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In the East Province of Cameroon, respectable womanhood has long been intrinsically related to ethics of production and reproduction: women attain social standing through productive work in the fields and through the reproduction of children - preferably within a marital setting. Yet, in the face of current alternative ‘horizons of honour’ such as schooling, employment or relationships with rich urban men, women's intentions with regard to marriage and motherhood acquire different meanings. On their pathways to urban forms of honour, formal engagements and childbearing are often postponed, while premarital sexual encounters proliferate. This paper explores the meanings of pregnancy within the context of these fragile relationships and women's urban aspirations; fertility will be shown to be a ‘bet’ that may either disrupt or stabilize urban affairs and ambitions. As such, pregnancies can be strategically anticipated and deliberately disclosed or unexpectedly encountered and secretly disrupted. This paper sheds light on women's strategies of concealment and disclosure of pregnancies and shows that these practices are often inspired by a notion of the ‘right timing’ of particular reproductive conjunctures - a notion that is of increasing relevance in current frames of female honour in Cameroon.

In this paper, I reflect on the notion of 'African men' as it is employed in global health scholarship and disentangle the way the idea is used as a generative concept. I explore how this notion circulates and gets modified, adapted and reproduced by scholars, on the one hand, and by various groups of men in Africa, on the other. I argue that the use of the idea of African men as an a priori category in scholarly imagination and practice presents us with stereotypes that impede much research. I then briefly connect with what has been analysed as the hegemonic discourse on Africa as the paradigm of difference, and the history of local modes of self-presentation as Africans. In Kenya, among both men and women, the use of the phrase African men as a natural category of sexual agents has been used to explain or justify men's multiple sexual relations. Yet if we look more closely at men's experiences, it becomes clear how men are caught up in conflicting discourses of masculinity. I conclude that we need to analyse gender as a performative quality that is both constructed and meaningful.

A distinguishing feature of the 1994 genocide against the Tutsi and the preceding 1990-1994 war in Rwanda was the social intimacy of the crimes committed. The legacy of this kind of violence includes distrust in social relations within communities and families, an increase of violence in everyday social interaction, transgressive sexual engagements, and a range of psychological problems. Many people feel nostalgia for their past social life, but are unable to change their current situation. In 2005, a community-based sociotherapy programme was introduced into this context of mental and social distress. The goal was to help people regain feelings of dignity and safety and to reduce distress. This paper is based on qualitative research, in particular, case studies. It explores how sociotherapy, as a specific form of peer group counselling, may facilitate the healing of suffering related to issues of sexuality, violence within the family and the breakdown of social connections on a community level.Una característica que distingue al genocidio en 1994 contra los tutsi de la anterior guerra entre 1990-1994 en Ruanda es la intimidad social de los crímenes cometidos. El legado de este tipo de violencia es la desconfianza en las relaciones sociales dentro de las comunidades y las familias, un aumento de la violencia en la interacción social diaria, la participación en actividades sexuales transgresoras y toda una serie de problemas psicológicos. Aunque muchas personas sienten nostalgia por su vida social anterior, son incapaces de cambiar su situación actual. En 2005 se introdujo un programa socioterapéutico de la comunidad para abordar las dificultades mentales y sociales. Su objetivo fue ayudar a las personas a recobrar sus sentimientos de dignidad y seguridad y reducir la angustia. Este artículo se basa en un estudio cualitativo, en particular con estudios de casos. Analizamos el modo en que la socioterapia, como una forma específica de asesoramiento en grupo, puede facilitar la curación del sufrimiento relacionado con cuestiones de sexualidad, violencia dentro de la familia y el deterioro de las conexiones sociales en la comunidad.Une particularité du génocide de 1994 contre les Tutsis au Rwanda et de la guerre qui l'avait précédé entre 1990 et 1994 a été l'intimité sociale des crimes commis. Les séquelles de ce type de violences comprennent la méfiance vis-à-vis des rapports sociaux au sein des communautés et des familles, une augmentation de la violence dans l'interaction sociale de tous les jours, des engagements sexuels transgressifs et un ensemble de problèmes psychologiques. Nombreux sont les gens qui sont nostalgiques de leur vie sociale passée mais qui sont incapables de changer leur situation actuelle. En 2005, un programme communautaire de sociothérapie a été introduit dans ce contexte de désarroi mental et social. Il avait pour but d'aider les personnes à retrouver un sentiment de dignité et de sécurité et de diminuer leur détresse. Cet article s'appuie sur une recherche qualitative - en particulier des cas d'études. Il examine comment la sociothérapie, en tant que méthode spécifique de counselling dans un groupe de pairs, peut faciliter la guérison des souffrances relatives aux questions de la sexualité, de la violence au sein des familles et de la dégradation des connexions sociales au plan communautaire.

