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This paper calls for a critical reframing of masculinity as an intersectional construct in the HIV epidemic and in public health. In-depth qualitative interviews were conducted with a sample of 56 Black men who have sex with men and women in the San Francisco Bay Area. Men described their sexual identities and practices via complex narratives of masculinity that drew on subordinated and resourceful adaptations to the structural effects of racism, economic marginalisation and homophobia. By focusing on men whose experience of masculinity operates outside fixed identity categories, the paper draws attention to the intersectionality that is, by necessity, constitutive of men's lived experiences. Findings suggest the value of an integrative framework for understanding Black masculinities as processes and practices simultaneously informed by structural inequalities (racism, economic marginalisation and/or homophobia, in particular) and cultural meanings of gender. By utilising an intersectional approach, public health and sociology can better understand the concurrent resilience and vulnerability of masculinities, while building an interdisciplinary understanding of the symbolic role of Black masculinities in the USA, as well as a means by which to promote health and well-being in and through these gendered contexts. [ABSTRACT FROM AUTHOR]

This paper describes experiences of sexuality stigma among same-sex attracted men in Zimbabwe and analyses the consequences of such experiences for healthcare seeking. It draws on qualitative research carried out in Harare in 2017, which included in-depth interviews with sixteen gay and bisexual men, and key informant interviews with three representatives of organisations that work with gay men. There were numerous stories about sexuality stigma in the study participants´ social environments, including at home, in local communities and in healthcare facilities. We first offer a description of these and then go on to trace the implications of stigma on the relations between men who have sex with men on the one hand and the healthcare sector on the other. We conceive of stigma as a pushing force that exerts pressure on and in these relations, and identify five types of consequences of this. Stigma works to (1) produce geographical shifts in healthcare, (2) promote private over public care, (3) compartmentalise healthcare (with dedicated providers for queer persons), (4) deprofessionalise care, and (5) block access to appropriate healthcare altogether for some same-sex attracted men. Most of these consequences have negative implications for preventive or treatment-focused HIV programming. [ABSTRACT FROM AUTHOR]

In studies of sexual risk behaviour among youth, the role of dominant conceptions of masculinity and femininity has received increasing attention. However, where research has sought to explore femininity, it has predominantly focused on adolescent girls. This paper departs from previous research by offering insights into how young women negotiate their femininity as they transition from adolescence to adulthood and encounter changing social contexts. Drawing on data from ethnographic enquiry, it argues that as young women transition out of school and into emerging adulthood, their options for negotiating different types of femininity become constrained, with consequences for engagement in sexual risk behaviours. This may to some extent explain why in some South African contexts older young women are more vulnerable to HIV infection than adolescent girls. The paper offer insights into future prospects for youth development programming seeking to reduce young women’s vulnerability to risk. [ABSTRACT FROM PUBLISHER]

This paper presents five concepts that articulate specific processes through which political and economic factors shape sexuality, drawing on ethnographic research on changing notions of marriage, love, and sexuality conducted in migrant-exporting rural Mexico and with Mexican migrants in Atlanta and New York. The first section describes how changing beliefs about love, marriage, sexual intimacy and fidelity constitute a cultural terrain which facilitates ‘vaginal marital barebacking’ in rural Mexico. The paper details sexual opportunity structures; sexual geographies; the multi-sectoral production of risk (including the ways in which housing, transportation, and other policy sectors together create the ‘recreation-deserts’ in which many migrants live); sexual projects, and externalities as conceptual tools that articulate how political and economic factors from the meso- to the macro-level shape sexuality. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Black men who have sex with men in the USA face disproportionate incidence rates of HIV. This paper presents findings from an ethnographic study conducted in New York City that explored the structural and socio-cultural factors shaping men’s sexual relationships with the goal of furthering understandings of their HIV-related vulnerability. Methods included participant observation and in-depth interviews with 31 Black men who have sex with men (three times each) and 17 key informants. We found that HIV vulnerability is perceived as produced through structural inequalities including economic insecurity, housing instability, and stigma and discrimination. The theoretical concepts of social risk, intersectional stigma, and the social production of space are offered as lenses through which to analyse how structural inequalities shape HIV vulnerability. We found that social risk shaped HIV vulnerability by influencing men’s decisions in four domains: 1) where to find sexual partners, 2) where to engage in sexual relationships, 3) what kinds of relationships to seek, and 4) whether to carry and to use condoms. Advancing conceptualisations of social risk, we show that intersectional stigma and the social production of space are key processes through which social risk generates HIV vulnerability among Black men who have sex with men. [ABSTRACT FROM PUBLISHER]

This paper draws upon recent research in Durban, South Africa to unravel the complexities of care ethics in the context of humanitarian aid. It investigates how the gendering of care shapes the provision of aid in the context of the HIV in Africa constructing an image of 'virile' and 'violent' African masculinity. Humanitarian organisations construct imagined relations of caring, invoking notions of a shared humanity as informing the imperative to facilitate change. This paper draws on varied examples of research and NGO activity to illustrate how these relations of care are strongly gendered. Humanitarian interventions that invoke universalising conceptions of need could instead draw on feminist care ethics that seeks to balance rights, justice and care in ways that attend to the webs of relationships through which specific lived realities are shaped. Essentialising feminised discourses on care result in a skewed analysis of international crises that invariably construct women (and children) as victims in need of care, which at best ignore the lived experiences of men and, at worst, cast men as virile and violent vectors of disease and social disorder. [ABSTRACT FROM AUTHOR]

