Men's Access Research Articles

When masculinity interferes with women's treatment of HIV infection: a qualitative study about adherence to antiretroviral therapy in Zimbabwe

BackgroundSocial constructions of masculinity have been shown to serve as an obstacle to men's access and adherence to antiretroviral therapies (ART). In the light of women's relative lack of power in many aspects of interpersonal relationships with men in many African settings, our objective is to explore how male denial of HIV/AIDS impacts on their female partners' ability to access and adhere to ART.MethodsWe conducted a qualitative case study involving thematic analysis of 37 individual interviews and five focus groups with a total of 53 male and female antiretroviral drug users and 25 healthcare providers in rural eastern Zimbabwe.ResultsRooted in hegemonic notions of masculinity, men saw HIV/AIDS as a threat to their manhood and dignity and exhibited a profound fear of the disease. In the process of denying and avoiding their association with AIDS, many men undermine their wives' efforts to access and adhere to ART. Many women felt unable to disclose their HIV status to their husbands, forcing them to take their medication in secret, and act without a supportive treatment partner, which is widely accepted to be vitally important for adherence success. Some husbands, when discovering that their wives are on ART, deny them permission to take the drugs, or indeed steal the drugs for their own treatment. Men's avoidance of HIV also leave many HIV-positive women feeling vulnerable to re-infection as their husbands, in an attempt to demonstrate their manhood, are believed to continue engaging in HIV-risky behaviours.ConclusionsHegemonic notions of masculinity can interfere with women's adherence to ART. It is important that those concerned with promoting effective treatment services recognise the gender and household dynamics that may prevent some women from successfully adhering to ART, and explore ways to work with both women and men to identify couples-based strategies to increase adherence to ART

Improving men's access to sexual health services

Denise Shone considers the personal, social and financial consequences of sexual ill health in young men and makes some evidence−based recommendations to improve service provision

Benign concurrency in context and practice: a response to Epstein and Stanton

Benign concurrency in context and practice: a response to Epstein and Stanton

Perceptions of Condom Fit and Feel Among Men Living with HIV

Promoting consistent and correct condom use remains a priority public health activity, although some HIV- and STI-related providers remain challenged by some men's resistance to condoms, which some claim do not fit properly or do not feel comfortable. Although these perceptions have been examined across multiple populations, they have not been documented among men living with HIV. During spring 2008, data were collected from 215 men living with HIV at HIV service organizations in the Midwestern and Southeastern United States. Participants completed the Condom Fit and Feel Scale and measures related to demographics and condom use during sexual interactions within the past 90 days. Men were primarily homosexual, African American, with a high school degree or higher, and unemployed. More than half of participants had used condoms for sexual intercourse within the previous 90 days. The majority of the men reported few problems with the fit and feel of condoms, with 63.1% reporting that condoms "fit my penis just fine," and 80.9% reported being able consistently to find condoms that they perceived to be "sized appropriately for my penis." Some men did report specific characteristics of condoms that challenged fit and feel, including 20.6% endorsing (always or often) that condoms feel too tight, 15.9% that condoms are too short, 17.8% or that condoms would not roll down far enough to cover their penis completely (15.6%). These data provide insights into mechanisms through which providers can help to increase men's access to the diverse range of condoms in the marketplace.

The development of a web- and a print-based decision aid for prostate cancer screening.

BackgroundWhether early detection and treatment of prostate cancer (PCa) will reduce disease-related mortality remains uncertain. As a result, tools are needed to facilitate informed decision making. While there have been several decision aids (DAs) developed and tested, very few have included an exercise to help men clarify their values and preferences about PCa screening. Further, only one DA has utilized an interactive web-based format, which allows for an expansion and customization of the material. We describe the development of two DAs, a booklet and an interactive website, each with a values clarification component and designed for use in diverse settings.MethodsWe conducted two feasibility studies to assess men's (45-70 years) Internet access and their willingness to use a web- vs. a print-based tool. The booklet was adapted from two previous versions evaluated in randomized controlled trials (RCTs) and the website was created to closely match the content of the revised booklet. Usability testing was conducted to obtain feedback regarding draft versions of the materials. The tools were also reviewed by a plain language expert and the interdisciplinary research team. Feedback on the content and presentation led to iterative modifications of the tools.ResultsThe feasibility studies confirmed that the Internet was a viable medium, as the majority of men used a computer, had access to the Internet, and Internet use increased over time. Feedback from the usability testing on the length, presentation, and content of the materials was incorporated into the final versions of the booklet and website. Both the feasibility studies and the usability testing highlighted the need to address men's informed decision making regarding screening.ConclusionsInformed decision making for PCa screening is crucial at present and may be important for some time, particularly if a definitive recommendation either for or against screening does not emerge from ongoing prostate cancer screening trials. We have detailed our efforts at developing print- and web-based DAs to assist men in determining how to best meet their PCa screening preferences. Following completion of our ongoing RCT designed to test these materials, our goal will be to develop a dissemination project for the more effective tool.Trial RegistrationNCT00623090

