The explicit inclusion of men’s issues as gender issues in the development agenda, or ‘men-streaming’ development,⁽²⁾ has represented a major challenge for experts working in Gender and Development (GAD). Indeed, most GAD professionals have been reluctant to introduce men into their projects because of the possibility of losing the scarce funds secured for women,⁽³⁾ or losing policy focus on women’s interests and the persistent gender gaps.⁽⁴⁾ However, it seems unavoidable that, in order to accomplish its key mission of addressing gender as relational and moving beyond Women in/and Development approaches, GAD will need to focus on men as gendered beings.⁽⁵⁾

To illustrate the need to focus on men as gendered beings, this CAI paper appraises a major social policy challenge, the HIV/AIDS epidemic in Sub-Saharan Africa. Released in 2000, the Joint United Nations Programme on HIV/AIDS (UNAIDS) policy paper Men make a difference ⁽⁶⁾ epitomises the attempts to expand from women-centred to men-inclusive policy designs, providing an invaluable case study. This paper seeks to move beyond the debate of whether or not men should be included in development interventions. Instead, it explores why feminist scholars and activists should be attentive to the ways in which men are included when addressed as gendered beings in their own right.

HIV/AIDS policies: From women’s empowerment to men-streaming responses

The HIV/AIDS intervention currently focuses on prevention in order to curb the number of new infections. This is notably meaningful in the case of Sub-Saharan Africa, where 1.8 million of the world’s 2.5 million new infections in 2011 occurred.⁽⁷⁾ Although the role of biomedical and anti-retroviral treatment (ARV) strategies has been acknowledged, particular emphasis has been put on behavioural change to reduce the spread of infection. As UNAIDS reports, the total expenditure on behaviour change programmes has risen from US$ 148 million (2008) to US$ 190 million (2010).⁽⁸⁾ In the case of Sub-Saharan Africa, behaviours such as abstinence, the delay of first sexual intercourse, faithfulness to a single sexual partner, and use of condoms have been promoted as part of the international agencies’ broader discourse on HIV/AIDS.⁽⁹⁾

A key particularity of the HIV/AIDS epidemic in Sub-Saharan Africa is the disproportionate impact the disease has had on women. Women in the region accounted for 58% of all people living with HIV in 2011 (UNAIDS, 2012b), whereas in other regions of the developing world, women accounted for 34% (Asia-Pacific), 36% (Northern and Latin America), and 41% (Middle-East and North Africa) of adults living with HIV in 2011. This is due to both physiological and social drivers; women all over the world face barriers in accessing HIV-related prevention and treatment services due to reasons such as restricted mobility, lack of control over financial resources, and reproductive workload.⁽¹⁰⁾

As a consequence, initial gendered approaches to HIV/AIDS focused on empowering women in decision-making instances to negotiate safer sexual encounters and make use of the female condom.⁽¹¹⁾ Unfortunately, those women-only approaches to prevention proved to be relatively ineffective in tackling the spread of HIV/AIDS in contexts where men refuse condom use or have multiple sexual partners.⁽¹²⁾ Similarly, empowering women to employ female condoms ⁽¹³⁾ does not address broader issues of stigmatisation (i.e., the risk of being labelled ‘promiscuous’) that may inhibit its use.⁽¹⁴⁾

Faithfulness, association with multiple sexual partners, and avoidance of condom use have been perceived as behaviours that are heavily influenced by culturally prescribed expectations on manhood. In this sense, the focus on normative or hegemonic masculinities ⁽¹⁵⁾ has matched previous insistence on prevention through behaviour modification. Gender inequalities and men’s behaviour have been identified as key vectors of the infection.⁽¹⁶⁾ Consequently, both academic experts and international bureaucrats have become increasingly aware of the need to bring men on board. As a response, UNAIDS and other international stakeholders have made great efforts to ‘men-stream’ their HIV/AIDS policies. Recently released policy papers and guidelines, such as the World Health Organisation’s (WHO) Engaging Men and Boys in Changing Gender-Based Inequity in Health ⁽¹⁷⁾ and Policy Approaches to Engaging Men and Boys,⁽¹⁸⁾ or the World Bank’s The Other Half of Gender,⁽¹⁹⁾ exemplify the current shift in policy-planning.