HIV-related counselling practices have evolved since emerging in Zambia in 1987. Whereas, initially, the goal of HIV counselling was to provide psychological support to the dying and their families, as knowledge about HIV grew, counselling objectives expanded to include behavioural change, encouraging safer sexual practices, encouraging disclosure, convincing people to test, treatment adherence and shaping HIV-positive people's sexual and reproductive choices. This paper highlights a number of key shifts in counselling practices in Zambia over the last 25 years, demonstrating the relationship between those shifts, changes in medical technology, (inter)national political will and the epidemiological maturity of the disease.Los métodos de asesoramiento sobre el virus del sida han cambiado desde que se introdujeron en Zambia en 1987. Si bien al principio lo más importante en el asesoramiento sobre el sida era ofrecer apoyo psicológico a los moribundos y sus familias, según se ha ido conociendo mejor esta enfermedad, en el asesoramiento se incluyen ahora cuestiones tales como el cambio de comportamiento, estimular prácticas sexuales más seguras, recomendar la revelación de la enfermedad, convencer a las personas que se hagan la prueba del sida, seguir los tratamientos e influir en las decisiones sexuales y reproductivas de las personas seropositivas. En este artículo destacamos una serie de modificaciones clave en los métodos de asesoramiento en Zambia en los últimos 25 años, demostrando la relación entre estas variaciones, las innovaciones en la tecnología médica, la voluntad política (inter)nacional y la madurez epidemiológica de la enfermedad.Les pratiques du counselling en matière du VIH ont évolué depuis leur apparition en Zambie, en 1987. Si elles avait pour objectif initial d'offrir un soutien psychologique aux mourants et à leur famille, à mesure que les connaissances sur le VIH se sont améliorées, cet objectif s'est élargi pour inclure une approche des changements de comportements; l'encouragement à n'avoir de rapports sexuels que protégés; la promotion du dépistage du VIH auprès du public; l'observance des traitements; et la détermination des choix sexuels et reproductifs pour les personnes séropositives au VIH. Cet article met l'accent sur un nombre de changements clé dans les pratiques de counselling en Zambie ces dernières 25 années, démontrant ainsi le rapport entre ces changements, ceux de la technologie médicale, la volonté politique (inter)nationale et la « maturité épidémiologique » de la maladie.