This paper explores the manifestation of HIV-related stigma in seven- and eight-year-old white South African children's responses to HIV and AIDS. Drawing from elements of ethnographic and interview data, it shows how young children's responses to HIV and AIDS are inscribed within popular accounts of contagion and articulate gendered, sexual, raced and classed discourses in South Africa. Rejecting static accounts of stigma, the paper shows how children resist and confirm power inequalities involving intense self-regulation as well as inscribing within discourses of care and concern for others infected with HIV and AIDS. The findings have implications for scaling up educational efforts to address awareness of HIV and AIDS and stigma, but also to build on positive insights that young children demonstrate with regard to the disease. [ABSTRACT FROM AUTHOR]

Ritual male circumcision is among the most secretive and sacred of rites practiced by the Xhosa of South Africa. Recently, the alarming rate of death and injury among initiates has led to the spotlight of media attention and government regulation being focused on traditional circumcision. While many of the physical components of the ritual have been little altered by the centuries, its cultural and social meanings have not remained unchanged. This paper attempts to understand how some of these cultural and social meanings have shifted, particularly with respect to attitudes towards sex and the role that circumcision schools traditionally played in the sexual socialisation of Xhosa youth. Ritual circumcision is often defended on the basis of its usefulness as a mechanism for the maintenance of social order, particularly in relation to the perceived crisis in youth sexuality marked by extremely high levels of gender-based violence as well as HIV infection. However, the paper suggests two key ways in which traditional Xhosa circumcision has changed. These include the erosion of the role which circumcision schools once played in the sexual socialisation of young men and the emergence of the idea that initiation gives men the unlimited and unquestionable right to access to sex rather than marking the point at which sexual responsibility and restraint is introduced into the lifestyle of young men. [ABSTRACT FROM AUTHOR]

While Australian Aboriginal conceptions of health have been described as holistic and collective, contemporary approaches to health services and health research are often premised on the rational, reflexive subject of neoliberal discourse. This paper considers how neoliberal conceptions of health and subjectivity arose and were negotiated in the context of a qualitative research project on Aboriginal experiences of HIV in Western Australia. Questions about 'coping', 'future' and 'life changes' stood out in the interview transcripts as examples of neoliberal discourse. This paper explores the reflexive, contextual and deflective responses to these questions and suggests they demonstrate how neoliberal discourse can produce the impression that 'everything is okay' despite the difficult social and economic conditions of everyday life experienced by many Aboriginal people. Aboriginal people with a chronic and serious infectious disease such as HIV may utilise the language of self-management and responsibility when talking about HIV with a non-Aboriginal researcher for pragmatic and utilitarian reasons. In this way, the responses of the Aboriginal participants in this study provide a valuable opportunity for exploring new approaches to both research methodology and health service delivery. [ABSTRACT FROM AUTHOR]

Gender inequalities are frequently cited as a major reason for high HIV-prevalence rates in southern Africa. While steps have been taken to promote and pass legislation that upholds equal rights for women, this paper examines the ways in which discourses of gender equality and ensuing sexual rights can have complex, contradictory and even adverse implications when they are mobilised, resisted and reinterpreted at local level. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines this ways in which men and women respond to ideas about gender equality, and seeks to place these responses within the wider context of socioeconomic change and understandings of morality prevalent within the region. The tendency of many young women to seek out relationships with older men and the increasing costs of bride-wealth payments play a key role in reinforcing patriarchal attitudes and fuelling disrespect for women's rights both before and within marriage. In addition, a failure to adhere to customary norms, which uphold men's dominant role, continues to threaten the support networks and assets available to women. The consequences of this situation are examined with particular focus on implications for the future transmission of HIV. [ABSTRACT FROM AUTHOR]

The primary objective in this study was to explore what HIV and AIDS mean to seven- and eight-year-old children in South Africa and how sexual and gender dynamics are embedded within these meanings. Against representations that associate young children with innocence, the paper argues for a more capacious view of young children as sexual and gendered agents with the ability to exercise their rights. In contrast to research that addresses children as relatively passive desexualised beings, focusing on their dependence on adults, their innocence and their need for protection, this paper examines how HIV and AIDS are constructed and negotiated by young people. It views children not simply in terms of their need for sexual rights but as potentially active participants in the negotiation of their rights. Viewing children's rights as highly contested, the notion that young children have sexual rights opens up possibilities for children (including those from marginalised groups) to talk about their concerns and pleasures, fears and hopes, as well as issues relating to sexual rights and resistances. By working creatively with teachers, it may be possible to broaden young children's knowledge of HIV and AIDS and sexuality within a more supportive environment. [ABSTRACT FROM AUTHOR]

Because of the multiple stigma attached to HIV/AIDS, disclosure of HIV-positive serostatus is a considerable social risk for those who disclose. While HIV/AIDS-related stigma affects all HIV-positive people, for people from minority cultures additional cultural factors may play a significant role in self-disclosure. This paper draws on data from semi-structured, in-depth interviews with HIV-positive people from minority cultures in Sydney. Disclosure decisions were influenced by gender, sexual orientation, as well as cultural background. Gay men drew on both collectivist and individualist notions of interdependence and self-reliance in different socio-cultural contexts. This enabled them to accommodate the imperative to maintain harmony with the family and meet their individual needs for support. Heterosexual men who had disclosed voluntarily or involuntarily experienced discrimination and avoidance, and interdependence with family and ethnic community was disrupted. Heterosexual women disclosed to no one outside the health care system and were anxious to avoid any disclosure in the future. For all participants, voluntary and involuntary disclosure caused potential and actual disruption of relationships with their families and ethnic communities. The paper concludes by arguing for an ecological perspective of health in which decisions are not located in rational decision making alone but in the broader context of family and community. [ABSTRACT FROM AUTHOR]