“No one can ask me ‘Why do you take that stuff?’”: men's experiences of antiretroviral treatment in South Africa

This paper examines the way gender shaped the health behaviours, health care experiences and narratives of HIV-positive men initiating antiretroviral treatment in South Africa. We conducted participant observation and in-depth, semi-structured interviews with eight men enrolled in a public HIV treatment programme in a rural health district in KwaZulu-Natal. We also interviewed their family members and programme staff. The study found that men's narratives and experiences of antiretroviral therapy (ART) were complex. Descriptions of control and coping juxtaposed with low self-esteem and guilt. Improvements in health following treatment increased optimism about the future but were readily undermined by men's concerns about being unable to meet strongly gendered expectations in relation to family and work. Alcohol use and abuse by men themselves or by family members was found to be an important issue influencing disclosure, uptake and adherence. Given messages discouraging alcohol use during treatment, men reported self-imposed delays to enrolment while they tried to stop or reduce alcohol use, although none had sought advice or professional help in doing so. Men also felt very threatened by alcohol abuse by family members fearing accidental disclose, insults and violence. With regards to health providers, men held strong views as to appropriate and professional behaviour by programme staff, particularly regarding confidentiality. As ART programmes in Africa become established and evolve, we not only need to identify barriers to men's access and adherence but monitor their health and treatment experiences. These findings suggest that the issue of alcohol and ART warrants further investigation. Additional training for primary health care providers and counsellors on health promotion with men may be useful.

Book Reviews

Book reviewed in this article:Forest Community Connections: Implications for Research, Management and Governance edited by Ellen M. Donoghue and Victoria E. SturtevantUnfolding Webs: The Dynamics of Regional Rural Development, edited by Jan Douwe van de Ploeg and Tarry MarsdenTrading Out? A Study of Farming Women's and Men's Access to Resources in Rural Ethiopia by Asa TorkelssonKilling Tradition: Inside Hunting and Animal Rights Controversies by Simon Bronner.

Trading Out? A Study of Farming Women's and Men's Access to Resources in Rural Ethiopia

Trading Out? A Study of Farming Women's and Men's Access to Resources in Rural Ethiopia

Social-environmental factors and protective sexual behavior among sex workers: the Encontros intervention in Brazil.

We sought to determine the association of social-environmental factors with condom use and sexually transmitted infections (STIs) among 420 sex workers participating in an STI/HIV prevention study in Corumbá, Brazil, to inform future intervention efforts. Participants provided urine samples for polymerase chain reaction testing of chlamydia and gonorrhea and responded to multi-item scales addressing perceived social cohesion, participation in networks, and access to and management of resources. We conducted multivariate log-linear and negative binomial regression analyses of these data. Increased social cohesion was inversely associated with number of unprotected sex acts in the preceding week among women (adjusted incidence rate ratio [IRR] = 0.80; P < .01), and there was a marginal association among men (adjusted IRR = 0.41; P = .08). Women's increased participation in social networks was associated with a decrease in frequency of unprotected sex acts (adjusted IRR = 0.83; P = .04), as was men's access to and management of social and material resources (IRR = 0.15; P = .01). Social-environmental factors were not associated with STIs. The social context within which populations negotiate sexual behaviors is associated with condom use. Future efforts to prevent STI/HIV should incorporate strategies to modify the social environment.

Exploring Women’s Perceptions About Their Role in Supporting Partners’ and Sons’ Reproductive Health Care

Women serve as important health information sources for young men. No previous study has explored women's perceptions about this role related to young men's sexual and reproductive health (SRH) care. Twenty African American women recruited from two clinics participated in three focus groups to explore perceptions to engage young men in SRH care. Themes were identified that may facilitate and/or hinder women to engage young men in SRH care: 1) communication/actions to provide support; 2) challenges in providing support; 3) traditional gender role perceptions and other access barriers; and 4) motivation, influence and control. Participants were interested and willing to support young men's SRH including sharing information about clinics (95%), making appointments (90%), going to visits together (90%), and having joint appointments (67%). Findings provide a foundation for programs interested to engage women as health promotion agents to improve young men's SRH care access. Future efforts should explore the generalizability of study findings.