Psychosocial support groups offer an important space for people living with HIV to pursue greater wellbeing as they learn how to accept and live with their HIV status. They are critical for the cultivation of responsible and adherent patients. Occasionally, support groups provide spaces where members are encouraged to discuss sexual struggles related to being HIV-positive, including sexual performance issues, sexual relationships, fertility desires and communicating with sexual partners. This paper examines an HIV-positive men's sex therapy support group at Kenyatta National Hospital in Nairobi, Kenya, where HIV-positive men access information about HIV and treatment, while getting tips on restoring sexual functioning and improving sexual gratification from medical experts, peer counsellors and fellow group members. In the group setting, members worked to rediscover and reconstruct masculinity under the guidance of a range of experts, while focusing on regaining or improving sexual prowess.Los grupos de apoyo psicosocial ocupan un espacio importante para las personas con VIH ofreciéndoles soluciones para mejorar su bienestar cuando aprenden a aceptar y vivir con su estado seropositivo. Desempeñan un papel fundamental para conseguir que los pacientes sean responsables y sigan la medicación. En ocasiones, los grupos de apoyo ofrecen espacios donde se anima a los miembros a hablar de sus problemas sexuales relacionados con su estado seropositivo, incluyendo temas como el desempeño sexual, las relaciones sexuales, los deseos de fertilidad y la comunicación con sus parejas sexuales. En este artículo analizamos un grupo de apoyo para la terapia sexual de hombres seropositivos en el Hospital Nacional de Kenyatta, en Nairobi, Kenia, donde hombres afectados con el VIH acceden a información sobre el virus del sida y el tratamiento, a la vez que expertos médicos, consejeros en su misma situación y compañeros del grupo ofrecen consejos sobre cómo recuperar el funcionamiento sexual y mejorar la satisfacción sexual. En el entorno del grupo, los miembros colaboraron para redescubrir y reconstruir la masculinidad con la supervisión de una serie de expertos, prestando atención a cómo recuperar o mejorar la capacidad sexual.Les groupes de soutien psychosocial sont des espaces importants pour les personnes vivant avec le VIH. Ils leur permettent d’envisager l’amélioration de leur bien-être en apprenant comment accepter et vivre avec leur séropositivité. Ils sont essentiels à l’éducation des patients responsables et adhérents à leurs traitements. Il arrive que les groupes de soutien offrent un espace où leurs participants sont encouragés à parler de leurs troubles sexuels déterminés par leur séropositivité, parmi lesquels ceux qui affectent leur performance sexuelle, leurs relations sexuelles, leur désir d’enfants et la communication avec leurs partenaires sexuel(le)s. Cet article rapporte l’observation d’un groupe de soutien axé sur la thérapie sexuelle et destiné à des hommes vivant avec le VIH à l’Hôpital national Kenyatta de Nairobi, Kenya, dans lequel les participants ont accès à de l’information sur le VIH et sur les traitements, et reçoivent des conseils sur la manière de retrouver leur fonction sexuelle et d’obtenir de meilleures gratifications sexuelles. Ces conseils sont donnés par des experts médicaux, des pairs-conseillers et d’autres participants au groupe. Dans ce contexte, les hommes ont participé au groupe pour redécouvrir et reconstruire leur virilité en suivant les recommandations de différents experts, tout en se concentrant sur la manière de retrouver ou d’améliorer leurs prouesses sexuelles.

Although pastoralists are a significant proportion of the rural population in many African countries, they are often underserved with regard to health-related interventions. This paper presents data on an effort to provide information about HIV prevention and treatment to Afar people living in remote, northeastern Ethiopia. Using an evidence-based approach, we worked together with the National Network of Positive Women Ethiopians to build relations with Afar communities to design and test an intervention to improve HIV awareness. In this study we observed how multi-directional, local level perceptions - of Afar regarding HIV and existing health-related interventions, of staff from organisations regarding Afar and of the researchers conducting this study regarding Afar - shape the ways in which health-related interventions are offered to Afar and how these are understood by them. While the Afar people express a desire for culturally appropriate HIV-related interventions, few such initiatives have reached them to date. Organisations working in the area often believed that Afar people did not want to accept HIV and were therefore not responsive to their interventions. We argue that the specific history of the Afar people and how this affects their understanding of HIV needs to be better understood and integrated into HIV interventions.

This introduction to this special issue of Culture, Health & Sexuality aims to intervene critically in debates in public health about sexual rights and ways of de-stigmatising HIV/AIDS, in which silence and secrets are seen to undermine well-being and perpetuate stigma. It presents key insights from collaborative studies on HIV/AIDS and youth sexual health, arguing that advocates of disclosure and sexual rights need to think more contextually and tactically in promoting truth-telling. The authors aim to enhance current thinking on secrecy, which examines it primarily as a social practice, by emphasising the centrality of the body and the experience of embodiment in the making and unmaking of secrets. To understand secrecy as embodied practice requires understanding how it simultaneously involves the body as subject - as the basis from which we experience the world - and the body as object - that can be actively manipulated, silenced and ‘done’. The authors show how tensions emerge when bodies reveal reproductive mishaps and describe how the dissonances are resolved through a variety of silencing practices. The paper ends by discussing the implications of these insights for sexual-health programmes.

