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Expectations about what it means to be a
man or a woman, which are an integral part of most children’s
socialization, leave many adults ill prepared to enjoy their sexuality or
protect their health. Gender has such a powerful influence on sexual
behavior that some experts believe challenging traditional views of
masculinity and femininity is essential to promoting sexual health.
Gender stereotypes of submissive females
and powerful males may restrict access to health information, hinder
communication, and encourage risky behavior among women and men in
different, but equally dangerous, ways. Ultimately, they increase
vulnerability to sexual health threats such as violence, sexual
exploitation, unplanned pregnancy, unsafe abortion, and sexually
transmitted infections (STIs), including HIV.
From an early age, people are socialized
to believe that gender roles are "natural," which contributes to
beliefs that risky sexual behavior is unavoidable, notes Dr. Jill Lewis,
who coordinated The Nordic Institute for Women’s Studies and Gender
Research’s Living for Tomorrow project with youth in Estonia from 1998
to 2000.
Projects such as Living for Tomorrow
encourage men and women to question and change the assumptions about
gender that govern sexual behavior. These projects are relatively new and
few, but their experience suggests that young people, in particular, are
open to reconsidering the gender roles that their societies have
constructed for them. This openness is important because the patterns of
sexual and reproductive behavior young people adopt during adolescence
will have long-lasting effects on their future health and well-being.1
Women’s vulnerability
Many societies prepare girls to be
"good" wives by socializing them to be submissive to men.2
Families, teachers, and peers reinforce the assumption that girls are
inferior to boys, until many young women come to believe that their
unequal status is justified.3
Women’s low social and economic status
throughout much of the world poses serious threats to their sexual health.
The power imbalance between men and women can make it impossible for women
to refuse unwanted or unprotected sex, negotiate condom use, or use
contraception against a husband’s or partner’s wishes. Women are also
more likely to exchange sex for money or favors and less likely to leave
an abusive or otherwise harmful relationship if they are economically
dependent on men.4
Society’s expectation that women defer
to male authority supports many practices that are harmful to women’s
sexual health, such as early marriage and sexual or domestic violence.5
In many societies, an emphasis on
preserving women’s virginity before marriage actually increases their
vulnerability. Fears that people will suspect they are sexually active
prevent many young women from asking questions about sex, using
contraceptives to prevent pregnancy, negotiating condom use to prevent
STIs, or seeking reproductive health services. Some young women believe
that they can remain virgins by engaging in anal sex, a practice that may
increase their risk of HIV infection.6 And in societies with
high HIV prevalence, virginity may put young women at greater risk of rape
and sexual coercion by men who believe that having sex with a virgin —
or even an infant girl — can cleanse a man of HIV infection.7
Concerns about high rates of HIV and other
STIs among youth and particularly young women, the prevalence of violence
against women, and men’s role in discouraging family planning have
focused new attention on the assumptions about gender that influence
sexual and reproductive behavior. Most efforts to challenge gender
stereotypes have sought to empower women, but there is growing recognition
that women cannot protect their sexual health without support from men.8
Being a man
Men benefit from their privileged status
in most societies, but traditional male gender roles also have their
costs. Research shows that socialization of boys to repress emotion, use
violence to resolve conflicts, and be independent at an early age has
harmful effects on their health.9 In a national survey of young
men ages 15 to 17 in the United States, for example, those who held
traditional views of manhood were more likely to report substance use,
violence, delinquency, and unsafe sexual practices.10
Unlike their female counterparts, boys are
often expected and even encouraged to be sexually active at an early age.
In one study in Jamaica conducted as part of FHI’s Women’s Studies
Project, 12-year-old boys spoke of encouragement and pressure from male
relatives and peers to be sexually active. A boy’s male relatives will
tell him that "girls will make him feel like a big man," one boy
said.11 Young men are much more likely than young women to
report having casual sex and, in some countries, may have their first
sexual experiences with sex workers.12 In many societies,
having multiple sex partners is considered essential to being a
"man."
The expectation that boys be sexually
experienced does not mean they know how to protect their sexual health.