Quantifying women's and men's rural resource portfolios – empirical evidence from Western Shoa in Ethiopia

It has been observed in many places that women access fewer resources than men across the range of resources in rural households. This unequal starting point inhibits the process of resource capitalization of women, and their capacity to move out of poverty. This article assesses the gender asset gap systematically, using data from two formal surveys undertaken in 2006 in rural Ethiopia, covering a probability sample comprising 604 farming women and men. Ethnography is used to assist in the identification of the locally relevant resources, which are organized in accordance with the sustainable livelihoods approach. The empirical analysis is dedicated to the assessment of women's and men's access to the identified range of rural resources, using descriptive statistics, and a specific analytical eye focuses on those women who head their own households. Doing so, the article quantifies the inequalities in resource access of women and men.

''I Come Here Before You Did and I Shall Not Go Away'': Race, Gender, and Evangelical Community on the Eve of the Nat Turner Rebellion

This article provides an expanded perspective on the Nat Turner rebellion by tracing the developing tensions between black and white visions of evangelicalism in southeastern Virginia in the early nineteenth century. As growing black membership prompted white-controlled churches to segregate and marginalize blacks, blacks took advantage of this segregation to exercise an increasing degree of independent action and judgment about fundamental aspects of evangelical faith. Many of the tensions produced by these developments revolved around the gendered issues of black men's access to religious authority and black congregants' willingness to accept the authority of white male church officials. Unlicensed preaching by black men became a particularly contested issue as black men sought sources of evangelical authority outside of the region's increasingly hostile white-controlled churches. This evolving religious dynamic profoundly affected the Turner rebellion's meanings for black and white Virginians. Nat Turner himself drew on independent black practices of preaching and evangelical authority to shape his leadership and recruit followers, and a variety of both black and white observers suggested that religious resentments helped spur the revolt. The uprising prompted a religious crisis in southeastern Virginia, as both blacks and whites came to distrust the patterns of interaction that had tentatively united them in evangelical fellowship in earlier decades. Understanding the Turner rebellion as an episode in a longer history of religious development and conflict helps us understand these dimensions more completely and better integrates the rebellion itself into the history of social and cultural change in early national Virginia.

Identifying Work as a Barrier to Men's Access to Chronic Illness (Arthritis) Self-Management Programs

Why are men under-represented as users of arthritis self-management programs? What are the main barriers to service access? This paper explores the interaction between work, gender, and self-management of a chronic illness from a socio-constructive perspective. A qualitative study was conducted involving in-depth interviews with 17 men with arthritis. This paper discusses the role of work as one of the factors affecting men’s access to arthritis selfmanagement services. Work was found to be a significant conceptual, structural, and social barrier due to: its role in relation to men’s concepts of health and fitness; practical difficulties in accessing services during business hours; and sociocultural influences resulting in prioritising of work commitments over health concerns. The structural, conceptual, and sociocultural work influences were more of a constraint for men in the middle stages of life when work and family obligations were greatest. Further research extending this understanding would inform the development of gender-sensitive delivery of self-management services.

Gender and procreative ideologies among the Kolams of Maharashtra

Procreative ideologies, alternatively called conception beliefs, are ideas concerning the male and female contributions to biological reproduction. Expressed through the metaphor of ‘seed’ and ‘earth’ in many South Asian cultures, these ideologies have been found to be demonstrably gendered, acting sometimes as a central variable in mediating men's and women's access to material and symbolic resources. Many gender-sensitive ethnographies have demonstrated the power of this metaphorical understanding in regulating and controlling the body and sexuality of women, and affecting the everyday lives of men and women as gendered subjects. The present article examines and evaluates the operation of procreative ideology in the case of the Kolams, a ‘primitive’ tribal community in south-eastern Maharashtra.

Trade Liberalization, Natural Resources and Poverty

Governments have committed to halve world poverty by 2015 and also collectively acknowledged that millions of the world's poorest people, especially women, are completely reliant on access to natural resources for their livelihoods. But there is also evidence to show that liberalizing natural resource sectors is likely to deplete those resources and restrict women's and men's access to them. Ronnie Hall suggests that integrated policy-making requires that natural resources be removed from trade liberalization negotiations in the World Trade Organization (WTO) and elsewhere, to prevent a further escalation of poverty.