This paper examines the shifting nature of contemporary epidemiological classifications in the HIV/AIDS epidemic. It first looks at assumptions that guide a discourse of vulnerability and circulate around risk categories. It then examines the underlying emphasis in public health on the popular frame of “vulnerable women” who acquire HIV through heterosexual transmission. Drawing on work on gender, sexuality, and intersectionality, the paper asks why a discourse of vulnerability is infused into discussions of heterosexually‐active women's HIV risks but not those pertaining to heterosexually‐active men's. The paper then moves to current surveillance categories that are hierarchically and differentially applied to women's and men's risks in the HIV epidemic. Here, the focus is on the way in which contemporary classifications allow for the emergence of the vulnerable heterosexually‐active woman while simultaneously constituting lack of fathomability concerning bisexual and lesbian transmission risk. Lastly, theories of intersectionality, are used to examine current research on woman‐to‐woman transmission, and to suggest future more productive options. [ABSTRACT FROM AUTHOR]

This paper provides a comparative analysis of modes of dialogue, non‐verbal communication and embodied action relating to sex and health in two contrasting countries—India and South Africa—which have the world's two most heavily HIV‐affected populations (in terms of numbers of people living with HIV). Drawing on material derived from multiple studies, including ethnographic and other forms of qualitative and multi‐disciplinary research, the paper identifies commonalities as well as differences in communication relating to sex and sexual health in these diverse settings. The paper considers: first, how and by whom sex is and is not talked about, in public discourse and private conversation; second, how sexual intention and desire are communicated through indirect, non‐verbal means in everyday life; and third, how references to sexuality and the sexual body re‐enter within a more explicit set of indigenous discourses about health (rather than ‘sexual health’ per se ), such as semen loss in India and womb ‘dirtiness’ in South Africa. The concluding section reflects on the implications of a comparative analysis such as this for current policy emphases on the importance of promoting verbal communication skills as part of ‘life skills’ for HIV prevention. [ABSTRACT FROM AUTHOR]

Studies of sexual risk behaviour in the context of HIV/AIDS often utilize theories of risk which are predicated on the idea of the rational actor making choices, and thus operate with a strong notion of the autonomous individual. The underlying assumption is that a well-informed individual would strive to reduce risk and therefore choose not to engage in risky behaviour in sexual encounters. Drawing on longitudinal fieldwork in Arusha town and the surrounding districts in northern Tanzania, this paper explores how people draw on a complexity of knowledge and experience when they try to reduce the likelihood of contracting HIV. It shows how the embeddedness of social relationships, and the constraints of culture restrict the possible range of options, particularly for women. The paper examines the paired concepts of risk and trust, arguing that trust in a sexual relationship is gendered in particular ways. Gender hierarchies often place women in a subordinate position to men as a result of which women have to make compromises which put their health at risk. [ABSTRACT FROM AUTHOR]

Recent advances in treatment have improved the health of many people living with HIV/AIDS. The research described in this paper shows that the changing context of care is also impacting significantly on people who provide services. In this paper, we explore both perspectives by comparing recent service provider data with that derived from research involving people living with HIV/AIDS. We explore four themes: (1) hope and optimism; (2) changing context, roles and identities; (3) changing relationships; and (4) quality of life. Treatment advances and a new focus on living has altered the context of working with people living with HIV/AIDS and challenges health professionals to find new meanings and relationships within that context. Study findings have implications for the wider health care context and the changing roles and power balances within this arena. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, young women engaged in relationships with multiple partners in order to gain material benefits play a key role in local HIV dynamics. This paper is based upon field observations and interviews with 38 young women who live along the Angolan-Namibian border. In the last 10 years, rapid urbanisation has attracted migrants in search of opportunities to do business in the region. Our findings show that sexual-affective economic networks reflect these socioeconomic changes. Women, particularly those from particular ethnic groups and/or from Namibia, with low levels of formal education and social support are often excluded from the labour market and turn to emotional-sexual male-centred networks for material and financial benefits. Men in these networks tend to be older, have higher socioeconomic status and greater geographic mobility. This ‘capitalisation’ of intimate relationships is material and symbolic; it enables women to acquire goods and access to services identified with an urban and globalised lifestyle. It is also emotional because relationships include affection and pleasure. Engaging in these relationships involves some social risks (bad reputation, family rejection, discrimination and violence), but maintaining ties often takes priority over safer sex and social sanctions. [ABSTRACT FROM PUBLISHER]

Young Thai men who have sex with men continue to have high HIV prevalence and incidence in spite of much investment in community-based prevention approaches. To make HIV services more appropriate for same-sex attracted young men in Thailand, it needs to be considered how target groups view themselves and manage their identities. This paper derives from a qualitative study of 25 same-sex attracted rural young Thai men. It identifies five tactics men employed to manage the discrepancy between their preferences and parental/societal expectations regarding gender and sexuality, and discusses how the young men viewed themselves in the wider context of Thai society, including whether they felt part of a separate gay community. Participants usually did not adopt a gay social identity and were reluctant to join in gay community activities beyond dating. Hence, they would likely experience barriers in accessing gay community-based HIV services. HIV services targeting young same-sex attracted Thai men need to be diversified if they are to be more inclusive, appropriate and effective. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which HIV-related programmes for heterosexual Ugandans and also for men who have sex with men work to deny healthcare services to transgender people in Uganda. Contrary to current conventional wisdom, the study found that the widespread use of the term ‘men who have sex with men’ produces greater barriers to healthcare for queer Ugandans than identity categories such as ‘lesbian’ or ‘transgender’. Interventions for men who have sex with men assume a male-identified sexual subject with agency over sexual practices, such as frequency of condom use. Based on two years of ethnographic research in Kampala, I suggest that the focus on individual sexual practices harms transgender people in two ways. First, current HIV prevention and treatment programmes fail to account for risk factors that accrue to both male and female transgender Ugandans due to the social enforcement of gender norms. Second, the term men who have sex with men directs attention towards stigmatised sexual practices, producing the neglect and abuse of non-heteronormative individuals. In the context of Ugandan healthcare, terms such as ‘transgender’ andkuchuinstead focus attention on the dignity and humanity of the rights-bearing person. These findings emphasise how health practitioners must pay attention to emic categories in order to address the ways in which vulnerability is distributed along social vectors of difference. [ABSTRACT FROM PUBLISHER]