Adults tend to assume that boys know more than they do, and boys are
afraid to ask questions that reveal their ignorance.13 Pressure
from peers and adults also influences the way young men approach sexual
relationships and often encourages them to engage in risky sexual
behavior. For many young men, sexual initiation is seen as proof of
manhood, and presenting their sexual conquests to a male peer group may be
as important as the sexual relationships themselves.14
One tactic used to pressure young men to
conform to a society’s expectations of male behavior is to imply that
those who do not are homosexual.15 Prejudice against homosexual
men is particularly harmful for young men who have sex with men, leading
to denial of sexual risk, low self-esteem, and even suicide. But
homophobia affects all men by discouraging behaviors that are considered
"feminine," such as caring for others or protecting one’s
health.16 Results from qualitative research among young men in
nine Latin American countries found that they considered health risks to
be far less important than perceived threats to their masculinity.17
Despite the strength of such pressures,
not all men conform to traditional gender roles. And, in many parts of the
world, gender roles are rapidly evolving as a result of a variety of
social, economic, and cultural changes, including increasing access to
education and mass media, urbanization, and participation of young women
in the work force.18 These changes often expose youth to
threats to sexual health for which they are unprepared, but may help free
them to consider new ways of relating to one another and different
patterns of sexual behavior.
For example, results from a study of youth
sexuality and sexual health in Lima, Peru, revealed high levels of
unplanned pregnancy, coerced sex, STI symptoms or diagnoses, and abortion,
but also indicated that some positive change might be under way among
sexually active adolescents. The 16- to 17-year-old boys surveyed were
half as likely as the men ages 19 to 30 to report having their first
heterosexual experience with a sex worker. The 16- and 17-year-olds —
particularly girls — were more likely than the young adults to report
using a condom the first time they had sexual intercourse. Such results,
wrote study author Dr. Carlos Cáceres, suggest a sexual experience
"that may be connected to love, the disposition to use protection
from STDs [sexually transmitted diseases], and other dimensions of respect
and responsibility."19
Challenging gender roles
Dr. Alice Welbourn, who wrote a training
package on gender and sexual health called Stepping Stones for the
Strategies for Hope series of the London-based ActionAid, notes that
efforts to challenge prevailing views about gender are often viewed as an
imposition of values from another culture. Rather than promoting specific
attitudes and behaviors, the Stepping Stones videotape and manual
leave the interpretation of gender to local par-ticipants and
facilitators. They present questions, stories, and exercises that
challenge participants to raise concerns, analyze their attitudes, and
practice new behaviors.20
Some groups have found that they can more
effectively reach men if they adopt a nonjudgmental attitude, even toward
the most unacceptable behaviors associated with traditional masculinity,
such as domestic violence.21 Others working to reduce gender
inequality, such as the Brazilian nongovernmental organization Instituto
Promundo, target young men who have already demonstrated an interest in
changing their behavior. Its Jovem para Jovem (Guy to Guy) project in Rio
de Janeiro offers these young men support from peers and adults and
encourages them to reflect on the potentially harmful effects of some
traditionally masculine behaviors.22
Instituto Promundo Director Dr. Gary
Barker notes that working with adolescents is important because between
puberty and adulthood young people rehearse the ways they may interact in
intimate relationships throughout their lives.23
"Nevertheless, men’s behaviors and attitudes can change over the
course of their lives and during different relationships," Dr. Barker
says. "There are also specific critical moments — such as at the
birth of a first child or at the beginning of a new intimate relationship
— when men seem more open to adopting alternative views. Program
planners seeking to promote behavior and attitude change can be attuned to
these critical moments."
Instituto Promundo and three other
nongovernmental organizations have designed training sessions and manuals
in Spanish and Portuguese about working with young men to change
health-threatening gender attitudes and related behaviors. With support
from the Population Council’s Horizons Project, the institute will
develop and test a scale to measure changes in attitudes or behavior among
young men participating in programs that use the manuals. Evaluators can
also use this scale to measure statistical correlations between gender
attitudes and sexual behaviors.
Impressions from the field
Most interventions designed to change the
gender-related attitudes and behaviors that threaten sexual health are
fairly new and have not been well evaluated. It is important to note that
indications of their impact are primarily anecdotal.
