Rural Men Research Articles

‘Taking care’ in the age of AIDS: older rural South Africans’ strategies for surviving the HIV epidemic

Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme: ku ti hlayisa (to take care of yourself). For older adults, ‘taking care’ in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one’s HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings.

"You've Gotta Be That Tough Crust Exterior Man": Depression and Suicide in Rural-Based Men.

Suicide rates in Canada are highest among rural men. Drawing on photovoice interviews with 13 women and two men living in a small rural Canadian town who lost a man to suicide, we inductively derived three themes to describe how contextual factors influence rural men's experiences of depression and responses to suicidal thoughts: (a) hiding depression and its cause, (b) manly self-medicating, and (c) mobilizing prevention. Further discussed is how gender relations and ideals of masculinity within rural milieu can inhibit men's acknowledgment of and help seeking for mental illness issues. Participants strongly endorsed a multifaceted approach to the destabilization of dominant ideals of masculinity that likely contribute to depression and suicide in rural men.

Prevalence, awareness, treatment and control of hypertension in four Middle East countries.

We report the prevalence, awareness, treatment, and control of hypertension across four Middle Eastern countries (Iran, Occupied Palestinian Territory, Saudi Arabia, and United Arab Emirates), using a standardized and uniform method. The Prospective Urban Rural Epidemiology study enrolled participants from 52 urban and 35 rural communities from four countries in the Middle East. We report results using definitions of hypertension, prevalence, awareness, treatment, and control, and the standards for uniform reporting of hypertension in adults as recently recommended by the World Hypertension League expert committee. Data for analyses were available on 10 516 participants, of whom 5082 (48%) were men. The mean age was 49 (±9.4) years for men and 48 (±9.3) years among women. A total of 3270 participants had hypertension (age-standardized rates, 33%), and n = 1807 (49%) of these participants were aware of their diagnosis. Of those with hypertension, n = 1754, (47%) were treated and only n = 673, (19%) had controlled blood pressure levels. Only 17% (n = 541) of those treated for hypertension received two or more blood pressure-lowering medications and 15% (n = 499) received statins. The prevalence, awareness, treatment, and control of blood pressure were higher among women and older (50-69 years) participants compared with men and younger individuals (30-49 years) (P < 0.0001 for all). The prevalence was higher in rural communities; however, awareness, treatment, and control were significantly higher among urban dwellers. Findings from this study indicate the need for improvements in hypertension diagnosis and treatment in the Middle East, especially in rural communities, men and younger individuals.

Towards An Ethnography of Climate Change Variability: Perceptions and Coping Mechanisms of Women and Men from Lambani Village, Limpopo Province

Attention to gender and equity has lagged behind in climate change research, programming, national policy-making and in the international negotiations. Studies on climate change and gender links with climate change have initially and by necessity been somewhat speculative in nature. While all societies are affected by climate change, the impacts also vary by location, exposure, and context specific social characteristics, identity, power relations and political economy. This draws attention to recognition of difference and sameness and the way in which common, confusing, contradictory results emerge across and within terrains. In its concern for gender-blindness, this paper specifically considers the way in which climate variability impacts on men and women in a given locale and captures the enriched narratives and voices of both rural women and men in two selected villages in Lambani, Limpopo Province, South Africa. To build women's participation in national climate change adaptation planning and to take heed of the multiple entanglements around this topic, participatory processes are required that enable diverse groups of disadvantaged women's as well as men's voices to be heard by policy-makers. We use participatory action research (PAR) to capture people's emotions and perceptions around climate change. In our context, difference is not positioned as the opposition to sameness. It is also incorporated into the self as difference within and is seen as a means of becoming. We consider climatic impacts to be moments where the human and non-human rub up against each other and where human affect becomes tangible. Here our attention to affect is twofold. Not only does it allow for a more realistic reflection of entanglements with nature but also we see affect as being more than emotion as it is a dynamic opening up to possibilities that can effectuate change.

What matters for rural teachers and communities? Educational challenges in rural Turkey

This research aims to unearth the educational challenges experienced by teachers and communities in rural Turkey. The research employs Nancy Fraser’s three dimensional justice approach – distribution, recognition and participation – to frame these challenges and to argue that rural challenges go beyond economic rationalities and concerns of infrastructure and resources. The study draws its data from 29 in-depth interviews with 20 teachers working in 16 different villages; 9 interviews with community members; and 2 focus group interviews, 1 with rural dwelling women and the other with rural dwelling men. The findings point out four significant difficulties that impede community and educational development: scarcity of resources; insufficient understanding of social, cultural and economic contexts that constrain educational attempts; lack of collaboration between teacher and communities; and irrelevant education. The study concludes by scrutinising how these difficulties interact with one another and result in marginalisation or casting out of rural lives.

