Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention

Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted.In South Africa, while gender identities show diversity, the dominant ideal of black African manhood emphasizes toughness, strength and expression of prodigious sexual success. It is a masculinity women desire; yet it is sexually risky and a barrier to men engaging with HIV treatment. Hegemonically masculine men are expected to be in control of women, and violence may be used to establish this control. Instead of resisting this, the dominant ideal of femininity embraces compliance and tolerance of violent and hurtful behaviour, including infidelity.The women partners of hegemonically masculine men are at risk of HIV because they lack control of the circumstances of sex during particularly risky encounters. They often present their acquiescence to their partners' behaviour as a trade off made to secure social or material rewards, for this ideal of femininity is upheld, not by violence per se, by a cultural system of sanctions and rewards. Thus, men and women who adopt these gender identities are following ideals with deep roots in social and cultural processes, and thus, they are models of behaviour that may be hard for individuals to critique and in which to exercise choice. Women who are materially and emotionally vulnerable are least able to risk experiencing sanctions or foregoing these rewards and thus are most vulnerable to their men folk.We argue that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours

Gender audit of health research - 10 years of the South African Medical Journal

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Carework and caring: A path to gender equitable practices among men in South Africa?

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. Interventions are being developed to work with masculinity and to 'change men'. Researchers now face a challenge of identifying change in men, especially in domains of their lives beyond relations with women. Engagement in carework is one suggested indicator of more gender equitable practice.</p> <p>Methods</p> <p>A qualitative approach was used. 20 men in three South African locations (Durban, Pretoria/Johannesburg, Mthatha) who were identified as engaging in carework were interviewed. The men came from different backgrounds and varied in terms of age, race and socio-economic status. A semi-structured approach was used in the interviews.</p> <p>Results</p> <p>Men were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment.</p> <p>Conclusions</p> <p>Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes. Interventions that promote caring also advance gender equity.</p

Mistreatment of Women in Childbirth: Time for Action on This Important Dimension of Violence against Women.

The mistreatment of women in childbirth has been documented by researchers for over three decades in all global regions. The scale of the problem is indicated by a systematic review conducted by Meghan Bohren and colleagues [1], which provides a foundation from which a typology of violence can be developed and used as a basis for developing measurement instru-ments and tools. This is a valuable complement to other work that is currently underway in this area [2]. A multicountry study on the mistreatment of women during childbirth could be extremely valuable in generating comparable information on prevalence, risk groups and facili-ties, and the health consequences (physical and mental, including future health-seeking prac-tices and expectations). It would provide the foundation needed for developing health policy, monitoring its impact, and advocating for proper resources. Mistreatment of Women in Childbirth as a Subset of Violence against Women From Bohren and colleagues ’ systematic review, it is very easy to draw parallels between the mistreatment of women in childbirth and violence against women more broadly, and these parallels may lead us to conclude that the former should indeed be viewed as a further subse

Risk factors for teenage pregnancy among sexually active black adolescents in Cape Town

Motivation. Teenage pregnancy is an important health and social problem in South Africa. So far research on adolescent sexual activity has been almost exclusively descriptive; as a result there is considerable knowledge about practices of adolescents in general and outcomes of their pregnancies, but very limited understanding of factors that place particular adolescents at increased risk of teenage pregnancy. Without this unqerstanding, our ability to intervene effectively to reduce teenage pregnancy rates is limited.Objective. To undertake an exploratory study to investigate risk factors for teenage pregnancy among sexually active adolescents in an urban and peri-urban context.Methods. The study used a matched case-control design, with 191 cases and 353 age-matched controls from the same school or neighbourhood. Subjects were under 19 years of age and were recruited from township areas of Cape Town. A structured questionnaire was used to obtain information on socio-economic factors, contraceptive knowledge and use, and sexual behaviour. Conditional logistical regression was used to analyse the relationship between teenage pregnancy and the factors investigated.Results. Teenage pregnancy was found to be most strongly associated with having frequent sex (risk ratio (RR) 30.81) without reliable contraceptive protection (RR 24.35), forced sexual initiation (RR 14.42), not owning a television set (RR 10.33), larger household size (RR 244), not living in a brick house (RR 5.09), not living with the biological father  (RR 3.26), talking openly about sex with a boyfriend (RR 4.72), and perceiving most friends to be pregnant (RR 4.38).Conclusions. The findings suggest associations between the promotion of sexual health among adolescents and broader social development and promotion of gender equality. Although further research is needed, it is likely that important foci for short-term strategies should include developing assertiveness, enhancing decision-making competence, and promoting contraception and condoms as part of comprehensive sexual and reproductive health educational interventions