Intravaginal insertion is often associated with the concept of ‘dry’ sex. All HIV-prevention microbicides tested to date have been vaginally applied lubricant-based gels. In this paper, we examine whether the use of intravaginal insertions could be in conflict with the introduction of vaginal microbicide gels. The Africa Centre site was part of the Microbicides Development Programme evaluating PRO2000/5 microbicide gel. We conducted in-depth-interviews and focus-group discussions with women enrolled in the trial as well as women and men from the community. The analysis focused on people's knowledge of intravaginal insertion in the community and trial participants’ experience of using trial gels. Intravaginal use of a variety of products was widely acknowledged. We found that the experience of using trial gels - which made sex ‘hot’, ‘tight’ and ‘dry’ - matched the desired outcomes of intravaginal insertion. We found that vaginal ‘dryness’ described the removal of excessive amounts of unusual discharge, rather than the removal of normal vaginal secretions and that intravaginal insertion is not exclusively associated with a desire for ‘dry’ sex. Study findings provide evidence that vaginal microbicide gels may be more acceptable in communities where intravaginal insertion is practiced than was previously thought.

HIV transmission in Vietnam is strongly linked to drug injection, but there is the potential for an epidemic driven by sexual behaviour. HIV‐education programmes to date focus largely on personal responsibility and fail to address adequately other aspects of HIV‐related risks in social contexts. Based on ethnographic fieldwork conducted in 2002, this paper examines the association between HIV‐related risks (unsafe drug use and unsafe sex) and gender relations among injecting drug users. Three patterns of relationships are analysed: between injecting drug users and their injecting partners; between injecting drug users and their smoking partners; and between injecting drug users and their non‐using partners. Data shows that intimate relations play an important role in managing HIV‐related risks among injecting drug users. HIV prevention must pay due attention to the specific contexts of injecting drug users' lives. Some implications of these findings are discussed and relevant recommendations are proposed.

Intersex people and those with variations of sex characteristics face significant health and social issues. This paper analyses the complexities of adult healthcare for this diverse population, including the root causes of deficiencies in care provision. Many minors with variations of sex characteristics are subjected to irreversible, non-consensual medical interventions, which can have negative effects on their health and wellbeing as adults. This ‘emergency’ approach to intersex paediatric healthcare has been challenged since the 1990s, but there is still a lack of understanding about how the paradigm affects adult care. This paper aims to raise awareness of the health challenges faced by adults with variations of sex characteristics. It identifies themes related to the challenges associated with accessing appropriate adult care, including the repercussions of childhood treatment, the lack of transitional services and psychological support, the limited general medical knowledge about variations of sex characteristics, and the reluctance to access services due to fear of stigma or past medical trauma. The paper indicates the need for more attention to intersex people’s health needs as adults, moving away from attempts to ‘fix’ them as minors towards approaches which consider and provide for their diverse healthcare needs in a broader temporal context.

Until 2018, abortion in the Republic of Ireland was banned in almost all circumstances under one of the most restrictive legal regimes in Europe. The main solution for Irish women and pregnant people seeking abortion services had been to pursue care abroad, typically in clinics in England. In this paper we focus on the hardships of waiting for abortion care experienced by Irish residents leading up to their travel for appointments in England in 2017 and 2018. Based on in-depth interviews with 53 Irish women collected at three British Pregnancy Advisory Services (BPAS) clinics in England we analyse women's experiences as they navigated an 'environment of secrecy' in Ireland. This included making specific secrecy efforts when navigating travel arrangements, conversations, movement, health records, and the travel itself. Despite the expansion of abortion access in Ireland in 2018, the need to travel abroad continues for many women. We argue that the continued need for secrecy when women have to travel abroad for care perpetuates this important phenomenon's invisibility. This argument also applies to other countries where abortion access is restricted, and women are forced to travel for care. We also caution against the presumption that all Irish residents are able to travel internationally for healthcare.