Differences Between Women's and Men's Access to Interventional Cardiovascular Procedures at Public Hospitals in Andalusia (Spain)

The aim of this study was to determine whether there are differences between women's and men's access to coronary revascularization procedures for acute coronary syndrome in Andalusia, Spain. This observational multicenter study was based on the Andalusian Minimum Basic Data Set (CMBDA). The study included all hospitalizations at public hospitals in the period 2000-2003 that involved emergency admission and in which the principal diagnosis was acute myocardial infarction or unstable angina. There were 46 007 cases (16 391 women and 29 616 men). The relationships between sex and the use of cardiac catheterization, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting were analyzed. Patients were categorized according to age, principal diagnosis, and comorbidity (Charlson index). Multivariate logistic regression analysis, which included adjustment for the other variables, was used to determine the association between sex and procedure use. Women in the study population were older and had more severe comorbidity than men. They underwent diagnostic and therapeutic procedures less frequently, irrespective of age group, diagnosis, and comorbidity. After adjusting for age, diagnosis, and comorbidity, the odds ratio (reference category: men) was 0.68 (95% CI, 0.64-0.72) for cardiac catheterization, 0.61 (95% CI, 0.57-0.66) for percutaneous transluminal coronary angioplasty, and 0.38 (95% CI, 0.29-0.50) for coronary artery bypass grafting. During hospitalization for acute coronary syndrome, women less frequently had access to interventional cardiovascular procedures than men. Further research is needed to clarify the roles played by social, cultural and biological factors in determining the observed differences.

NURSES' TENDING INSTINCT AS A CONDUIT FOR MEN'S ACCESS TO MENTAL HEALTH COUNSELING

No article has been found melding the phenomenon of nurses' tending instinct and men's mental health counseling access. This theoretical article presents nurses' tending instinct as a viable rationale to support men in utilizing mental health counseling services. Nurses can be the conduit that assists men in accessing mental health counseling when the need arises. An amalgamation of related topics, including nurses' tending instinct, men's illness/injury/disease profile, psychological medicine, and counselor skills, were forged together to unify this innovative theoretical consideration. Implications for nursing practice also were explored.

Western Heterosexual Masculinity, Anxiety, and Web Porn

This article is an examination of nine pornographic Web sites. Web porn is important because the Internet increases men's access to pornography. The pornography presented on these Web sites is first examined in terms of the way that it manifests important continuities with pornography delivered in other ways. Central to these continuities is the way that pornography manifests the anxiety that is here taken to be fundamental to the acquisition of Western heterosexual masculinity or male identity. An important difference, though, is that this anxiety appears more clearly manifested in these sites than it is elsewhere. In addition, however, these sites appear to intensify this anxiety by making it harder for men to prove that they are truly “man enough.”

Illegitimate birth and the English clergy, 1198-1348

This article studies illegitimacy, which was a canonical impediment to ordination, within the English clergy between 1198 and 1348. Scholarship on illegitimacy in the clergy has previously relied on canon law, conciliar decrees, and dispensations preserved in papal registers. Using these sources, historians have concluded that the papacy tightly controlled illegitimate men's access to orders, that the burdens of obtaining dispensations for illegitimacy (the defectus natalium) could pose substantial obstacles to a man's clerical career, and that priests' sons made up a significant percentage of the illegitimate clergy. This article, which draws on the large and previously untapped body of dispensations surviving in English episcopal registers to supplement the papal sources, reaches different conclusions. It argues that the great majority of illegitimate clerics in the thirteenth- and fourteenth-century English clergy were the sons of unmarried lay parents. It further argues that dispensations were more readily accessible than has previously been suggested, and emphasises the importance of local branches of the ecclesiastical hierarchy to an individual's efforts to attain a dispensation to enter holy orders.

HIV testing and the role of individual- and structural-level barriers and facilitators

This study determined the overall prevalence of HIV testing within a community sample of heterosexual men and women at high risk for HIV infection, and analysed the gender-specific individual- and structural-level barriers and facilitators to testing. Data were collected through 1,643 personal interviews conducted in Philadelphia between 1999 and 2000. Overall, 79.4% of participants had ever taken an HIV test; women were significantly more likely to have tested than were men. Among the individual-level factors we examined, very few, including sexual and drug-using risk behaviours, were significantly associated with an increased likelihood of ever being tested for HIV. Structural-level factors were important correlates of HIV testing for both women and men. Results of this study indicate that there are gender-based similarities and differences in the correlates of testing, and that efforts to increase HIV testing must consider how structural factors, including access to health care, may deter or facilitate opportunities for HIV testing. In particular, efforts to improve the uptake of HIV testing by heterosexual men at high risk should focus on improving men's access to, and utilization of, routine health care.