Changing intergenerational contracts: gender, cohorts and elder care in central rural China, 2005–2013

ABSTRACTIn the absence of stable pension systems, elder care arrangements in rural China depend on intergenerational contracts. The existing scholarship on elder care in rural China tends to treat the elderly as a homogeneous group and depict them mainly as ‘care recipients’. Based on a diachronic qualitative study in central rural China between 2005 and 2013, this research examines the changing intergenerational contracts between two cohorts of rural elderly and their adult children. These cohorts hold different positions in terms of family structure, number and sex composition of adult children, living arrangement, physical situation, economic standing and appreciation of intergenerational exchange. These differences further produce different social exchange patterns and disparate elder care modalities between genders and cohorts. Drawing upon insights from gender theory on social gerontology, this research identifies the ‘agency’ of older rural women and explores ageing issues among older rural men. This study also presents policy implications by identifying the most disadvantaged group in terms of elder care support.

Epidemiological characteristics of waist circumference and abdominal obesity among Chinese adults in 2010-2012

Objective: To investigate the epidemiological characteristics of waist circumference (WC) and abdominal obesity (AO) among Chinese adults aged 18 and above. Methods: Data were collected from China National Nutrition and Health Surveillance in 2010-2012. Multi-stage stratifies proportion to the population cluster random sampling method was conducted to determine 120 265 subjects aged 18 and above at 150 counties in 31 provinces in China mainland. WC was determined for all subjects, and AO was judged according to the "Healthy Adult Weight Determination" (WS/T 428-2013). Using the demographic data published by the National Bureau of Statistics of China in 2009, we performed complex sampling weighted treatment to calculate the WC, AO rate and 95%CI. Results: The mean WC of Chinese men aged 18 and above was 82.8 cm, which of urban men (84.1 cm) was higher than that of rural men (81.4 cm) (P<0.001). The average WC of women was 78.5 cm. There was no statistical difference between urban (78.7 cm) and rural women (78.4 cm) (P=0.965). With the increase of education level, the mean WC of male increased gradually from 81.2 cm to 84.3 cm (P<0.001), and the mean WC of female decreased from 80.3 cm to 74.3 cm (P<0.001). With the family income rose, the mean WC of men increased gradually from 81.9 cm to 84.7 cm (P<0.001), and the mean of WC of women decreased from 78.8 cm to 77.6 cm (P<0.001). The AO rate was 25.7% (95% CI: 23.7%-27.7%) in adults aged 18 years and older. The AO rate in urban males (29.8% (95%CI: 26.5%-33.1%)) was significantly higher than that of rural males (22.3% (95%CI: 19.3%-25.2%)) (P=0.001). There was no significant difference in the female AO rate between urban (25.6% (95%CI: 22.8%-28.4%)) and rural areas (25.1% (95%CI: 22.2%-27.9%)) (P=0.772). With the increase of the educational level, the AO rate of men increased from 20.1% (95%CI: 18.0%-22.1%) to 32.6% (95%CI: 28.6%-36.6%) (P<0.001), the rate of women decreased gradually from 31.3% (95%CI: 28.7%-33.9%) to 13.5% (95%CI: 10.9%-16.1%) (P<0.001). With the increase of family income, the AO rate of male increased gradually from 23.3% (95%CI: 20.7%-25.9%) to 31.8% (95%CI: 27.6%-36.1%) (P<0.001), the rate of female decreased from 26.5% (95% CI: 24.2%-28.7%) to 20.0% (95% CI: 17.2%-22.8%) (P<0.001). Conclusion: The prevalence of AO among Chinese residents aged 18 years and above was high, and there were significant differences in WC and AO rate between men and women under different age, region, educational level and family income level.

Men's Perceptions of Treatment as Prevention in South Africa: Implications for Engagement in HIV Care and Treatment.

While South Africa provides universal access to treatment, HIV testing and antiretroviral therapy (ART) uptake remains low, particularly among men. Little is known about community awareness of the effects of treatment on preventing transmission, and how this information might impact HIV service utilization. This qualitative study explored understandings of treatment as prevention (TasP) among rural South African men. Narratives emphasized the know value of ART for individual health, but none were aware of its preventive effects. Many expressed that preventing transmission to partners would incentivize testing, earlier treatment, and adherence in the absence of symptoms, and could reduce the weight of a diagnosis. Doubts about TasP impacts on testing and care included enduring risks of stigma and transmission. TasP information should be integrated into clinic-based counseling for those utilizing services, and community-based education for broader reach. Pairing TasP information with alternative testing options may increase engagement among men reluctant to be seen at clinics.

