How have notions of masculinity increased HIV prevalence amongst men in

Uganda and what can institutions do to alleviate the problem?

http://www.scribd.com/doc/208464976/Analysing-Males-in-Africa

http://www.scribd.com/doc/45146834/Uganda

Context
Notions of masculinity in Uganda have caused increases in HIV prevalence among
males in a multitude of ways, often through direct behavioural causality or through
socially constructed phenomena. Masculinity in Uganda is synonymous with virility,
promiscuity, fearlessness, self-sufficiency and dominance. The way men construct
their personal and social identities is through the attainment of these ideals and the
consequence of pursuing them is often an increase in HIV rates. This essay will focus
on how conceptions of masculinity have exacerbated the epidemic in two ways;
encouraging men to engage in sexual promiscuity and through the discouragement of
treatment uptake through conformity to familial hierarchical concepts of male
hegemony. Moreover, it will show how the issues of promiscuity and conformity have
been exacerbated by a stagnating economy as well as pervasive social stigmatisation.
By analysing how masculine aspirations have lead to a worsening of the HIV
epidemic, this essay will also identify what the role of institutions is in assuaging the
problem. Institutions need to improve the degree of invisibility of men in the gender
equation, which produces gender inequality that is a major driving force behind the
HIV epidemic (Prince, Pugh 2007).
1
They need to focus on initiating dialogues
between men and women on how notions of masculinity maintain structural
inequalities that determine morbidity and mortality (Prince, Pugh 2007).
2
They need
to focus on revising and transforming notions of masculinity through educating men
as well as continuing the political and economic empowerment of women and girls
that has been instrumental in changing risky sexual practices (Seidler 2006).
3
Finally,
in terms of homosexuality legislation, institutions in Uganda should follow the
pragmatic approach of the Kenyan government where HIV prevention programming
is provided despite the act of men having sex with other men (MSM) being
criminalised (Semugoma, Beyrer & Baral 2012).
4

Sexual Promiscuity

In Uganda, virility is often perceived as a fundamental indication of masculinity and
therefore it is a prerequisite for achieving masculine status both personally and
socially; masculinity and sexuality go hand in hand (Subero 2013).
5
In order to
develop and maintain their personal and social identity, men engage in sexually
promiscuous acts with multiple partners. Men are socially conditioned into
promiscuity that endangers their health, the greater the number of sexual partners they
have, the greater risk there is of exposure, contraction and transmission of HIV. This

1
Prince, B and Pugh S (2007). Skills-building Ior Gender Mainstreaming in HIV/AIDS . Dakar: HSRC. p6-30.
2
Prince, B and Pugh S (2007). Skills-building Ior Gender Mainstreaming in HIV/AIDS . Dakar: HSRC. p6-30
3
Seidler, V (2006). Transforming Masculinities. New York: Routledge. p40-52.
4
Semugoma, P; Beyrer, C and Baral, S. (2012). Assessing the effects of anti-homosexuality legislation in Uganda
on HIV prevention, treatment, and care services. Social Aspects of HIV/AIDS. 9 (3), p173-176.
5
Subero, G. (2013). HIV in World Cultures : Three Decades oI Representations . Social Sciences. 1(4), 300-313.
promiscuity aggravates the HIV epidemic for both men and women as it increases the
likelihood of transmission for both the virile man and his sexual partner. A man who
demonstrates his virility in the pursuit of masculinity will have far more sexual
partners than the world average (Avert 2013),
6
with the multiplier effect of just one of
these partners testing HIV positive is an exponential increase in HIV prevalence.
Furthermore, the consequences of the extensive notion of virility and engagement in
promiscuity for the HIV epidemic are further exacerbated by the risk-preference men
have in Uganda. The rejection of condom use, the use of alcohol and the injection of
IV drugs are all embedded in the beliefs about fearlessness that coincides with
masculinity (Subero 2013).
7
These notions are detrimental to sexual health and the
ubiquitous nature of the practises means that there is a double burden of promiscuity.
Sexual encounters are often associated with intoxication and a lack of protection; the
number of Ugandans who report using condoms during their last sexual encounter
was extremely low at 13.7% in a 2011 survey (Avert 2013).
8
***MORE***