Research reveals how homophobia and stigma link closely to HIV among men who have sex with men in sub-Saharan Africa. This paper considers the varying impact of homophobic stigma on HIV prevention programmes among men who have sex with men in South Africa. It explores how a community-based HIV prevention programme based in the peri-urban townships of Cape Town was ‘translated’ to peri-urban Johannesburg. Drawing on interviews with volunteers and programme facilitators in Johannesburg, it argues that an altered homophobic environment to that found in Cape Town gave different opportunities to engage both with other men who have sex with men and the broader community. It also argues that programme facilitators should be mindful of how varying degrees of homophobic stigma may relate to broader theoretical debates about sexual binary relationships, which can help us understand why particular programmes choose to focus on certain activities rather than others. [ABSTRACT FROM PUBLISHER]

In Lesotho, men have lower HIV testing rates, less contact with HIV clinical settings and less knowledge of HIV prevention than women. However, women's HIV prevalence has consistently remained higher than men's. This paper explores gender norms, sexual decision-making and perceptions of HIV among a sample of Basotho men and women in order to understand how these factors influence HIV testing and prevention. A total of 200 women and 30 men were interviewed in Lesotho between April and July 2011. Participants reported reluctance among women to share information about HIV prevention and testing with men, and resistance of men to engage with testing and/or prevention services. Findings demonstrate a critical need for educational initiatives for men, among other strategies, to engage men with HIV testing and prevention. This study highlights how gender issues shape perceptions of HIV and sexual decision-making and underlines the importance of engaging men along with women in HIV prevention efforts. More studies are needed to determine the most effective strategies to inform and engage men. [ABSTRACT FROM AUTHOR]

This paper applies a social-ecological theory of power to posit that individual HIV-related vulnerability stems from how power is leveraged across situations over time. The current study identified six power domains and explored how the interchangeability of power shapes HIV-related vulnerability among men who have sex with men of colour. Data were collected as part of a mixed-methods study on the social networks and experiences of racial/ethnic and sexual minority status. A total of 35 Asian/Pacific Islander, Black and Latino men who have sex with men were recruited and individual in-depth interviews were conducted. Results showed that men who have sex with men of colour actively traded upon various domains to alter their relative power within a given situation. Results suggest that power interchangeability, or the degree to which power from one domain can be leveraged to gain power in another, may shape HIV-related vulnerability. Findings offer a dynamic understanding of the nature of HIV risk as derived from everyday power exchanges and provide theoretical foundation for future work on individual resilience against HIV-related risks over time. [ABSTRACT FROM PUBLISHER]

This paper explores notions of fatherhood and their linkages to fertility desires and intentions among a treatment-naïve cohort of Xhosa-speaking male key informants living with HIV, aged 20–53 in Cape Town, South Africa. Analysis is based on an initial 27, and 20 follow-up, interviews with men who were part of a study that assessed the acceptability of safer conception and alternative parenting strategies among men and women newly diagnosed with HIV to inform an intervention. Grounded theory analysis revealed themes related to the cultural imperative of biologically-connected fatherhood. Certain safer-conception strategies aimed at minimising the risk of HIV transmission were perceived as threats to paternity. These findings suggest that understanding of social and cultural beliefs related to notions of paternity and fatherhood may inform the implementation of acceptable safer-conception options for HIV-positive men and their infected and uninfected female partners in a high-HIV prevalence, low-resource setting. [ABSTRACT FROM PUBLISHER]

Migrants from sub-Saharan Africa bear a disproportionate burden of HIV infection in Europe, with an increasing proportion of them acquiring HIV after migration. This transformation in the epidemic pattern has raised concerns about the sexual mixing and preventive behaviours of migrants. This paper aims at exploring how racial boundaries shape sexual networks and structure prevention practices among migrants from sub-Saharan Africa. Analyses are based on a French survey carried out among 1874 individuals born in sub-Saharan Africa, aged 18–49 and living in Paris and its surroundings. Our results provide evidence of the existence of African sexual networks, over and beyond those of national origin. The intra-African segregation of these sexual networks leads to sexual contacts between migrants from low- and high-HIV prevalence countries, which probably contribute to the development of the epidemic amongst these migrants. Moreover, racially-based perceptions of HIV-related risk seem to produce a specific attitude toward prevention practices as shown by higher rates of condom use among migrant women from sub-Saharan Africa with a partner born outside sub-Saharan Africa. As a consequence, community-based approaches to HIV prevention should take into account the identification of migrants from sub-Saharan Africa as a racial minority and not only focus on national borders. [ABSTRACT FROM AUTHOR]