The Association Between Socioeconomic Status and Adult Mortality in a Developing Country: Evidence From a Nationally Representative Longitudinal Survey of Indonesian Adults.

To estimate the association between socioeconomic status (SES) and adult mortality in Indonesia and determine the contribution of adult behavioral risk factors to SES differences in mortality. Discrete failure-time regression models and period life tables were used to estimate life expectancy at age 30 (e30) across wealth and consumption groups by sex and urban/rural residence. For urban men, e30 increases by an average of 1.10 years per wealth quartile (p = .014) from 38.7 years (95% confidence interval (CI): 37.4-40.5) in the bottom wealth quartile to 42.1 years (95% CI: 40.3-44.1) in the top quartile; for rural men, e30 increases by an average of 1.35 years per quartile (p = .007) from 40.6 years (95% CI: 39.2-42.5) in the bottom wealth quartile to 44.3 years (95% CI: 42.4-46.6) in the top quartile. SES differences are smaller for women. Behavioral risk factors are inconsistently patterned across SES and do not explain SES differences in mortality. The associations between SES and adult life expectancy in Indonesia are moderate when compared with developed countries and are not explained by traditional behavioral risk factors. In a context where behavioral risk factors are inconsistent across SES groups, mortality inequality may be driven by inequalities in health care access or other social factors.

Marital Status and Sleeping Arrangements Predict Salivary Testosterone Levels in Rural Gambian Men

Variation in male testosterone has been hypothesized to reflect the evolved hormonal regulation of investment in mating versus parenting effort. Supporting this hypothesis, numerous studies have observed lower testosterone in married men and fathers compared with unpartnered and childless men, consistent with relatively elevated resource allocation to parenting as opposed to mating effort. Furthermore, lower testosterone has been reported among fathers more actively engaged in direct caregiving. However, it remains unclear whether these findings generalize cross-culturally. Most studies have been conducted in relatively urban, affluent, and low fertility settings where marriage is predominantly monogamous. We contribute new data on testosterone variation in 100 rural Gambian men from a polygynous, high fertility population, where cultural norms dictate that marriage and fatherhood occur in close succession. Married men (almost exclusively fathers) had lower average morning salivary testosterone than unmarried men (almost exclusively childless). This difference, however, could not be statistically differentiated from declines in testosterone observed with age. Independently of age differences and other potential confounds, we find that (i) among married men, polygynously married men had higher afternoon testosterone than monogamously married men; and (ii) fathers who sleep in the same room as their children had lower morning and afternoon testosterone than those who sleep apart from their children. We also document that body mass index was positively associated with afternoon testosterone. These findings, from a novel setting, provide additional support for the hypothesis that testosterone regulates human paternal care.

The influence of substance use on depressive symptoms among young adult black men: The sensitizing effect of early adversity.

Depressive symptoms have been identified as an important consequence of substance use. Both heavy drinking and marijuana use have acute and short-term effects on systems that regulate emotion, increasing the potential for substance use to induce problems with negative affect and irritability. We investigated the effects of alcohol and marijuana use on depressive symptoms among a sample of young Black men. We also tested the stress sensitization hypothesis that exposure to adverse childhood experiences would amplify the influence of substance use on men's depressive symptoms. Hypotheses were tested with 505 rural Black men who, at ages 19-22 years, provided data on their substance use, adverse childhood experiences, and depressive symptoms; they provided data again 18 months later. Substance use forecasted increases in depressive symptoms; cross-lagged analyses yielded no evidence for the inverse path, depressive symptoms increasing substance use. The impact of substance use on depressive symptoms was amplified among young Black men who were exposed to adverse childhood experiences. Substance use did not significantly predict depressive symptoms when adversity was low. Our findings suggest that, during young adulthood, substance use increases depressive symptoms among Black men who were exposed to childhood adversity. Because childhood adversity disproportionately affects Black men, these findings inform future cross-group research designed to investigate racial disparities in the consequences of substance use. Depressive symptoms may be understood as an effect as well as a cause of substance use, particularly among vulnerable young Black men. (Am J Addict 2017;26:400-406).

Screening of Oxidative Stress and Prostate Cancer Biomarkers among Rural and Urban Elderly People in Erbil Governorate-Kurdistan Region

The present study was designed to evaluate prostate-specific antigen (PSA) and oxidative stress (OS) markers in rural and urban old aged men in Erbil governorate, Iraqi Kurdistan region. The level of Prostate Specific Antigen (PSA), Malondialdehyde (MDA), total antioxidant activity (TAC) and nitric oxide (NO) were determined among men aged over 40 years living in different rural regions and center of Erbil city. The results indicated that TAC in urban males was significantly higher than rural people, while the level of NO in rural males was significantly higher than urban males. On the other hand, there were no statistical significant differences between serum PSA and MDA levels of rural and urban residences. In conclusion, these findings indicated obvious differences between urban and rural people regarding the OS markers excluding prostate tumor marker.