This approach was consolidated by the release of UNAIDS’ landmark Men Make a Difference ⁽²⁰⁾ (2000) policy paper. The paper namely contends that cultural beliefs and expectations not only place women at special risk of infection, but men as well. Therefore, certain so-called ‘masculine’ attitudes, as pinpointed in the following sections, are examined to illuminate men’s vulnerabilities to HIV and create political momentum in favour of men’s inclusion in the fight against HIV/AIDS.

Focusing on hegemonic masculinities: The risk of casting blame on men

Feminist literature has traditionally understood normative or hegemonic masculinities as the gender norms that create social pressure for men to enact risky behaviours, be self-reliant, and prove their manhood through sexuality. As outlined before, the UNAIDS (2000) policy paper underscores the role that young men have as transmitters of the disease. Normative masculinities, associated with risk and irresponsibility, are stereotyped as key drivers of the disease:

    Men are less likely to seek health care than women, and are much more likely to engage in behaviours – such as drinking, using illegal substances or driving recklessly – that put their health at risk. Men are also less likely to pay attention to their sexual health and safety, and are more likely to inject drugs, risking infection from needles and syringes contaminated with HIV.⁽²¹⁾

It is on the basis of this particular depiction and generalisation of male behaviour that UNAIDS justifies men’s inclusion in policy-planning. Although it tries to emphasise the impact of cultural and social conditioning on men, as well as to pinpoint the historical roots of normative notions of manhood, UNAIDS cannot avoid the residual essentialism that is inherent to the notion of hegemonic masculinity itself. The agency outright warns:

    We need to strike a careful balance between recognizing how some men’s behaviour contributes to the epidemic and pointing the finger at all men and their actions. Blaming individuals or groups has never been a successful way of encouraging greater involvement in HIV prevention and care… Ideas about ‘manhood’ have evolved over time. They differ from culture to culture and within cultures.⁽²²⁾

But they immediately follow that statement with a generalisation: “Studies from around the world, however, show that men on average have more sex partners than women.”⁽²³⁾ Hence, they fail to identify the particular social and cultural dynamics behind such a pattern, and therefore to provide tailored, context-specific explanations to hegemonic masculinity. As a consequence, the agency’s efforts to encourage positive behaviours from men remain half-hearted.

In this sense, the initial discourse of multiple and fluid masculinities is displaced by one that reinstates the terms of a singular normative masculinity.⁽²⁴⁾ Women are re-inscribed in the man/predator – woman/victim binary, with the policy paper declaring that “women find themselves at special risk of HIV because of their lack of power.”⁽²⁵⁾ Although many women and girls may still have little capacity to negotiate sex or condom use, this image of hegemonic masculinity and feminine disempowerment does not encompass the entirety of HIV transmission.

Beyond hegemony: What has been left out?

The focus on hegemonic masculinity, as exemplified by UNAIDS’ policy paper, renders invisible or marginal those who do not fit the stereotype of man/predator – woman/victim. This is the case, for instance, with the young men involved in transactional sex with older, married women in Sub-Saharan Africa, the so-called ‘sugar mummies’.⁽²⁶⁾ Despite these men being equally exposed to the disease, no specific policy analysis is conducted beyond labelling them as marginal ‘special groups’. Neither are their specific vulnerabilities and needs examined. Equally, the vulnerabilities of those sugar mummies, who defy their society’s norms by enacting such ‘masculine’ behaviours, remain unexplored.

Similarly, traces of the framework of hegemonic masculinity are still visible when policy makers explicitly target men who have sex with other men. In the case of UNAIDS’ paper, reference is still made to irresponsible attitudes (such as inconsistency in condom use and health-seeking behaviour) when addressing their vulnerabilities, rather than focusing on their social and/or economic deprivation, or the specific power dynamics intimately linked to the marginalisation they may face in intersection with their sexuality.⁽²⁷⁾

In addition, although it has been highlighted by other UN agencies, older people’s vulnerability to HIV/AIDS is overlooked in the UNAIDS paper, since policy focus tends to be on youth and early sexual encounters. In this sense, it should be underscored that the elderly can be at risk of infection due to negative socio-cultural practices, and that furthermore, their role as caregivers is often dismissed. As a result of the disproportionate infection levels among young parents, increasing numbers of grandparents have assumed the effective headship of the household or have become responsible for their orphaned grandchildren.⁽²⁸⁾ The crisis triggered by HIV/AIDS has not only upended existing family structures, but also put older people under considerable pressure, when in many cases they should be receiving care themselves. Inter-generational solidarity has emerged as a response for needed support and care-giving, but at a high human cost.