Relationship between single and multiple perpetrator rape perpetration in South Africa: A comparison of risk factors in a population-based sample

BACKGROUND:Studies of rape of women seldom distinguish between men's participation in acts of single and multiple perpetrator rape. Multiple perpetrator rape (MPR) occurs globally with serious consequences for women. In South Africa it is a cultural practice with defined circumstances in which it commonly occurs. Prevention requires an understanding of whether it is a context specific intensification of single perpetrator rape, or a distinctly different practice of different men. This paper aims to address this question. METHODS: We conducted a cross-sectional household study with a multi-stage, randomly selected sample of 1686 men aged 18-49 who completed a questionnaire administered using an Audio-enhanced Personal Digital Assistant. We attempted to fit an ordered logistic regression model for factors associated with rape perpetration. RESULTS: 27.6% of men had raped and 8.8% had perpetrated multiple perpetrator rape (MPR). Thus 31.9% of men who had ever raped had done so with other perpetrators. An ordered regression model was fitted, showing that the same associated factors, albeit at higher prevalence, are associated with SPR and MPR. CONCLUSIONS: Multiple perpetrator rape appears as an intensified form of single perpetrator rape, rather than a different form of rape. Prevention approaches need to be mainstreamed among young men

The Relationship between Intimate Partner Violence, Rape and HIV amongst South African Men: A Cross-Sectional Study

OBJECTIVE: To investigate the associations between intimate partner violence, rape and HIV among South African men. DESIGN: Cross-sectional study involving a randomly-selected sample of men. METHODS: We tested hypotheses that perpetration of physical intimate partner violence and rape were associated with prevalent HIV infections in a cross-sectional household study of 1229 South African men aged 18-49. Violence perpetration was elicited in response to a questionnaire administered using an Audio-enhanced Personal Digital Assistant and blood samples were tested for HIV. A multivariable logistic regression model was built to identify factors associated with HIV. RESULTS: 18.3% of men had HIV. 29.6% (358/1211) of men disclosed rape perpetration, 5.2% (63/1208) rape in the past year and 30.7% (362/1180) of had been physically violent towards an intimate partner more than once. Overall rape perpetration was not associated with HIV. The model of factors associated with having HIV showed men under 25 years who had been physically violent towards partners were more likely to have HIV than men under 25 who had not (aOR 2.08 95% CI 1.07-4.06, p = 0.03). We failed to detect any association in older men. CONCLUSIONS: Perpetration of physical IPV is associated with HIV sero-prevalence in young men, after adjusting for other risk factors. This contributes to our understanding of why women who experience violence have a higher HIV prevalence. Rape perpetration was not associated, but the HIV prevalence among men who had raped was very high. HIV prevention in young men must seek to change ideals of masculinity in which male partner violence is rooted

Prevalence of and factors associated with non-partner rape perpetration: fi ndings from the UN Multi-country Crosssectional Study on Men and Violence in Asia and the Pacifi c

