal and Pakistan, who are showing the way. There are several other organizations in the region which have arisen from networks of MSM and developed as self-help providers, including Humsafar Trust in Mumbai, MANAS Bangla in Calcutta, Sahodaran in Chennai, Blue Diamond Society in Kathmandu, and Bandhu Social Welfare Society in Bangladesh. While these, and others, are providing excellent services, in a region of 1.5 billion people there is still a lot more that can be done, and should be done. Some of the issues that need to be addresses are: O Repeal of legislation that impedes sexual health promotion among MSM O Address human rights violations of MSM and reduce sexual violence, harassment and abuse O Empower local networks of self-identified MSM to develop their own services O Address the risks of unprotected anal sex in all HIV/STI education programmes for the general population O Include MSM in policy and decision-making at all levels O Ensure that appropriate STI treatment centres are available, accessible and sympathetic to the needs of the many differing sub-populations of MSM. Since 1996, NFI, along with several other MSM agencies in the region, has been strongly advocating for change, and for ensuring that appropriate services for at-risk populations of MSM are available and accessible. Donors, governments and NGOs in South Asia are now beginning to recognize the real risks of the HIV epidemic spreading through the various MSM sub-populations, and into the general population. However, such advocacy needs to be maintained, strengthened, and upstreamed, so that more funds can be leveraged to develop new services, and those most at risk can be ensured equity, social justice and well-being. Shivananda Khan, Chief Executive Naz Foundation International; Palingswick House, 241 King Street, London W6 9LP, UK; tel.: +44-20-856.301.91, fax: +44-20874.198.41, e-mail:
[email protected], web: www.nfi.net. Regional Office: 9 Gulzar Colony, New Berry Lane, Lucknow 226 001, India; tel.: +91-522-220.57.81/2, fax: +91-522220.57.83, e-mail:
[email protected] 1.
2.
Resources located on the NFI website (www.nfi.net): e.g., Situational Assessment Report for Hyderbad, 2000; NFI Briefing Paper No. 7: Social Justice, human rights and MSM; and Against the odds – a report on the impact of legal, socio-cultural, legislative and socio-economic impediments to effective HIV/AIDS interventions with males who have sex with males in Bangladesh. NFI also publishes the quarterly newsletter Pukaar on HIV/AIDS, sexual health and Asian masculinities and sexualities (available online). NFI is currently supporting a number of its partner agencies to develop local advocacy cells within their programmes, which take on this sensitization role. A toolkit consisting of 6 books on implementing an MSM sexual health project has recently been published: Developing manual. Developing community-based organisations addressing HIV/AIDS, sexual health, welfare and human rights issues for males-who-have-sex-with-males, their partners and families, NFI, 2005. Available online.
15
Online Resources
O HIV/AIDS -
The role of men in the fight against HIV/AIDS. N. Wainaina, UN Division for the Advancement of Women/ILO/UNAIDS/UNDP, 2003 (11 p.): www.un.org/womenwatch/daw/egm/men-boys2003/EP4Wainaina.pdf
-
Working with men. Special issue AIDS action, No. 48, 2000: www.aidsaction.info/aa/aa48.html
-
Young men and HIV – Culture, poverty and sexual risk. T. Scalway, Panos Report No 41, Panos Institute/UNAIDS, 2001 (48 p.): www.panos.org.uk/resources/reportsection.asp?ID=1001
-
Young men and HIV prevention. Horizons Report, 2004 (12 p.): www.popcouncil.org/pdfs/horizons/hrptdec04.pdf
-
Working with men, responding to AIDS. Gender, sexuality and HIV – a case study collection. International HIV/AIDS Alliance, 2003 (68 p.): www.eldis.org/static/DOC13895.htm
-