Prevalence of varicocoele and its association with body mass index among 39,559 rural men in eastern China: a population-based cross-sectional study

Varicocoele is a common cause of male infertility. We undertook a population-based cross-sectional study to evaluate the prevalence of varicocoele among rural men in eastern China and its association with body mass index. A total of 39,559 rural men in six counties in Beijing, Guangdong and Shandong provinces were recruited from 2011 to 2012. The presence and severity of varicocoele were measured by physical examinations. Univariate and multivariate logistic regression models were constructed to assess the association between varicocoele and body mass index after adjusting for possible confounders. Varicocoele was diagnosed in 1911 of 39,559 participants with an overall prevalence of 4.83%. The prevalence of varicocoele was highest in underweight (6.29%) and lowest in obese patients (3.71%, p<0.05). The prevalence also decreased as body mass index increased in all three varicocoele grades. In multivariate logistic regression analysis after adjusting for region, age, height, occupation, cigarette smoking and alcohol consumption, body mass index was still inversely and independently associated with varicocoele (p<0.001). Compared with normal weight men, underweight men (OR=1.34; 95% CI, 1.10-1.63) were more likely to have varicocoele, whereas overweight men (OR=0.88; 95% CI, 0.79-0.99) and obese men (OR=0.75; 95% CI, 0.58-0.97) were less likely to have varicocoele. This study revealed that the prevalence of varicocoele was 4.83% among rural men in eastern China; body mass index was inversely and independently associated with the presence of varicocoele. Future efforts should be made to validate the risk factors for varicocoele and strengthen the prevention and treatment of varicocoele, especially in underweight men.

Prevalence and risk factors for anemia severity and type in Malawian men and women: urban and rural differences

BackgroundThe global burden of anemia is large especially in sub-Saharan Africa, where HIV is common and lifestyles are changing rapidly with urbanization. The effects of these changes are unknown. Studies of anemia usually focus on pregnant women or children, among whom the burden is greatest. We describe prevalence and risk factors for anemia among rural and urban men and women of all ages in Malawi.MethodsWe analyzed data from a population-wide cross-sectional survey of adults conducted in two sites, Karonga (rural) and Lilongwe (urban), commencing in May 2013. We used multinomial logistic regression models, stratified by sex to identify risk factors for mild and moderate-to-severe anemia.ResultsAnemia prevalence was assessed among 8,926 men (age range 18–100 years) and 14,978 women (age range: 18–103 years). Weighted prevalence levels for all, mild, and moderate-to-severe anemia were 8.2, 6.7 and 1.2% in rural men; 19.4, 12.0 and 7.4% in rural women; 5.9, 5.1 and 0.8% in urban men; and 23.4, 13.6 and 10.1% in urban women. Among women, the odds of anemia were higher among urban residents and those with higher socioeconomic status. Increasing age was associated with higher anemia prevalence in men. Among both men and women, HIV infection was a consistent risk factor for severity of anemia, though its relative effect was stronger on moderate-to-severe anemia.ConclusionsThe drivers of anemia in this population are complex, include both socioeconomic and biological factors and are affecting men and women differently. The associations with urban lifestyle and HIV indicate opportunities for targeted intervention.

Barriers to modern contraceptive use in rural areas in DRC

Recent research in the Democratic Republic of Congo (DRC) has shown that over a quarter of women have an unmet need for family planning and that modern contraceptive use is three times higher among urban than rural women. This study focuses on the reasons behind the choices of married men and women to use contraception or not. What are the barriers that have led to low levels of modern contraceptive use among women and men in DRC rural areas? The research team conducted 24 focus groups among women (non-users of any method, users of traditional methods and users of modern methods) and husbands (of non-users or users of traditional methods) in six health zones of three geographically dispersed provinces. The key barriers that emerged were poor spousal communication, sociocultural norms (especially the husband’s role as primary decision-maker and the desire for a large family), fear of side-effects and a lack of knowledge. Despite these barriers, many women in the study indicated that they were open to adopting a modern family planning method in the future. These findings imply that programming must address mutual comprehension and decision-making among rural men and women alike in order to trigger positive changes in behaviour and perceptions relating to contraceptive use.