Background Rape perpetration is under-researched. In this study, we aimed to describe the prevalence of, and factors associated with, male perpetration of rape of non-partner women and of men, and the reasons for rape, from nine sites in Asia and the Pacifi c across six countries: Bangladesh, China, Cambodia, Indonesia, Papua New Guinea, and Sri Lanka. Methods In this cross-sectional study, undertaken in January 2011–December 2012, for each site we chose a multistage representative sample of households and interviewed one man aged 18–49 years from each. Men self-completed questions about rape perpetration. We present multinomial regression models of factors associated with single and multiple perpetrator rape and multivariable logistic regression models of factors associated with perpetration of male rape with population-attributable fractions. Findings We interviewed 10 178 men in our study (815–1812 per site). The prevalence of non-partner single perpetrator rape varied between 2·5% (28/1131; rural Bangladesh) and 26·6% (225/846; Bougainville, Papua New Guinea), multiple perpetrator rape between 1·4% (18/1246; urban Bangladesh) and 14·1% (119/846; Bougainville, Papua New Guinea), and male rape between 1·5% (13/880; Jayapura, Indonesia) and 7·7% (65/850; Bougainville, Papua New Guinea). 57·5% (587/1022) of men who raped a non-partner committed their fi rst rape as teenagers. Frequent reasons for rape were sexual entitlement (666/909; 73·3%, 95% CI 70·3–76·0), seeking of entertainment (541/921; 58·7%, 55·0–62·4), and as a punishment (343/905; 37·9%, 34·5–41·4). Alcohol was a factor in 249 of 921 cases (27·0%, 95% CI 24·2–30·1). Associated factors included poverty, personal history of victimisation (especially in childhood), low empathy, alcohol misuse, masculinities emphasising heterosexual performance, dominance over women, and participation in gangs and related activities. Only 443 of 1933 men (22·9%, 95% CI 20·7–25·3) who had committed rape had ever been sent to prison for any period. Interpretation Rape perpetration committed by men is quite frequent in the general population in the countries studied, as it is in other countries where similar research has been undertaken, such as South Africa. Prevention of rape is essential, and interventions must focus on childhood and adolescence, and address culturally rooted male gender socialisation and power relations, abuse in childhood, and poverty

Prevalence of and factors associated with male perpetration of intimate partner violence: fi ndings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacifi c

Background Male perpetration of intimate partner violence (IPV) is under-researched. In this Article, we present data for the prevalence of, and factors associated with, male perpetration of IPV from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacifi c. We aimed to estimate the prevalence of perpetration of partner violence, identify factors associated with perpetration of diff erent forms of violence, and inform prevention strategies. Methods We undertook standardised population-based household surveys with a multistage representative sample of men aged 18–49 years in nine sites in Bangladesh, China, Cambodia, Indonesia, Sri Lanka, and Papua New Guinea between January, 2011, and December, 2012. We built multinomial regression models of factors associated with lifetime violence perpetration: physical IPV, sexual IPV, both physical and sexual IPV, multiple emotional or economic IPV versus none, and calculated population-attributable fractions. In the analysis, we considered factors related to social characteristics, gender attitudes and relationship practices, victimisation history, psychological factors, substance misuse, and participation in violence outside the home. Findings 10 178 men completed interviews in our study (between 815 and 1812 per site). The response rate was higher than 82·5% in all sites except for urban Bangladesh (73·2%) and Sri Lanka (58·7%). The prevalence of physical or sexual IPV perpetration, or both, varied by site, between 25·4% (190/746; rural Indonesia) and 80·0% (572/714; Bougainville, Papua New Guinea). When multiple emotional or economic abuse was included, the prevalence of IPV perpetration ranged from 39·3% (409/1040; Sri Lanka) to 87·3% (623/714; Bougainville, Papua New Guinea). Factors associated with IPV perpetration varied by country and type of violence. On the basis of population-attributable fractions, we show factors related to gender and relationship practices to be most important, followed by experiences of childhood trauma, alcohol misuse and depression, low education, poverty, and involvement in gangs and fi ghts with weapons. Interpretation Perpetration of IPV by men is highly prevalent in the general population in the sites studied. Prevention of IPV is crucial, and interventions should address gender socialisation and power relations, abuse in childhood, mental health issues, and poverty. Interventions should be tailored to respond to the specifi c patterns of violence in various contexts. Physical and sexual partner violence might need to be addressed in diff erent ways. Funding Partners for Prevention—a UN Development Programme, UN Population Fund, UN Women, and UN Volunteers regional joint programme for gender-based violence prevention in Asia and the Pacifi c; UN Population Fund Bangladesh and China; UN Women Cambodia and Indonesia; UN Development Programme in Papua New Guinea and Pacifi c Centre; and the Governments of Australia, the UK, Norway, and Sweden