A study is under way to assess the impact
of adaptations of the Stepping Stones training package in South
Africa. Meanwhile, anecdotal evidence from youth and adults who have
participated in Stepping Stones workshops in different countries
and cultural contexts suggests that such attitudes and behaviors can be
changed. Changes reported in group discussions and questionnaire responses
include improved communication between parents and children, less
gender-based violence, reduced use and abuse of alcohol, greater demand
for condoms, greater self-confidence, and more respect between men and
women. Some young women say that they are able to say "no" to
unwanted sex, and some young men report resisting peer pressure to have
sex.24
A program for adolescent boys in
southeastern Nigeria seeks to help them challenge traditional gender
assumptions through continuous involvement in their lives. These young men
are beginning to treat women more respectfully. Meanwhile, adolescent
girls in a sister project called the Girls’ Power Initiative (GPI) are
using their new knowledge and skills. During one of the "checking
in" sessions that begin each weekly meeting, a girl reported quizzing
a boy who asked to be her friend and then informing him that she was not
ready for the kind of "friendship" he had in mind — a sexual
relationship. The boy’s response was one the other girls recognized:
"Why do GPI girls ask all those questions?"25
Young people in the Living for Tomorrow
project in Estonia also said that their peers had noticed a change in
their perspectives and in their ability to speak up for themselves.
Addressing young people’s concerns about gender and sex was the key to
these and other behavior changes, says Project Coordinator Dr. Jill Lewis.
"If you can raise these gender issues, you are tapping into a whole
set of anxieties, questions, and hopes that become a rich soil in which
messages about sexual safety can take root," she says.
— Kathleen Henry
Shears
References
- Mensch B, Bruce J, Greene M. The
Uncharted Passage: Girls’ Adolescence in the Developing World.
New York: Population Council, 1998; World Health Organization. What
About Boys? A Literature Review on the Health and Development of
Adolescent Boys. Geneva: World Health Organization, 2000.
- Mensch.
- Irvin A. Taking Steps of
Courage: Teaching Adolescents about Sexuality and Gender in Nigeria
and Cameroun. New York: International Women’s Health Coalition,
2000.
- Rao Gupta G. Gender,
sexuality, and HIV/AIDS: the what, the why, and the how. XIIIth
International AIDS Conference, Durban, South Africa, July 9-14,
2000.
- Mane P, Aggleton P. Gender and
HIV/AIDS: what do men have to do with it? Curr Soc
2001;49(4):23-37.
- Weiss E, Whelan D, Rao Gupta
G. Gender, sexuality and HIV: making a difference in the lives of
young women in developing countries. Sex Rel Ther
2000;15(3):233-45.
- Rao Gupta; Pitcher JG, Bowley
DMG. Infant rape in South Africa. Lancet 2002;359(9303):274-75.
- Rivers K, Aggleton P. Working
with Young Men to Promote Sexual and Reproductive Health. London:
Department for International Development, 2002.
- World Health Organization.
- Courtenay WH. Better to die
than cry? A longitudinal and constructionist study of masculinity and
health risk behavior of young American men [dissertation; University
of California at Berkeley]. Dissertation Abst Int
1998;59(08A0). In Barker G. Gender equitable boys in a gender
inequitable world: reflections from qualitative research and program
development with young men in Rio de Janeiro, Brazil. Sex Rel Ther
2000;15(3):262-82.
- Jackson J, Leitch L, Lee A, et
al. The Jamaica Adolescent Study Final Report. Research
Triangle Park, NC: Family Health International and the University of
the West Indies, 1998.
- Barker.
- Rao Gupta.
- Barker.
- Rivers K, Aggleton P. Adolescent
Sexuality, Gender and the HIV Epidemic. New York: United Nations
Development Programme, 1999.
- Rao Gupta; Rivers and Aggleton,
2002.
- Rivers and Aggleton, 2002.
- Mensch.
- Cáceres C. Sexual cultures
and sexual health among young people in Lima in the 1990’s
[dissertation]. Berkeley, CA: University of California, 1996.
- Welbourn A. Gender, Sex and
HIV: How to Address Issues that No-One Wants to Hear About.
London: ActionAid, 2000. Available: http://www.steppingstonesfeedback.org.
- UNAIDS. Working with Men
for HIV Prevention and Care. Geneva: Joint United Nations
Programme on HIV/AIDS, 2001.
- Barker.
- World Health Organization.