‘Helpin’ a buddy out’: Perceptions of identity and behaviour among rural straight men that have sex with each other

I conducted semi-structured interviews with ten American rural, white, straight-identified men who have sex with men to understand how they perceive their sexual identity and sexual behaviour. All ten tell other people that they identify as straight, and eight actually identify as straight. I detail three main themes: changes to sexual attractions, reasons for identifying as straight, and the meanings attached to sexual behaviour with other men. Half of the participants reported experiencing major changes to their sexual attractions, challenging the assumption that male sexuality is static. They described several reasons for identifying as straight, demonstrating that attractions and behaviour are not the only bases for sexual identity. The participants also explained that they experience sex with men in a variety of ways, many of which reinforce their straight identity. The results indicate that heterosexuality is a performance, rather than a natural expression of sexuality, and that interpretations – not just attractions and behaviour – are central to being straight.

Gender Norms and Beliefs, and Men's Violence Against Women in Rural Bangladesh.

Prevention of violence against women requires understanding men's controlling attitudes and behaviors toward women. In Bangladesh, while the incidence of men's violence against women is alarmingly increasing, existing research to understand the determinants of men's violent behavior resulted in contradictory findings. The current study explores rural Bangladeshi men's support for gender norms, beliefs, and attitudes concerning violence against women, and looks at how these are influenced by men's age, marital status, education, and affiliation with organizations that promote gender equality. The study also attempts to understand men's bystander attitudes and responses to incidents of violence against women. Using the theoretical framework of hegemonic masculinity, the study was conducted among a sample of 1,200 men and women. Results indicate that in the study areas, young, unmarried men are less supportive to gender norms, beliefs, and attitudes that promote violence against women. Positive association was observed with men's educational attainment and affiliation with nongovernmental organization (NGO) interventions. Regardless of age, marital status, or education, men's bystander response toward intervening to prevent violence against women was found to be low. Women showed similar level of support for inequitable gender norms, beliefs, and attitudes. Analysis of the findings using a hegemonic masculinity lens reveals more complicated dynamics of power and hegemonic control at work that perpetuate men's violence against women. Based on the findings, the study also identifies possible strategies for violence prevention interventions in Bangladesh.

Critical geographies of education: an introduction

Critical geographies of education: an introduction

Knowledge and Practice Regarding HIV among Urban-Rural Men in Bangladesh: A cross sectional study

Background: Human immunodeficiency virus (HIV) is one of the very much concerning issues and nearly 30 million people have died because of HIV related causes, which are found mostly low and lower income countries of the world. Objective: The objective of this study was to evaluate knowledge and practice to reduce risk factors of getting HIV among urban and rural men in Bangladesh with the comparative analysis among them. Methodology: This is a cross sectional study among 3997 men (urban=1437 and rural=2560). Frequency and percentage on knowledge and practice to reduce risk factors of getting HIV were counted to describe and also urban-rural significance levels of knowledge and practice issues regarding HIV were tested. Result: Knowledge and practice regarding HIV among urban-rural men were comparatively different where 93.7% urban and 81.9% rural men heard about HIV; 88.3% urban and 74.8% rural men thought that HIV can get by using unsterilized needle or syringe; 90.3% urban and 75.6% rural men thought that unsafe blood transfusions resulted HIV; 78.3% urban and 62.2% rural men use condom always during sex; and these urban-rural knowledge and practice related differences are statistically significant at P&lt;.000. Conclusion: In Bangladesh, there weren’t massive differences between urban and rural men’s knowledge and practice reducing risk factors of getting HIV; but urban men have comparatively more knowledge and practice levels than those of rural men have because of having urban men’s higher level of socio-demographic and economic status. Bangladesh J Infect Dis 2015;2(1):3-8

Masculinity and fathering in the lives of rural men with a disability

This paper contributes to the literature on masculinities and rurality, and masculinities and disability through interviews about fatherhood with 16 rural men with an acquired disability. In the context of shifting notions of fatherhood in broader society, and dominant discourses of rural and disabled masculinity, we explore interviewees' understandings and enactments of being a parent. We address the question of how rural fathers with a disability define fatherhood through reference to Gerschick and Miller's (1995) typology of reliance, rejection and reformulation. The majority of the men in the sample understood fatherhood via discourses of breadwinning, physicality, and the outdoors. We argue that these strategies of reliance on traditional discourses of masculinity have particularly negative implications for men with a disability living in rural areas, due to the nature of the rural economy, poor service provision and limited accessibility to facilities. In the final section of the paper, we turn to constructions of fatherhood articulated by four participants. These men adopt strategies of both reliance and reformulation. They incorporate dimensions of hegemonic masculinity into their definition of parenthood, while simultaneously encompassing more normatively feminised practices and spaces.