In Uganda, the opportunities for men to engage in sexual promiscuity are expanded
by the pursuit of modernity. The attainment of wealth by males means an increase in
sexual relations, an expansion of risky sexual practises and an increase in HIV
prevalence. The more wealth attained means a strengthening of masculinity and a
more sexualised one in the eyes of both genders. Women desire men who possess
wealth as they associate it with power, authority, security and an expansion of their
own opportunities. Modernity encourages sexual relations through women pursuing
an improvement in their livelihoods (regardless of the likelihood of HIV
transmission), while men use the attainment of wealth to increase the likelihood of
sexual relations with multiple females. The sexual partners of men who have attained
wealth are often uneducated girls below the age of 18 who are mesmerised by what
wealth symbolises, the inter convertible relationship of love and money is a key
aspect of negotiating masculinity that has serious implications for HIV transmission
(Cornwall 2005).
9
The opportunities for promiscuity that wealth grants men in
Uganda means an intensification of the HIV epidemic that has serious negative
externalities for both men and women. Modernity, power and male hegemony are all
associations of masculinity that women desire, yet these desires mean they engage in
sexually risky encounters that create a barrier to men engaging with HIV treatment.
10


MSM

Separately, in a homophobic environment providers could be un-willing to
provide services to these men. Through the limitation of the uptake of services
and provision of services, coverage of HIV prevention, treatment, and care
services to a population that has been demonstrated to carry a very high risk
for HIV will decrease.
MSM are 19 times more likely to be HIV-positive compared to the general
population
iii


6
HIV and Aids in Uganda. (2013) Available: http://www.avert.org/hiv-aids-uganda.htm. Last accessed
20.04.2013.
7
Subero, G. (2013). HIV in World Cultures : Three Decades oI Representations . Social Sciences. 1(4), 300-313.
8
(2013). HIV and Aids in Uganda. Available: http://www.avert.org/hiv-aids-uganda.htm. Last accessed
20.04.2013.
9
Cornwall, A (2005). Readings in Gender in Africa. Indiana: James Currey and International African Institute
North America. p4-10.
10
(2013). Viral Sexually Transmitted Diseases: Advances in Research and Treatment. Medicine. 1. (4.), p80-112.
The limited ability to develop social capital has been shown to be associated
with low self-efficacy and a dearth of community infrastructure among MSM,
arguably limiting the effectiveness of HIV prevention interventions.
Thus, MSM living with HIV would be expected to be less likely to disclose
their sexual practices resulting in risk misclassification with HIV case-based
surveillance systems
Predicted downstream consequences of the bill as a law include heightened
HIV risk and crippled access to care for MSM, and indeed, among all people
of reproductive age in the country by limiting the ability to provide evidence-
based HIV prevention treatment and care

Familial Male Hegemony

Within the familial hierarchy in Uganda, notions of masculinity have developed a
structure of male hegemony whereby men are prescribed to be dominant,
independent, self-sufficient and heterosexual. The personal and socially constructed
identity of males suggests that they should provide for and support their families
through income generating activities, thereby subordinating women and children into
dependency. Gaining employment is a prerequisite to attaining masculinity, but with a
stagnating economy plagued by high inflation rates and insufficient GDP growth of
4.4% in 2012 (AFDB)
11
, the lowest for more than a decade, poverty and structural
unemployment means there is a barrier to men affirming their masculinity through the
prescribed route of income producing hegemony. Associated with this barrier is a
struggle to maintain an identity and hence a loss of purpose, this often leads to
seeking affirmations of masculinity through other means, such as the aforementioned
sexual promiscuity. ***MORE*** Furthermore, the practice of men spending large
proportions of their income on attempting to alleviate their HIV symptoms as an
alternative to seeking treatment means there is an exacerbation of their identity crisis,
while the reluctance to seek treatment further increases the risk of HIV transmission
(Godfrey, Seeley & Wight 2013).
12
Research in a rural mining town in Eastern
Uganda illustrated the effect of male commitment to maintaining a strong,
independent and fearless hegemonic appearance. Many men would refuse antiviral
drugs because the side effects negatively affected their ability to work. Disclosing
HIV diagnosis and treatment to employers can even reduce job offers and
collaboration with other colleagues; they fear working with contaminated people
(Godfrey, Seeley & Wight 2013).
13


Not only do hegemonic notions of masculinity encourage dangerous sexual relations
when men fail to perform in their role of independently supporting a family, but
framing men as self-sufficient family providers also subordinates HIV-positive men
as unmanly, inadequate and unable to live up to proper ideals of manhood (Prince,
Pugh 2007).
14
This is an important indication of why men are under-represented in
HIV treatment, seek it later than women and have a higher mortality while on
antiretroviral therapy. However, the disproportionate under-utilisation of HIV