This paper presents a synthesis of lessons learned from field experiences in HIV prevention, treatment and care services for men who have sex with men in the four contiguous West African countries of the Gambia, Guinea-Bissau, Guinea-Conakry and Senegal. Service provision for men who have sex with men in these countries is contextualised by the epidemiology of HIV, as well as the socio-political environment. These countries share notable commonalities in terms of social structures and culture, though past approaches to the needs of men who have sex with men have varied greatly. This synthesis includes three distinct components. The first focuses on what is known about HIV epidemiology among men who have sex with men in these countries and provides an overview of the data gaps affecting the quality of service provision. The second aspect describes the HIV prevention and treatment services currently available and how organisations and strategies have evolved in their approach to working with men who have sex with men. Finally, an examination of the political and cultural climate highlights socio-cultural factors that enable or impede HIV prevention and treatment efforts for men who have sex with men. The review concludes with a series of recommendations for impactful research, advocacy and service provision to improve the health and human rights context for men who have sex with men in West Africa. [ABSTRACT FROM AUTHOR]

This paper investigates how current transformations in HIV prevention in the USA are intensifying a logic of viral containment rooted in biomedicine and behavioural science, in order to curb the recent rise in new HIV infections, predominantly among young African-American ‘men who have sex with men’. Based on fieldwork in Baltimore, I examine how this paradigm shift is translated into concrete prevention activities that focus on HIV testing and treatment. By attending to the affective labour performed by members of Baltimore's Ballroom scene – a kinship system of black queer youth structured around competitive dance and performance – I show how the emergent ‘Test & Treat’ approach becomes a polyvalent object that attracts a host of optimistic investments in collective and individual prosperity, which nevertheless threaten to remain unrequited. Finally, I argue that the current move towards a biomedically mediated model of viral management depoliticises the struggle against HIV by suggesting that we can treat our way out of an epidemic that in fact remains intricately interwoven with racialised violence against the queer, the poor and the otherwise dispossessed. [ABSTRACT FROM AUTHOR]

Increasing international mobility presents a risk for communicable disease transmission. Overseas-acquired HIV infections have been increasingly observed across Australian jurisdictions. This includes a mix of men emigrating from countries with high HIV prevalence and men travelling abroad. There is currently little research exploring international mobility and HIV risk, and as a consequence the increase of men acquiring HIV while travelling overseas is poorly understood. This paper draws on data from a qualitative study exploring the risk perspectives and experiences of 14 Australian men who acquired HIV while travelling overseas in the years between 2000 and 2009. Participants articulated a strong desire to distance themselves from the identity of a tourist. Social networks were highlighted as important entry points to engage with other foreign travellers and expatriates. These networks were highly influential and were understood by the participants to provide guidance on how they should negotiate the local scene, including where to meet sex partners. Limited discussion of safe sex and HIV was mentioned in these contexts. The findings suggest that prevalent social norms and social networks play an influential role in how participants negotiate sex and social relations in overseas settings. These networks could potentially provide sites for effective HIV-prevention programmes. [ABSTRACT FROM PUBLISHER]

This paper compares and contrasts number of partners and condom use behaviour for female sex workers and a sample of women working in other economic activities, with both samples drawn from the large informal settlement of Kibera, Nairobi. As expected, univariate analysis revealed much higher numbers of overall sexual partners and higher levels of condom use among female sex workers compared to Kibera women in other occupations. An unexpected finding, however, was that female sex workers with a romantic partner had significantly fewer sexual partners per unit time than female sex workers without such a partner. This finding held for multivariate analysis, with negative binomial regression analyses showing that having a romantic partner was significantly associated with reductions in total number of both sexual partners overall and with sexual partners who did not use condoms. In contrast, HIV status, education, number of immediate family members and levels of alcohol consumption were non-significant factors for both regression analyses. Results suggest that female sex workers' romantic partners act as more than sources of possible HIV infection; rather, romantic partners appear to have an important positive impact on health. We discuss this finding in light of possible harm-reduction programmes focusing on female sex workers and their romantic partners. [ABSTRACT FROM AUTHOR]

Like many countries in sub-Saharan Africa, Mozambique is facing a severe HIV epidemic. Evidence suggests that male sexual behaviour is one of the driving forces behind the epidemic. Yet, there is limited understanding of how notions of masculinity influence such behaviour in the context of HIV. Using data collected through focus group discussions and in-depth interviews with sexually active men and women, this paper investigates how notions of masculinity influence the risk of HIV infection among men. The study findings suggest that traditional norms of masculinity, the man as the main provider and figure of authority, continue to exert a strong influence on male attitudes and behaviour. Alternative approaches are urgently needed in HIV programming that take into consideration notions of masculinity in order to reduce risky sexual behaviour. [ABSTRACT FROM AUTHOR]

This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programmes can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception. [ABSTRACT FROM AUTHOR]

HIV is conceived as a disease that combines stigma elements of perceived contagion and socially undesirable behaviours. Drawing on in-depth interviews with professional adolescent service providers from Australia, Canada, the UK and the USA, this paper explores HIV stigma and stigma management in the lives of HIV-positive young people. Findings elucidate how additional layers of stigma relating to 'adolescent rights' and 'embodied innocence' are added to HIV stigma as it is more usually conceived. This study suggests that managing this stigma entails managing silence in the context of the social worlds of the young person, the family and the service provider. Silence emerged as a key theme in the participant narratives and was embedded in the descriptions of young people's lived experiences. Crucially, silence is a product of oppression and inequity but is also a tool for resistance. Silence defends secrets and exists in the spaces, both physical and social, that are created for them in order to manage the stigma in young people's lives. Silences associated with HIV therefore need to be exposed if we are to better understand what HIV truly means to seropositive young people and how 'silences' may minimise or exacerbate their experience of HIV stigma inside and outside the context of programmes. [ABSTRACT FROM AUTHOR]

