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

Abstract

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.

The influence of social constructs of hegemonic masculinity and sexual behaviour on acceptability of vaginal microbicides in Zambia

“…The findings from this study strengthen of the findings from previous studies, which have shown how hegemonic masculinity affected HIV prevention and uptake of sexual health services (Baker & Ricardo, 2005;Brown et al, 2005;Jewkes & Morrell, 2010;Skovdal et al, 2011). Our study adds to the consensus that women's vulnerability to HIV is not only biological but is sustained by gender inequalities, which also complicates the introduction of HIV interventions for long-term sexual relationships (Bhana et al, 2007;Chimbiri, 2007;Smith, 2007).…”

“…Finally, though the results from this study may not be directly relevant to oral PreExposure Prophylaxis (PrEP) roll-out; the fact that this study and others show that individuals, couples, and communities contextualize their decisions and experiences of HIV prevention services to dominant gender regimes such as hegemonic masculinity (Jewkes & Morrell, 2010;Kelly et al, 2015;Lanham et al, 2014;Skovdal et al, 2011), suggests a need to pay close attention on the potential impact of hegemonic masculinity on PrEP roll-out.…”

“…In contrast, HIV risk behaviours such as gender-based violence and multiple sexual relations is associated with frustrations of failing to fulfil hegemonic masculinity due to modern gender dynamics and social challenges such as poverty and unemployment (Baker & Ricardo, 2005;Brown et al, 2005;Jewkes & Morrell, 2010;Lesch & Bremridge, 2006). Brown et al (2005) explicitly showed that men who failed to achieve hegemonic masculinity, in the context of changing gender roles, resorted to alternative, and high HIV risk related, behaviour such as multiple sexual partners, alcoholism, unprotected sex, and fathering many children.…”

Prevalence of oral and oropharyngeal human papillomavirus in a sample of South African men: A pilot study

“…[11] In many African cultures it is acceptable for men to have multiple partners and engage in sex outside the primary relationship. [21,22] A statistically significant association between the number of sexual partners and the presence of oral HPV was seen in this study (p=0.027), with 4/7 HPV-positive participants having had >20 sexual partners and 2/7 having had between five and 20 partners. The numbers of sexual partners of the HPV-positive participants in the past 6 months ranged from one to three.…”

‘When I see them I feel like beating them’: Corruption and the South African Police Service

“…Jewkes and Morrell suggest that 'South African masculinities all valorise the martial attributes of physical strength, courage, toughness and an acceptance of hierarchical authority… they demand that men are able to exercise control.' 6 In this regard, participants' perceptions of police are perhaps indicative of trends in masculinity across the country, rather than in the SAPS alone. Nevertheless, sexual discrimination and harassment by police remains a matter that can be addressed within the organisation.…”