The focus on sexual transmission precludes an in-depth analysis of the crisis of care associated with the epidemic.⁽²⁹⁾ Scholars have identified severe crises of care in those parts of the world where care provision is becoming increasingly difficult. At the root of these crises, scholars such as E. Esplen have identified three key factors: first of all, the decreasing availability and willingness of women and girls to undertake unpaid care work, due to educational achievement and professional aspirations. Secondly and thirdly, while the available female domestic labour is decreasing, the reluctance of most men to take up a larger share of unpaid care work, coupled with the lack of public support to provide accessible welfare services, has exacerbated this phenomenon.⁽³⁰⁾

The fact that the care crisis in the UNAIDS policy paper is left unproblematic is not banal. The public spending cuts on the health care sector and the current care crisis have become absorbed through unpaid, feminised labour. Returning to the issue of gender normativity, cultural definitions of masculinity are outlined in opposition to those of femininity, which include ‘womanly behaviours’ such as being in need of protection or as confined to the realm of the domestic and private. Similarly, feminine normative images frequently rely on the depiction of woman as wives and/or mothers.⁽³¹⁾ This has consequently led to the gendered construction of the binary of men/production – women/reproduction, where reproductive tasks are depicted as feminine and commonly devalued for men, since they are understood as inherently women’s roles.⁽³²⁾ While UNAIDS does encourage fathers to get involved in the care of their children,⁽³³⁾ the care of the sick is not mentioned, and therefore, it is rendered invisible and re-inscribed as a feminine task. In both cases, care-giving – both of children and the sick – is re-privatised into the household, rather than addressed by the public sector.

These constructed images could be subverted by exemplifying cases of alternative masculinities, such as those reported by E. Esplen about a young South African man who had to care for his sick sister after his mother died, thereby becoming a role-model among his peers.⁽³⁴⁾ In this sense, existing examples of men who perform care-giving activities would challenge the association of masculinity with irresponsibility and problematise the men/production – women/reproduction binary. It has been reported how, even though they were initially perceived as deviant and unmanly by the wider community, male care-givers in South Africa have contributed to raising awareness on non-normative masculinities.⁽³⁵⁾

Towards human rights-based responses

The change of normative masculinities is not framed in the UNAIDS policy paper through a language of human rights or gender equality. Rather, it is framed as a tool to achieve a reduction of new HIV/AIDS infections, complemented by appeals to individual gains, rather than broad community benefits. For instance, section headings such as “Men’s behaviours puts them at risk of HIV”⁽³⁶⁾ and campaigns that seek to make men realise that “uncontrolled sexuality puts them at risk”⁽³⁷⁾ emphasise the hazards of normative masculinities for the individual’s health, rather than underscoring its broad dangers at the collective level (i.e., for public health and gender equality). While this could trigger positive short-term changes, these may not be sustainable unless the whole community is invited to reflect upon the broader gender relations they perpetuate on a daily basis.

Hence, one should be wary of this depiction of male displays as violent and irresponsible, and instead think about alternative discourses beyond this policy language. In this sense, the emphasis on male sexuality as guided by peer pressure – which understands sexual acts as displays of manhood, rather than acts of intimacy ⁽³⁸⁾ – precludes a more positive, rights-based approach to sexuality in conjunction with the disease. Initiatives such as the Pleasure Project (2005) offer an alternative programme that encourages men’s and women’s empowerment at all ages, avoiding the stigmatisation of men while seeking to change perspectives on masculinity. While understanding pleasure as the main driver of sex, safer and healthier sex is promoted through the eroticisation of male and female condoms, and the design of erotica for HIV-positive people.⁽³⁹⁾ In brief, a healthier language of alliances and cooperation is created between the infected population and the policy-makers, while a focus on companionship and intimacy is prioritised over that of aggression and violence.

