He tries not to get the three confused.
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He tries not to get the three confused. |
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Scroll down for a more positive view. Health and Place 1999 p315 This book, the latest in the series of publications by the Panos AIDS Programme, forms part of Panos' especial emphasis upon AIDS and men for the 1999-2000 period. In the past few years reflecting the fundamental significance and complexities of human interaction in HIV transmission there have been growing bodies of research, policy and programme development seeking to address the implications of gender for prevention strategies. Key questions which underlie this book are - "Why do some men regularly risk their own lives, the lives of their loved ones and the lives of acquaintances and strangers? Can men be persuaded to change their behaviour?" As an increasing number of sexual behaviour surveys (including those of the now-replaced Global Programme on AIDS) have shown, in virtually all countries it is only a minority of men who take HIV-related risk. The explicit recognition of this fact is one of the qualities of this book, which helps it avoid the all-too-common gender stereotyping of men. The book is structured in two parts. The first 50 pages (by Martin Foreman) provide an introductory overview, touching upon the nature of HIV-related vulnerability and risk, masculinity, factors underlying male sexual propensities, women's social disadvantage, and strategies to foster 'safer sexual' behaviour. From a research point of view this is rather pedestrian and too weakly conceptualised and theorised to provide much of value. The second 170 pages section comprises articles by journalists on a wide range of AIDS and gender themes including domestic violence, religion, sex education, male homosexuality, injecting drug use, sexual brutality in male prisons, living with HIV and the contraceptive dilemmas of fatherhood. These articles essentially comprise case studies from Latin America (Brazil and Mexico), Africa (Ghana, Ivory Coast, Kenya, Malawi and Uganda), Asia (Bangladesh and Thailand) and Russia. Much of this makes fairly lively reading, often quite vividly and evocatively expressed, yet able to carry important insights. Overall this is a somewhat casual and journalistic book. Although listing references for each chapter, there is no index, probably reflecting the problem of so much repetition of themes and ideas. From its range of geographical milieux it provides some indication of cultural variety. However the major deficiency of the book is the absence of any synthesis or conclusion, which could, for instance, have provided some pattern of convergences and differences on the place- related dimensions of AIDS and men. Nicholas Ford Department of Geography, University of Exeter Jan - Mar 2001 "a must for all those who are directly or indirectly involved in the control of the HIV epidemic" Following the International Conference in Cairo (1994), discussions on a wide range of issues surrounding reproductive and sexual health have directed our attention to the importance of sexuality, development of sexual identities and resulting patterns of gender relations. There is a growing recognition that the concept of masculinity and male concepts of sexuality are central to our understanding of the complex relationships involved in programmes aimed at comprehensive reproductive health of women and men, particularly those aimed at preventing HIV/AIDS. The consequences of failure to recognize and respond appropriately to gender issues in terms of women's health and other reproductive health issues are now well known, but how much of this recognition has actually been translated into effective programmatic responses is not yet clear. In view of these concerns, AIDS and Men: Taking Risks or Taking Responsibility? is an extremely useful attempt at highlighting the inevitability of involving men in HIV/AIDS prevention programme and several interrelated issues. The book is divided into two parts. The first part examines the relationship between men's actions and AIDS around the world and the impact of those actions on men and women. The second part, written by journalists from 11 countries, illustrates many different aspects of that relationship. Written in a lucid and graphic format, the book is a must for all those who are directly or indirectly involved in the control of the HIV epidemic. The book fosters greater insights into how men in different circumstances take risks and also what prevents them from taking responsibilities. The case studies discussed range from 'machismo' in Mexico to drug injection in Russia, from men in prison in Brazil to men living with HIV in Thailand, from men as fathers in Ivory Coast to men who have sex with men in Kenya. These case studies elucidate varying contexts and responses that inhibit the implementation of HIV/AIDS prevention programmes that would address the issue in a holistic framework. For example, using the case studies from Kenya and Bangladesh, the book highlights the ambiguity that exists in most cultures about men who have sex with men and whether to accept or change it. Similarly, there is a distinct failure to recognize and do anything about men in the military or police (Malawi), or men in prison (Brazil). Although located in different regions of the world, these case studies remind us that the issues facing men's behaviour cut across the boundaries of regions and cultures. While the authors of the different case studies do not offer any easy solutions, their detailed and insightful discussions help the reader to delineate the different kinds of challenges facing those fighting the epidemic in reaching men and changing them. In the words of the editor: 'AIDS and Men attempts to show [that] the physical, social and psychological factors which lead men to place themselves and others at risk allow no single, easy solution'. Yet, the different case studies gave hope and encouragement to find solutions from within rather than outside and without blame and stigmatisation. Signs of change particularly among the younger generation (Mexico, Tanzania, Bangladesh and Uganda) are encouraging. There is, however, a long way to go. A case study from Ghana shows that religion has to play a major role in recognizing that those young men and women who cannot live up to the ideals of chastity and mutual fidelity need to be educated about safe sex and use of condoms. There are other examples from some Church based organizations in Kenya that offer medical, counselling and financial help to men who are HIV infected and have sex with men. These experiences clearly need to be shared ton a wider scale. There are other optimistic examples of Thai men and women who have learned to lead normal dignified lives. The other side of the story is the need to teach HIV positive men about the risk of transmitting HIV to their children. They should learn to prepare for their children's future, especially if the children are likely to be orphans (Cote d'Ivoire). These examples obviously point out to the importance of enhancing quality of life more than the prolongation of life. The book raises fundamental questions about what it means to be man and explains the complex interrelationship between the notion of masculinity and sexual prowess that makes both women and men vulnerable to HIV/AIDS. It also reminds us in no uncertain terms that a failure to recognize and respond to the contexts and circumstances in which men take risks and fail to take responsibility would be disastrous beyond imagination. At the core of these issues is the inter-relationship between masculine identity and sexual activity. The book also attempts to generate debate on whether HIV/AIDS prevention can truly be successful without separating masculine identity from sexual prowess. Highlighting three different approaches to HIV prevention, described as 'informative', 'supportive' and 'social', the editor rightly points out that the 'third approach, which depends on deep rooted social change, may be the one most likely to overcome the epidemic [although] it is the hardest to achieve'. The major prevention measures on the part of men - fidelity, condom use, non-penetrative sex, masturbation and abstinence for those not in marriage - 'are attempts to distinguish between masculinity and sexual prowess'. The attempt to find solutions within existing structures and values has allowed the epidemic to spread country after country. While the need for enhancing changes in man's behaviour is highlighted, the editor rightly cautions at the outset that, just as HIV prevention for women cannot succeed without the active involvement of men, prevention of HIV/AIDS is meaningless without the participation of women. In fact, the message of the book is well summarized in the following words of Eda Chavez: 'AIDS has opened a window of opportunity for men and women to begin to think and seriously discuss how to break ancient patterns of behaviour which are having such a negative impact on the eve of the 21st Century'. It will need a lot of courage and honesty on the part of everyone in society to bring these fundamental changes. The irony is that a long-term solution to the epidemic is not possible without these most basic fundamental changes. Ravi K Verma International Institute for Population Sciences, Mumbai, India |
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