HIV This Week

Questioning gender norms with men to improve health outcomes: Evidence of impact.

Barker G, Ricardo C, Nascimento M, Olukoya A, Santos C. Glob Public Health. 2009; 9:1-15.

This article describes a review of 58 evaluation studies of programmes with men and boys in sexual and reproductive health (including HIV prevention, treatment, care and support); father involvement; gender-based violence; maternal, newborn and child health; and gender socialisation more broadly. While few of the programmes go beyond the pilot stage, or a relatively short-term timeframe, they offer compelling evidence that well-designed programmes with men and boys can lead to positive changes in their behaviours and attitudes related to sexual and reproductive health; maternal, newborn and child health; their interaction with their children; their use of violence against women; their questioning of violence with other men; and their health-seeking behaviour. The evidence indicates that programmes that incorporate a gender-transformative approach and promote gender-equitable relationships between men and women are more effective in producing behaviour change than narrowly focused interventions, as are programmes which reach beyond the individual level to the social context.

Editors’ note: Gender norms are the social expectations of appropriate roles and behaviours for men and women. They vary across historical and local economic, religious, and cultural contexts and are created and reinforced by families, communities, and social/political/legal environments. Because gender norms are learned and internalized, rather than being biologically determined, they can also be questioned and transformed to be more gender-equitable. This review confirms that comprehensive programmes with men and boys that include specific discussions about the social meanings of men and masculinity seem to show the highest levels of effectiveness. More research is needed to assess the impact of public policy changes and social trends on the behaviour of men and boys, on the bidirectional expectations of both sexes, and on early and potentially gender-transformative practices in men’s involvement as fathers .

 Intimate Partner Violence Perpetration, Standard and Gendered STI/HIV Risk Behaviour, and STI/HIV Diagnosis Among A Clinic-Based Sample of Men.

Decker M, Seage G 3 rd, Hemenway D, Gupta J, Raj A, Silverman JG. Sex Transm Infect. 2009 [Epub ahead of print]

The estimated one in three women worldwide victimized by intimate partner violence consistently demonstrate elevated STI/HIV prevalence; abusive male partners’ risky sexual behaviours and subsequent infection are implicated. Little empirical data exist to characterize men’s sexual risk as it relates to violence perpetration and STI/HIV. Data from a survey of men aged 18-35 recruited from three community-based health clinics in an urban area (n=1585) were analyzed to assess the prevalence of intimate partner violence perpetration and relations of such violent behaviour with both standard (e.g., anal sex, injection drug use) and gendered (e.g., coercive condom practices, sexual infidelity) forms of sexual risk, and STI/HIV diagnosis. Approximately one third of participants (32.7%) reported perpetrating violence against an intimate partner in their lifetime; 1 in 8 (12.4%) participants reported history of STI/HIV diagnosis. Men’s intimate partner violence perpetration related to both standard and gendered STI/HIV risk behaviours (AORS 1.72 to 6.22) and to STI/HIV diagnosis (OR 4.85, 95% CI 3.54, 6.66). In a multivariate model, the association of men’s intimate partner violence perpetration with STI/HIV diagnosis was partially attenuated (AOR 2.55, 95% CI 1.77, 3.67), and a subset of gendered sexual risk behaviours were found to be independently related to STI/HIV diagnosis. Men’s perpetration of violence against intimate partners is common among this population. Abusive men are at increased risk for STI/HIV, with gendered forms of sexual risk behaviour partially responsible. Findings indicate the need for interwoven sexual health promotion and violence prevention efforts targeted to men that include addressing gendered sexual risk.

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Editors’ note: In this cross-sectional US study of young, urban, adult men attending community health centres, a third of participants reported having perpetrated physical or sexual violence against an intimate partner. Multivariate analysis found an independent association between a history or such violence and gendered STI/HIV risk (e.g. sexual infidelity, coercive condom practices). Programmes that integrate men’s prevention of intimate partner violence into STI/HIV prevention should focus on modifying masculinity norms that support men’s entitlement to sexual control of women because these attitudes underpin both intimate partner violence and sexual risk behaviour.