- Initial Feedback from Stepping
Stones Users. Unpublished report. London: ActionAid, 1997.
- Irvin.
Contradictory
Messages Put Young Women at Risk
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Many young women are so
constrained by contradictory messages about purity, submission, and
love that they cannot say "yes" or "no" to sex,
results of qualitative research among Rwandan youth suggest.1
Conducted under FHI’s
Implementing AIDS Care and Prevention (IMPACT) project in Rwanda,
the research was designed to help program planners better understand
sexual behavior among individuals ages 15 to 35 (primarily younger
than 26) in the Rwandan capital of Kigali and two provinces. Almost
300 young people drawn from the target groups of two
IMPACT-supported projects — members of Catholic youth groups in
the Archdiocese of Kigali and the Diocese of Byumba, as well as
young people in Byumba with other or no religious affiliation —
participated in a total of 28 focus group discussions. In these
sessions, young men or young women discussed stories about
relationships and sexual behavior, enabling them to talk about
sensitive subjects without suggesting that they had engaged in any
socially forbidden behavior themselves.
The findings revealed that
social prohibitions against young women having premarital sex make
it almost impossible for those who do want to have sex to admit it,
let alone seek reproductive health services or negotiate condom use
with sex partners.
Young men, on the other
hand, are pressured by their peers to be sexually active early. A
period of sexual initiation before marriage, called kwitoza
(training), is believed to prevent impotence.
| Art Explosion |
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Male focus group participants
spoke of young men looking for signs that a young woman is willing
to have sexual relations. They said many young men believe that if a
woman sits on a bed or agrees to go for a walk late in the evening,
she may be signaling her consent to have sex.
Focus group participants
confirmed that the pressure for young women to have sex can be as
strong as the social taboo against it. In discussing the fictional
encounters between youth, participants said that some young women
have sex with their boyfriends to prove their love. Often a young
woman will do so after her boyfriend promises to marry her or
threatens to leave her unless she has sex with him.
But a young woman who
agrees to sex in hopes of securing the relationship with her partner
is often disappointed. The young man, focus group participants said,
is likely to conclude that she is promiscuous and abandon her.
"Usually, one doesn’t sleep with a girl you love, because a
girl who says ‘yes’ to one guy will say ‘yes’ to
others," one young man explained.
These findings presented a
formidable challenge for program planners. In response,
IMPACT-Rwanda and its local partners have developed a participatory
program to improve communication between young men and women and
enable them to protect themselves from HIV and other sexual health
risks. These efforts, which will be evaluated through periodic
surveys of sexual behavior among youth and further qualitative
research, include building the confidence and communication skills
young women need to say "no" to unwanted sexual advances
and helping young men learn to respect a young woman’s refusal to
have sex.
—
Kathleen Henry Shears
Reference
- Ndabamenye P. Rapport
de Recherche Qualitative de Base auprès des Jeunes de la JOC/Archdiocese
de Kigali. Kigali, Rwanda: Family Health International and
Jeunesse Ouvrière Chrétienne, 2000; Muramutsa F. Rapport
d’Evaluation Qualitative de Base dans le cadre du Programme de
Prevention du VIH/SIDA auprès des Jeunes du Diocese de Byumba.
Kigali, Rwanda: Family Health International and the Diocese of
Byumba, 2001.
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Youth
Programs Challenge Stereotypes
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Whether programs that work
with youth to help them challenge health-threatening assumptions
about what it means to be a man or a woman actually improve
reproductive health has yet to be demonstrated. But existing
programs designed to achieve that goal are remarkably similar in
their approaches. Many of these programs:
-
Address gender and
sexual health issues in context, provoking reflection,
discussion, and analysis with information and examples drawn
from participants’ experiences and local research.
Participants in workshops in India have re-examined popular
beliefs by talking about personal experiences in their
relationships with family members and peers that are exceptions
to standard behaviors.1 Analyzing media advertising
and content has helped young people in India and Estonia
understand how the messages they receive often reinforce gender
discrimination and stereotyping.2
-
Use creative,
interactive methods to keep participants engaged, encourage them
to think critically, and help them address sensitive issues.