The Vietnamese Government continues to take steps to address trafficking in women and girls. However, rather than perceiving trafficking as a violation of human rights, greater attention is given by the government to its effects on society and social morals, particularly where victims have engaged in sex work in destination countries. Trafficked returnees are directly implicated in the State's approach to defining sex work as a 'social evil'. This approach reproduces the socio-economic inequality involved in trafficking and further marginalises trafficked women. Simultaneously, although Vietnamese women are often drawn into trafficking due to family obligations, they frequently face dishonour upon their return or are forced to hide the truth of their experience of being trafficked. This paper argues that the language of 'social evils' and the responses of the State and family undermine the ability of trafficked returnees to reintegrate. This is heightened where returnees are deemed to be transmitters of HIV infection, hence suffering human trafficking, sex-work and HIV/AIDS-related stigma. I also reflect upon whether the approach of service providers exacerbates stigma, particularly in the context of shelter rehabilitation and present several recommendations for reform, the most pressing being the need to eliminate the language of 'social evils'. [ABSTRACT FROM AUTHOR]

Central Asia has experienced a rapid increase in HIV. HIV interventions and prevention programmes are needed that adequately appreciate and account for the ways that ongoing cultural, political and economic changes in this region affect HIV risk reduction efforts. Drawing on relevant literature, this paper provides a contextual foundation to better understand the impact of context on HIV risk behaviour in the countries of Central Asia and to begin the conversation on the contextual factors of Islam and polygamy. [ABSTRACT FROM AUTHOR]

This study aims to better understand STI/HIV-related vulnerability among self-identified lesbians and bisexual young women aged 18-26 years in two neighbourhoods in Rio de Janeiro. Based on ethnographic observations and in-depth interviews, the paper analyses their life experiences and trajectories. Findings reveal that sexual identities and ties attributed to sexual interactions with women and men have an important role in influencing perceptions of vulnerability. The notion of STI and HIV risk is not well developed among women who have sex with women. It emerges largely in practices with bisexual female partners and those of the opposite sex, since in these the potential for HIV transmission (through contact with semen) is recognized. Sexually transmitted infection and HIV-related risk with male partners is seen as small by the women in the study, since such relationships are seen as 'occasional' and generally speaking occur with someone they know well. The value given to trust and the lack of alignment between sexual identities and sexual practices reinforces the need for approaches to STI and HIV prevention and care that prioritise the sexual history and practices of women and their sexual identities within specific contexts. [ABSTRACT FROM AUTHOR]

Recent research has highlighted concerns about sexually transmitted infection with hepatitis C virus (HCV) in populations of HIV-positive men who have sex with men. This paper presents results from a qualitative pilot study exploring the experience of stigma in HIV/HCV co-infected men. The preliminary findings suggest that HCV infection can be experienced as more stigmatising than HIV among gay and other men who have sex with men. This hierarchical stigmatisation complicates the disclosure of HCV infection, threatening the 'safety' of HIV serosorted unprotected sexual practice. Further research is required to explore the effect of stigma on HIV/HCV co-infected men, but these preliminary findings suggest that heath promotion initiatives are needed to counter hepatitis C stigma by raising awareness and facilitating greater empathetic ownership of hepatitis C as a gay community issue. [ABSTRACT FROM AUTHOR]

Using data collected through semi-structured interviews and focus group discussions with adult men in Zimbabwe, this paper explores the decision-making process associated with help-seeking for sexual-health concerns. Help-seeking is located in the complex and dynamic socio-cultural contexts around men's sexualities, masculinities and reproductive health. Pathways to help-seeking include identifying symptoms and the condition, seeking information and advice, and seeking and accessing treatment. Health is grounded in the cultural, spiritual and religious context of Zimbabwean men's lives. Men interpreted sexual-health concerns as due to either natural (disease, psychological stress) or supernatural (displeased ancestral and religious spirits, witchcraft) causes. These interpretations influence their choice of treatment and health service provider. Dominant gender norms of resilience and self-reliance, together with shyness and embarrassment, can delay men's treatment-seeking. The HIV epidemic has made sexual health a more prominent issue in society. However, HIV-related stigma can hinder men's help-seeking for sexual-health concerns (particularly for sexually transmitted infections). Understanding and taking account of these issues in research, health promotion and healthcare services should benefit the sexual health of both men and women. [ABSTRACT FROM AUTHOR]

African American men who have sex with men and who do not identify as gay are at high risk for HIV infection. This paper presents the results of the photovoice component, a participatory action research method, of a two-tiered qualitative study design that explored the perceptions of non-gay identified African American men who have sex with men living or working in the San Francisco Bay Area regarding the social, cultural, community, and family influences associated with their HIV risk and their general sexual health. Major themes that emerged from the photographs and discussions fell into three main categories: (1) The importance of a black identity, (2) factors inhibiting HIV prevention, and (3) factors that maintain health or promote health. Through their photographs, the men in this study explored the challenges and difficulties associated with maintaining their sexual health, in addition to describing the health promoting factors that reinforce wise choices in their everyday lives. [ABSTRACT FROM AUTHOR]

