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      The promises and limitations of gender-transformative health programming with men: critical reflections from the field

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          Abstract

          Since the 1994 International Conference on Population and Development, researchers and practitioners have engaged in a series of efforts to shift health programming with men from being gender-neutral to being more gender-sensitive and gender-transformative. Efforts in this latter category have been increasingly utilised, particularly in the last decade, and attempt to transform gender relations to be more equitable in the name of improved health outcomes for both women and men. We begin by assessing the conceptual progression of social science contributions to gender-transformative health programming with men. Next, we briefly assess the empirical evidence from gender-transformative health interventions with men. Finally, we examine some of the challenges and limitations of gender-transformative health programmes and make recommendations for future work in this thriving interdisciplinary area of study.

          Translated abstract

          Desde la Conferencia Internacional sobre Población y Desarrollo de 1994, investigadores y profesionales han aunado esfuerzos para cambiar los programas de salud para hombres desde un enfoque de género neutro hacia uno más sensitivo y transformativo. Especialmente en la última década, los esfuerzos en esta última categoría se han utilizado cada vez más para intentar transformar las relaciones de género de forma que sean más justas en aras de mejorar los resultados sanitarios tanto para hombres como para mujeres. En primer lugar, evaluamos la progresión conceptual de las contribuciones de la ciencia social a los programas sanitarios transformativos de género para hombres. A continuación, valoramos brevemente las pruebas empíricas de las intervenciones sanitarias transformativas de género para hombres. Y para terminar, analizamos algunos de los retos y las limitaciones de los programas sanitarios transformativos de género y hacemos recomendaciones para el futuro trabajo en esta floreciente área interdisciplinaria de estudio.

          Translated abstract

          Depuis la conférence internationale sur la population et le développement de 1994, les chercheurs et les praticiens se sont impliqués dans une série d'actions visant à transformer les programmes de santé destinés aux hommes, caractérisés par le sexisme, en programmes de santé plus sensibles à la dimension de genre et favorables à l'évolution des inégalités de genre. Les actions entrant dans cette dernière catégorie ont été menées de plus en plus fréquemment, en particulier au cours des dix dernières années; elles visent à rendre les relations de genre plus équitables au nom de l'amélioration de la santé, des hommes comme des femmes. Nous commençons par évaluer le progrès conceptuel de la contribution des sciences sociales aux programmes de santé ciblant les hommes et favorables à l'évolution des inégalités de genre. Ensuite, nous évaluons brièvement les données empiriques des interventions de santé dans ces mêmes programmes. Enfin, nous examinons certains des défis et des limites inhérents aux programmes de santé favorables à l'évolution des inégalités de genre et nous formulons des recommandations pour ce qui concerne les futurs travaux dans ce dynamique champ de recherche interdisciplinaire.

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          Constructions of masculinity and their influence on men's well-being: a theory of gender and health.

          Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.
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            Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention

            Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted. In South Africa, while gender identities show diversity, the dominant ideal of black African manhood emphasizes toughness, strength and expression of prodigious sexual success. It is a masculinity women desire; yet it is sexually risky and a barrier to men engaging with HIV treatment. Hegemonically masculine men are expected to be in control of women, and violence may be used to establish this control. Instead of resisting this, the dominant ideal of femininity embraces compliance and tolerance of violent and hurtful behaviour, including infidelity. The women partners of hegemonically masculine men are at risk of HIV because they lack control of the circumstances of sex during particularly risky encounters. They often present their acquiescence to their partners' behaviour as a trade off made to secure social or material rewards, for this ideal of femininity is upheld, not by violence per se, by a cultural system of sanctions and rewards. Thus, men and women who adopt these gender identities are following ideals with deep roots in social and cultural processes, and thus, they are models of behaviour that may be hard for individuals to critique and in which to exercise choice. Women who are materially and emotionally vulnerable are least able to risk experiencing sanctions or foregoing these rewards and thus are most vulnerable to their men folk. We argue that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours.
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              Structural interventions: concepts, challenges and opportunities for research.

              Structural interventions refer to public health interventions that promote health by altering the structural context within which health is produced and reproduced. They draw on concepts from multiple disciplines, including public health, psychiatry, and psychology, in which attention to interventions is common, and sociology and political economy, where structure is a familiar, if contested, concept. This has meant that even as discussions of structural interventions bring together researchers from various fields, they can get stalled in debates over definitions. In this paper, we seek to move these discussions forward by highlighting a number of critical issues raised by structural interventions, and the subsequent implications of these for research.
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                Author and article information

                Journal
                Cult Health Sex
                Cult Health Sex
                TCHS
                tchs20
                Culture, Health & Sexuality
                Taylor & Francis
                1369-1058
                1464-5351
                16 October 2015
                8 May 2015
                : 17
                : sup2 , Beyond Working with Men and Boys
                : 128-143
                Affiliations
                [ a ]Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, USA
                [ b ]Center for AIDS Prevention Studies, School of Medicine, University of California , San Francisco, USA
                [ c ]Department of Health Behavior, University of North Carolina , Chapel Hill, USA
                [ d ]School of Public Health and Family Medicine, University of Cape Town , South Africa
                Author notes
                Article
                1035751
                10.1080/13691058.2015.1035751
                4637253
                25953008
                12356764-c12a-4a17-afd3-11979a9937de
                © 2015 The Author(s). Published by Taylor & Francis

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

                History
                : 19 October 2014
                : 26 March 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 76, Pages: 16
                Funding
                Funded by: National Institute of Allergy and Infectious Diseases
                Award ID: T32 AI007001
                Funded by: Eugene Kennedy Shriver National Institute of Child Health and Human Development
                Award ID: R24HD077976,T32 HD007168
                Paul J. Fleming was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number T32 HD007168) and National Institute of Allergy and Infectious Diseases (grant number T32 AI007001). Chris Colvin was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (grant number R24HD077976). Shari L. Dworkin was supported by a National Institute of Health grant to the UCSF Gladstone Institute of Virology & Immunology (Center for AIDS Research, grant number P30-AI027763) and by a UCSF School of Nursing intramural grant.
                Categories
                Article
                Articles

                Sexual medicine
                gender norms,masculinities,hiv,violence,intervention
                Sexual medicine
                gender norms, masculinities, hiv, violence, intervention

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