11
(2013). Uganda Economic Outlook. Available: http://www.afdb.org/countries/east-africa/uganda/uganda-
economic-outlook/. Last accessed 21.04.2014.
12
Godfrey, S; Seeley, J & Wight, D. (2013). Dividuality, masculine respectability and reputation: How
masculinity affects men's uptake of HIV treatment in rural eastern Uganda. Social Science & Medicine. 89, 45-52.
13
Godfrey, S; Seeley, J & Wight, D. (2013). Dividuality, masculine respectability and reputation: How
masculinity affects men's uptake of HIV treatment in rural eastern Uganda. Social Science & Medicine. 89, 45-52.
14
Prince, B and Pugh S (2007). Skills-building Ior Gender Mainstreaming in HIV/AIDS . Dakar: HSRC. p6-30.
treatment by men and poor access to resources is in contrast to the concept of
hegemonic masculinity whereby men demonstrate greater access to nearly all
resources due to their powerful patriarchal position in society (Greig, Kimmel & Lang
2000).
15
A universal patriarchy that advocates superior access to resources for men
but simultaneously renders them to be disproportionately represented is clearly
paradoxical. Notions of masculinity in Uganda have increased HIV prevalence
amongst men by constricting them to a unique role of unattainable familial
hegemony; a stagnating economy, a desire by individuals to maintain a self-sufficient
identity and an unwillingness to access treatment have all worsened the HIV
epidemic.

Social Stigmatisation..

Masculinity shouldnt exclusively be viewed as a relationship oI power
because it too easily blinds us to the diverse cultures of masculinity and ways
they are framed in mysogynist and homophobic terms
Men describe experiences where they are ostracized from their families,
dismissed from places of employment, thrown out of schools, severely
discriminated against in health care settings and beaten by police for their
sexual orientation. More targeted services and a shift in the legal framework
would potentially limit the increased stress from social isolation and limited
access to health services
Stigma and discrimination by families, local communities and the government
continues to marginalise people living with HIV. This undermines national
prevention and treatment efforts by creating fear of testing.
The dominant biomedical approaches to HIV/AIDS have paid inadequate
attention to grasping the socio-cultural representations of the disease,
stymieing local, national and global responses to preventing and controlling
AIDS

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Role of Institutions

Initiating dialogues. Revising masculinities. Homosexuality legislation.


DICHOTOMY. Most civil society organizations in Uganda have several years
of experience in handling various specialized aspects of HIV/AIDS. Yet,
funding for these organizations is fragmented and often too limited to expand
effective programmes. The district local government structures, which have
been the focus of donor funding in recent years, lack the capacity and
experience to deliver quality HIV/AIDS services.
More focused and prioritized attention to key geographic areas and
communities, based on appropriate surveys, can strengthen both national and

15
Greig, A; Kimmel, M & Lang, J. (2000). Men, masculinities & development: Broadening our work towards
gender equality: Gender in development programme). PDF. . (.), 1-20.
local responses to the HIV/AIDS epidemic. Increased utilization of civil
society organizations that have a proven track record for delivery of quality
services in the implementation of state and donor-funded projects will go a
long way in ensuring more effective management of the epidemic and
appropriate use of resources. This can be done through a coordinated
mechanism that ensures open competitive bidding in which civil society
organizations would be invited to submit requests for resources,
25
Rather than giving local government structures preferential treatment in the
management of these resources.
Development of the policy and legal framework
Resolving this challenge calls for independent monitoring of the HIV/AIDS
epidemic and assessment of success; optimum accountability and de-
politicization of the budget; funding empowerment; and including multiple
stakeholders in the decision-making process. An HIV/AIDS policy is needed
to give guidance to appropriate responses and to provide a basis for generating
legal safeguards for PLWHA and people affected by the epidemic. This policy
would be a means to provide adequate laws and guidelines for the economic
and material support to PLWHA, assure the legal rights and responsibilities of
the infected individuals and protect spouses and children affected by
HIV/AIDS. Such a policy would be critical to guide the mainstreaming of
HIV/AIDS into different aspects of the development process of Uganda to
ensure that its mitigation is founded on a rights-based approach and to expand
planning in this era of AIDS to go beyond simplistic economic analysis.
A nationally acceptable HIV/AIDS policy can provide a means for
successfully controlling the epidemic. Such a policy would expand the
national response if it includes businesses, the armed forces, the teaching
service, FBOs, NGOs and others that are a part of the national scene. The
policy needs to be addressed in its own right and not as an appendage to other
laws without operational modalities for implementation. The UAC and the
presidents oIIice should push Ior a parliamentary debate oI a national
HIV/AIDS policy and ensure that there are legally binding instruments to
assist programme development and implementation. These moves would be
legitimate political actions toward success.

Conclusion

How is a study of masculinities relevant to gender and development?
Why should men care, support or engage with issues of gender, HIV, sexual
health and/or other issues in gender and development?
Why are (reproductive) health programmes bound to fail if men are left out?
What can be learnt from work with men on issues of HIV and AIDS, gender and
sexuality?