Scientific studies demonstrate high rates of HIV infection among male-to-female (MTF) transgender individuals and that stigma and discrimination place MTFs at increased risk for infection. However, there is little research examining how gender roles contribute to HIV risk. This paper reports on in-depth interviews with 20 MTFs attending a community clinic. Data reveal that stigma and discrimination create a heightened need for MTFs to feel safe and loved by a male companion and that in turn places them at a higher risk for acquiring HIV. Male-to-female transgender individuals appear to turn to men to feel loved and affirmed as women; their main HIV risk stems from their willingness to engage with sexual partners who provide a sense of love and acceptance but who also may also request unsafe sexual behaviours. A model illustrating how HIV risk is generated from stigma and discrimination is presented. [ABSTRACT FROM AUTHOR]

This paper reports on an assessment of community preparedness for HIV vaccine trials in the Democratic Republic of Congo. Formative research was conducted in the capital city of Kinshasa during the period October 2003 to March 2004 to answer questions pertinent to planning trials of a preventive HIV vaccine and to identify related issues. Twenty-seven in-depth interviews and two focus groups were held with potential trial participants and community leaders. Data was collected on the subjects of vaccines, HIV/AIDS and sexual behaviour, and an HIV vaccine. The study also sought to identify factors that motivate a person to volunteer for a vaccine trial or which are disincentives to participation, along with preparedness of the larger community for trials. Personal concerns for health and for the impact of the epidemic on families and country were common motivations for participation. The danger of an experimental vaccine and the stigma of a positive HIV antibody test as the result of vaccination are major concerns and disincentives. The health, educational, and local non-governmental sectors are identified as having important roles to play in assuring preparedness for trials, although significant challenges exist to achieving community preparedness. [ABSTRACT FROM AUTHOR]

The HIV epidemic has had major impact on men who have sex with men in China. Most current studies view male-to-male sex as a behavioural dimension or variable affecting HIV infection, paying little attention to the socio-cultural meanings of homosexuality and their impacts on men's experiences with HIV/AIDS. This oversight has impeded understanding of the health practices of this population. Based on a qualitative study of experiences of Chinese people living with HIV/AIDS, this paper explores the complex processes in which men who have sex with men struggle and negotiate with their sexuality, family obligations, and this disease. To facilitate Chinese men who have sex with men in responding effectively to HIV and AIDS, researchers and practitioners should take into account a wide range of contextual factors including desired gender roles, family obligations, homophobia, and HIV-related stigma that contribute to current constructions of 'homosexuality' in China. [ABSTRACT FROM AUTHOR]

The paper examines the context of women's risk for HIV by assessing men's and women's sexual behaviour, attitudes towards sex work, and perception of risk for HIV in the city of Chiang Mai, Thailand. The findings are based on data collected in the mid‐1990s, at the height of the epidemic. A range of significant issues were highlighted by the men and women who participated in this study. First, some men continued to have unsafe sex with sex workers. Second, fear of HIV motivated men to seek out friends and acquaintances instead of sex workers for sexual encounters because they were considered ‘safe’ from infection. Third, women in this study were largely unaware of this expansion of the sexual network beyond the sex work itself. Lastly, women's sexuality was largely unrecognized in public health responses, or by the male and female participants, leaving them at risk for HIV. Résumé Dans cet article, l'auteur explore le contexte dans lequel la femme risque d'attraper le virus du Sida dans la ville de Chiang Mai en Thaïlande. Il examine le comportement sexuel des hommes et des femmes, leur attitude vis‐à‐vis des métiers du sexe et la perception du risque d'attraper le VIH. Ses conclusions sont tirées des données recueillies au milieu des années 90, au plus fort de l'épidémie. Les hommes et les femmes qui participèrent à cette recherche soulignèrent un certain nombre de thèmes importants. Tout d'abord, certains hommes continuaient à avoir des rapports sexuels non protégés avec des professionnelles du sexe. Deuxièmement, au lieu d'avoir recours aux professionnelles du sexe, les hommes, étant donné leur crainte du Sida, étaient conduits à chercher des partenaires sexuels parmi leurs amies et connaissances car ces personnes étaient censées ne présenter aucun danger par rapport à l'éventuelle transmission du virus. Troisièmement, les femmes qui participèrent à cette recherche ignoraient en grande partie cette extension du réseau sexuel au delà du milieu professionnel du sexe proprement dit. Enfin, la sexualité des femmes était en grande partie méconnue de ceux chargés de promouvoir la politique de santé publique; les participants hommes et femmes n'en tenaient pas compte non plus, ce qui mettait les femmes en danger d'attraper le VIH. Resumen En este artículo examino en qué contexto las mujeres corren el riesgo de contraer VIH valorando la conducta sexual de hombres y mujeres, las actitudes hacia el trabajo sexual y la percepción de riesgo de HIV en la ciudad tailandesa de Chiang Mai. Los resultados se basan en datos recopilados durante mediados de los noventa cuando la epidemia estaba en su punto más álgido. Los hombres y mujeres que participaron en este estudio destacaron una serie de cuestiones importantes. En primer lugar, algunos hombres seguían teniendo sexo arriesgado con las trabajadoras sexuales. En segundo lugar, el miedo a contraer VIH motivaba a los hombres a buscar amigas y conocidas en lugar de trabajadoras sexuales para sus encuentros amorosos porque pensaban que así estaban seguros de no infectarse. En tercer lugar, las mujeres de este estudio desconocían en gran medida la expansión de la red sexual más allá del trabajo sexual. Por último, la sexualidad de las mujeres en general no era reconocida en las respuestas de salud pública o por los participantes masculinos y femeninos, con lo que corrían el riesgo de contraer VIH. [ABSTRACT FROM AUTHOR]

This paper reports on a study of the relationship of homophobia to HIV/AIDS-related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS-related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti-stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals. [ABSTRACT FROM AUTHOR]

