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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]

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]

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]

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]

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 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]

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 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]

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]

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. [ABSTRACT FROM PUBLISHER]

In South Africa, as elsewhere in the world, responses to HIV and AIDS have been accompanied by calls to ‘break the silence’ and to openly talk about aspects of intimate life, otherwise considered private. These calls have been followed by the production of new bodies of knowledge about sex, and projections of transparent sexualities. In this context, the concept of counselling has taken on particular significance in terms of re-conceptualising diverse institutional sites as places of education, advice giving and moral inculcation with a view toward behavioural change. In this paper, I trace a series of processes and practices of negotiation whereby in a big church in the city of Cape Town sexuality has been rendered an object of knowledgeability and inquiry. The same processes work as conditions of possibility for the emergence of counselling practices by facilitating the circulation of concepts such as ‘responsible relationships’, ‘responsible choices’ and so on through the sites of faith-based health activism. Adopted from public health discourse, but inflected by religious idioms, these concepts allowed for the dissemination of new vocabularies of sex in which counselling is construed as a key mechanism. [ABSTRACT FROM PUBLISHER]