These methods include gender role reversals, debates, and
participatory exercises. Many programs have found that drama and
other performing arts help them maintain participants’
interest, raise questions that might otherwise be too
controversial for public discussion, and demonstrate models of
more equitable gender behavior, such as shared decision-making
about contraceptive use, acceptance of a partner’s decision to
practice abstinence, or the use of communication instead of
violence to resolve conflicts.
-
Address sexual
health broadly, rather than focusing on reproductive health or
preventing specific risk behaviors.
Linnea Renton, an advisor for the London-based ActionAid and
former coordinator of the Stepping Stones Training and
Adaptation Project, believes that the Stepping Stones
training package on gender and sexual health resonates with
people from many countries because it is not just aimed at
changing their sexual behavior. A participant in Living for
Tomorrow, a gender and HIV project for Estonian youth, said:
"If it had only been about condoms and facts and disease,
it would have been boring."
-
Identify and train
facilitators who are open to new ideas and willing to question
their own attitudes about sexuality, gender, and equality.
"Training that attempts to influence social attitudes
demands much deeper involvement, intellectually and emotionally,
from the trainers," write the authors of a case study about
a gender and reproductive health project in India.3
Joseph Robinson, who directs the Jamaican performing arts group
Ashe and has trained family life educators in Jamaica, says that
much of the training involves helping participants become
comfortable with their own sexuality so that they do not pass on
negative sexual attitudes to their students.
-
Work with parents,
teachers, and others in a community to create a more supportive
environment for youth who want to change their behavior.
In a low-income area of Kingston, Jamaica, Robinson has begun
with youth, parents, teachers, guidance counselors, and health
professionals a pilot project called It Takes an Island. This
adaptation of the African proverb, "It takes a village to
raise a child," reflects his conviction that youth need to
hear consistent messages from all the people who play a role in
their socialization.
| Gary Barker/Instituto
Promundo |
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| The Jovem para Jovem
(Guy to Guy) project in Rio de Janeiro, Brazil, helps young
men reflect on potentially harmful effects of some
traditionally masculine behaviors. |
-
Take a positive
approach to sex and sexuality.
Stepping Stones author Dr. Alice Wellbourn writes that
many HIV/AIDS campaigns "have ignored the fact that sex can
also be enjoyable and creative." By linking sex with death
but not with life, they have alienated many of the people they
tried to reach.4 A purely negative approach to sexual
health can also affect a program’s credibility, because many
young people know that sex can be pleasurable.5
-
Empower young people to
act for themselves. Young men in the Jovem para Jovem project in
Brazil perform a play they created about domestic violence. In
India, young people have developed detailed "personal work
plans" outlining specific ways to change their behavior and
counter expected resistance.6 In Nigeria, young men
in a gender and sexual health program read their essays at
public workshops and even hold press conferences.7
However, Dr. Carlos Cáceres, author of a study of youth sexual
health in Lima, Peru, cautions that empowerment means adults
must be prepared to trust young people. "The solutions they
propose may be somewhat different from those proposed by
adults," he says.
—
Kathleen Henry Shears
References
- Gupta P, Joshi A, Crook
B. Leadership, Responsibility, and Men’s Partnership
with Women to Improve Reproductive Health. A Case Study Prepared
for the Men and Reproductive Health Subcommittee of USAID Gender
Working Group. Mussoorie, India: Society for Integrated
Development of Himalayas, 2001.
- Lewis J. Learning to
relearn givens. PLA Notes 2000;37(20):100-105. Available:
http://www.nikk.uio.no/forskning/nikk/living/index.html
- Gupta P, Joshi A. Leadership,
Responsibility and Men’s Partnership with Women to Improve
Reproductive Health: A Process Documentation of Designing a
4-Day Training Module for Youth in the Jaunpur Area in Tehri
Farhwal District in the Central Himalayas of Uttar Pradesh.
Mussoorie, India: Society for Integrated Development of
Himalayas, 1998.
- Welbourn A. Gender,
Sex and HIV: How to Address Issues That No-One Wants to Hear
About. London: ActionAid, 2000. Available: http://www.steppingstonesfeedback.org.
- Irvin A. Taking Steps
of Courage: Teaching Adolescents about Sexuality and Gender in
Nigeria and Cameroon. New York: International Women’s
Health Coalition, 2000.
- Gupta, 2001.
- Irvin.
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