This paper analyses on the discourses employed by a subset of gay and bisexual men who no longer practise protected sex more than twenty years into the HIV epidemic. In-depth interviews with 102 men in Toronto are used to examine the moral reasoning of those for whom the language of barebacking provides a shared set of accounts and tacit understandings for unprotected sex. Barebacking raises some of the central issues of contemporary theory around risk, responsibility, and ethics, and poses new challenges to HIV prevention policy as barebacking discourses adapt some of the major tenets of neoliberal ideology by combining notions of informed consent, contractual interaction, free market choice, and responsibility in new ways. At the same time, interviews with barebackers reveal competing and contradictory discourses that suggest new avenues of engagement for HIV prevention initiatives. [ABSTRACT FROM AUTHOR]

Studies of female sexuality in Africa tend to adopt an instrumental approach, many times problematizing sexual conduct in relation to HIV infection and/or reproduction. This study aimed to explore sexuality as a relational concept. Using interviews and participant observation, the paper shows how sexuality becomes a point of self-identification for young professional women in Nairobi between 20 and 30 years-old. These women form a group who implicitly and explicitly criticize conventional gender roles through the overt pursuit of sexual pleasure as recognition of their womanhood. This aspect of the feminine sense of self is at odds with normative notions of femininity. To avoid criticism for being ‘un-proper’, women adopt a deferential attitude towards men. The focus on upwardly mobile professional women and their experiments with new types of heterosexual relations in dating provides insight into both sexuality and gender. [ABSTRACT FROM AUTHOR]

This paper describes some of the more prohibitive aspects of HIV prevention among gay men in England. It argues that much current HIV prevention work assumes that prohibition is the most appropriate means of governing gay male sexual practice--most particularly in relation to the treatment of unprotected anal sex or bare-backing . The prohibitive approach constructs an opposition between the good gay citizen who privileges health maximisation and the evil irresponsible bare-backer who embodies the transgressive pleasure of unprotected sex. It becomes impossible to represent bare-backing outside of this cycle of prohibition and transgression without being re-inscribed within it through the sickness of low self-esteem. [ABSTRACT FROM AUTHOR]

Studies of men who have sex with men in South Asian countries including Bangladesh have tended to focus mainly on measuring male-to-male sexual risk behaviours, with less attention being given to understanding the nature and meaning of their sexual relations with women. This can result in missed opportunities for HIV/AIDS-related intervention. This paper, based on a small scale qualitative study, attempts to develop a cultural model to understand men who have sex with men's sexual relations with women within a gender and masculinity framework. Findings reveal that in Bangladesh men who have sex with men frequently surrender to societal pressures to marry, become husbands and shoulder fatherhood. This forces some women to become the silent sufferers of some of the negative consequences of hetero-normative patriarchal practice. Importantly, however, men who have sex with men consider sex with women a form of real sex within a framework of masculine sexual potency irrespective of preference, desire or eroticism. Thus, challenges exist to undertaking sexual health promotion and HIV/AIDS prevention in culturally sensitive ways. [ABSTRACT FROM AUTHOR]

In the context of HIV/AIDS, there is increasing interest in female controlled barrier methods. HIV prevention suffers from a critical 'technology gap': namely, the lack of products to enable women to reduce their own risk of sexually transmitted infection, independent of their male partners. An ideal technology should be low-cost, free of side effects, effective against both HIV and other STIs, and undetectable by male sexual partners. A first generation of barriers is already in circulation: namely, female condoms (FCs). But what can we learn from FCs that will help to increase the chance that programmes focused on other barrier methods will be successful? This paper draws on lessons from the past decade of FC programming. Interviews with 34 professional stakeholders in FC programming from the USA and South Africa highlight a number of factors that can help create public and institutional cultures, in which barrier methods can be considered feasible and can be put into use. [ABSTRACT FROM AUTHOR]

Early sexual debut and premarital sex are increasingly common features of female adolescence in Kenya--putting girls at the risk of unwanted pregnancy and infection by sexually transmitted infections and HIV/AIDS. Levels of knowledge concerning the protective value of condoms and other contraceptives are high, but unprotected sex is still common. Against this background, this paper examines the strategies used by young women to deal with these risks. Qualitative data were obtained from eight focus group discussions conducted with school attending girls aged between 15 and 19 years in Makueni District of Eastern Kenya. Findings suggest that, despite knowledge of the protective value of condoms and other contraceptives, the use of these methods by girls is hampered by inability to access them, the fear of the side effects of contraceptives, and the desire by girls to remain faithful to their religious calling. Most girls also resort to the use of traditional methods such whose potency and efficacy is unproven. These findings suggest the need to make condoms more easily accessible to girls in rural areas, and also for education in the proper use of 'natural' family planning methods. Young women may also benefit from training in how to be more assertive in sexual negotiations. [ABSTRACT FROM AUTHOR]

This paper presents findings from qualitative research carried out by the CARAM Southeast Asia Research Network in the period 1997–1999. In several countries in Asia, interviews and focus group discussions were held with migrant workers about their working conditions, access to health care, and factors affecting vulnerability to HIV/AIDS. Factors that have an impact on migrants' sexual behaviour include the country of destination and the availability of a commercial sex sector. Cultural differences with respect to sexual behaviour are also important. As social control in migrant communities is often limited, sexual relationships that are prohibited at home are often possible abroad. Besides continuing to belong to their home communities, migrants gradually adapt to their new communities abroad. In so doing, they adopt a so-called 'migrant identity' which can lead to a denial of certain (sexual) behaviours. This can make them difficult to reach by means of conventional HIV/AIDS prevention approaches. [ABSTRACT FROM AUTHOR]