Between men – HIV/STI prevention for men who have sex with men. International HIV/AIDS Alliance, 2003 (64 p.): www.eldis.org/static/DOC13606.htm (English, French or Spanish)
O Recent articles in Sexual Health Exchange (www.sexualhealthexchange) -
-
The need to scale up HIV/AIDS programmes for gay men and other MSM in Latin America and the Caribbean. S. Lewis, No. 1, 2005 Working with young men to address violence and HIV in Tanzania. H. Lary et al., No. 3/4, 2004
O Gender inequality, masculinity & violence -
Young men and the construction of masculinity in subSaharan Africa: Implications for HIV/AIDS, conflict and violence. G. Barker & C. Ricardo (Instituto Promundo, Brazil). World Bank Social Development Papers No. 26, 2005 (96 p.): www.promundo.org.br/Pesquisa/Young Men SubSaharan_ Web.pdf
-
Special issue of Sexuality in Africa magazine on masculinity. Vol. 2, No. 1, April 2005: www.arsrc.org/downloads/sia/apr05/apr05.pdf
-
Gender equality and men: Learning from practice. S. Ruxton, Oxfam Publishing, 2004 (258 p.): www.oxfam.org.uk/what_we_do/resources/geneqmen.htm, hardcopy: £13.95 (
[email protected])
-
-
-
-
Hacerse hombres (“Becoming men”, Spanish only). WHO/ PAHO, 2002 (30 p.): www.paho.org/Spanish/HPP/HPF/ADOL/Hacerse%20hombres 1.pdf Working with men and boys to promote gender equality and to end violence against boys and girls. L. Karlsson & R. Karkara, Save the Children Sweden-Denmark, Regional Programme for South and Central Asia, 2004 (20 p.): www.crin.org/docs/resources/publications/SC-Masculinities.doc HIV prevention with men: Toward gender equality and social justice. A. Greig, discussion paper expert group meeting on “The role of men and boys in achieving gender equality”, Brazil, October 2003 (19 p.): www.un.org/womenwatch/daw/egm/men-boys2003/EP7Greig.pdf Addressing gender-based violence from the reproductive health/HIV sector. A literature review and analysis. A. Guedes, Poptech/IGWG, 2004 (115 p.): www.prb.org/pdf04/AddressGendrBasedViolence.pdf
O Sexual and reproductive health -
Enlisting the armed forces to protect reproductive health and rights. Lessons learned from nine countries. UNFPA, 2003 (99 p.): www.unfpa.org/rh/armedforces
-
It takes 2: Partnering with men in reproductive and sexual health. UNFPA, 2003 (59 p.): www.unfpa.org/publications/detail.cfm?ID=99&filterListType=1, hardcopy:
[email protected] (Michele Chapoteau)
-
Reaching men to improve reproductive health for all. Implementation guide. Interagency Gender Working Group, USAID, 2003 (142 p.): www.jhuccp.org/igwg
-
Working with young men to promote sexual and reproductive health. K. Rivers & P. Aggleton, Safe Passages to Adulthood Programme, 2002 (37 p.): www.socstats.soton.ac.uk/cshr/pdf/guidelines/workingwithy men.pdf
All resources are accessible through our website: www.sexualhealthexchange.org
Sexual Health Exchange is published four times per year by the Royal Tropical Institute (KIT) in the Netherlands, in collaboration with SAfAIDS (Southern Africa HIV and AIDS Information Dissemination Service), Zimbabwe. Financial support has been provided by the Dutch Ministry of Foreign Affairs and GTZ, Deutsche Gesellschaft für Technische Zusammenarbeit, Germany. Articles may be reproduced free of charge, provided that the source is credited and clippings are sent to our contact address. All correspondence should be sent to:
[email protected] or Sexual Health Exchange, The Editor, c/o Royal Tropical Institute, Information & Library Services; P.O. Box 95001, 1090 HA Amsterdam, the Netherlands. Managing editor: Nel van Beelen Executive editors: Nel van Beelen & Eliezer Wangulu (SAfAIDS) Secretarial and administrative support: Dorothy Timmerman & Ewa Cudowska Editorial advisers: Mabel Bianco (Argentina), Maria de Bruyn (USA), Jacques du Guerny (France), Helen Jackson (Zimbabwe), Gesa Kupfer (Germany), Lee-Nah Hsu (Thailand), Marina Mahathir (Malaysia). Layout: Fontline Electronic Publishing (Pvt) Ltd. (Zimbabwe) ISSN: 1388-3046
Printer: Drukkerij MacDonald/SSN Nijmegen (The Netherlands)