Concluding remarks

Policy-makers have relied on a depiction of men as embodiments of normative masculinity, which in turn has reinforced the hegemonic behavioural-modification discourse. Rather than exploring whether or not men should be included in development policy-planning, this CAI article has shown that future analyses should explore what particular images, exclusions, and implications derive from policies that address men as gendered beings in their own right.

It should be underscored that the current emphasis on prevention through male behavioural modification, rather than universalisation of ARV, is resonant with the broader policy paradigm of the New Poverty Agenda. The insistence on boosting beneficiaries’ capabilities and resilience to change their own behaviours can be associated with the New Poverty Agenda’s focus on participation, self-help, and empowerment of the beneficiaries.⁽⁴⁰⁾ Furthermore, in the aftermath of the structural adjustment programmes implemented in the developing world, the pressures to reduce public expenditure levels and the extension of user fees on health services explain that preventive, rather than healing, responses have been given priority.⁽⁴¹⁾

Human rights-based initiatives such as the Pleasure Project or the rendering visible of alternative masculinities can open up new possibilities for policy-making to avoid the unintended consequences of previous approaches (i.e., the reinforcement of the feminisation of labour and the care crisis), as well as to guarantee long-term sustainability of the attained results.

Written by Cristina Rovira Izquierdo ⁽¹⁾

NOTES:

(1) Cristina Rovira Izquierdo is a CAI Research Associate and political scientist and ‘La Caixa’ scholarship holder expert on international development and social policy initiatives, with a focus on gender issues. Contact Cristina through Consultancy Africa Intelligence's Rights in Focus unit ( rights.focus@consultancyafrica.com). Edited by Kate Morgan.
(2) Chant, S. and Gutmann, M.C., 2002. ‘Men-streaming’ gender? Questions for gender and development policy in the twenty-first century. Progress in Development Studies, 2(4), pp. 269-282; Correia, M.C. and Bannon, I., 2006. “Gender and its discontents. Moving to men-streaming development”, in Banon, I. and Correia, M.C. (eds.). The other half of gender. Men’s issues in development. The World Bank: Washington DC.
(3) Mannell, J., 2012. “It’s just been such a horrible experience”. Perceptions of gender mainstreaming by practitioners in South African organisations. Gender & Development, 20(3), pp. 423-434.
(4) In this sense, it has been contended that gender-neutral development projects have historically benefited men, due to the so-called ‘male bias’ in the development process. Elson, D., 1995. “Male bias in the development process: An overview”, in Elson, D. (ed.). Male bias in the development process. Manchester University Press: Manchester; White, S.C., 2000. Did the earth move? The hazards of bringing men and masculinities into gender and development. IDS Bulletin, 31(2), pp. 33-40.
(5) Chant, S. and Gutmann, M.C., 2002. ’Men-streaming’ gender? Questions for gender and development policy in the twenty-first century. Progress in Development Studies, 2(4), pp. 269-282; Esplen, E., ‘Engaging men in gender equality: Positive strategies and approaches. Overview and annotated bibliography,’ BRIDGE, 2006, http://www.bridge.ids.ac.uk.
(6) ‘Men make a difference. Men and AIDS – a gendered approach. 2000 World AIDS Campaign’, UNAIDS Secretariat, March 2000, http://data.unaids.org.
(7) ‘Global report: UNAIDS report on the global AIDS epidemic 2012’, UNAIDS Secretariat, 2012, http://www.unaids.org.
(8) Ibid.
(9) ‘Global report: UNAIDS report on the global AIDS epidemic 2012’, UNAIDS Secretariat, 2012, http://www.unaids.org; ‘Online Q&A factsheet on HIV/AIDS’, World Health Organisation, http://www.who.int.
(10) UNAIDS Website, http://www.unaids.org.
(11) Bujra, J., 2000. Targeting men for a change: AIDS discourse and activism in Africa. Agenda Feminist Media, 44, pp. 6-23; ‘Gender and HIV/AIDS’ World Health Organisation, Gender and Health Report, November 2003, http://whqlibdoc.who.int.
(12) Bujra, J., 2000. Targeting men for a change: AIDS discourse and activism in Africa. Agenda Feminist Media, 44, pp. 6-23; Esplen, E., ‘Engaging men in gender equality: Positive strategies and approaches. Overview and annotated bibliography,’ BRIDGE, 2006, http://www.bridge.ids.ac.uk; ‘Global report: UNAIDS report on the global AIDS epidemic 2012’, UNAIDS Secretariat, 2012, http://www.unaids.org.
(13) According to the UNFPA definition, the female condom is a loose-fitting polyurethane sheath that is 17 centimetres long, with a flexible ring at each end. Given the fact that it is the only available method that women and girls can apply to their bodies to protect against both unwanted pregnancies and sexually transmitted infections, it has become an important supplement to the male condom. UNFPA – Preventing HIV/AIDS website, http://www.unfpa.org.
(14) ‘Gender and HIV/AIDS’ World Health Organisation, Gender and Health Report, November 2003, http://whqlibdoc.who.int.
(15) ‘Gender and HIV/AIDS’ World Health Organisation, Gender and Health Report, November 2003, http://whqlibdoc.who.int; Correia, M.C. and Bannon, I., 2006. “Gender and its discontents. Moving to men-streaming development”, in Banon, I. and Correia, M.C. (eds.). The other half of gender. Men’s issues in development. The World Bank: Washington DC; Esplen, E., ‘Engaging men in gender equality: Positive strategies and approaches. Overview and annotated bibliography,’ BRIDGE, 2006, http://www.bridge.ids.ac.uk.
(16) Jacobsen, J.P., 2006. “Men’s issues in development”, in Banon, I. and Correia, M.C. (eds.). The other half of gender. Men’s issues in development. The World Bank: Washington DC; ‘Global Report: UNAIDS Report on the global AIDS epidemic 2012’, UNAIDS Secretariat, 2012, http://www.unaids.org.
(17) Barker, G., Ricardo, C. and Nascimento, M., ‘Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions’, World Health Organisation and Promundo, 2007, http://www.who.int.
(18) ‘Policy approaches to engaging men and boys in achieving gender equality and health equity’, World Health Organisation, July 2010, http://whqlibdoc.who.int.
(19) Bannon, I. and Correia, M.C. (eds.), ‘The other half of gender’, The World Bank, 2006, https://openknowledge.worldbank.org.
(20) ‘Men make a difference. Men and AIDS – a gendered approach. 2000 World AIDS Campaign’, UNAIDS Secretariat, March 2000, http://data.unaids.org.
(21) Ibid.
(22) Ibid.
(23) Ibid.
(24) Bujra, J., 2000. Targeting men for a change: AIDS discourse and activism in Africa. Agenda Feminist Media, 44, pp. 6-23.
(25) ‘Men make a difference. Men and AIDS – a gendered approach. 2000 World AIDS Campaign’, UNAIDS Secretariat, March 2000, http://data.unaids.org.
(26) Barker, G. and Ricardo, C., 2006. “Young men and the construction of masculinity in Sub-Saharan Africa. Implications for HIV/AIDS, conflict and violence”, in Banon, I. and Correia, M.C. (eds.). The other half of gender. Men’s issues in development. The World Bank: Washington, D.C.
(27) ‘Men make a difference. Men and AIDS – a gendered approach. 2000 World AIDS Campaign’, UNAIDS Secretariat, March 2000, http://data.unaids.org.
(28) ‘Population ageing and development. Operational challenges in developing countries’, UNFPA, Population and Development Strategies Series No. 5, October 2002, http://www.globalaging.org.
(29) Greene, M.E., 2000. Changing women and avoiding men. Gender stereotypes and reproductive health programmes, IDS Bulletin, 31(2), pp. 49-59; ‘Population ageing and development. Operational challenges in developing countries’, UNFPA, Population and Development Strategies Series No. 5, October 2002, http://www.globalaging.org; Esplen, E., ‘Gender and care. Overview report’, University of Sussex – Institute of Development Studies, BRIDGE Cutting Edge Pack series, February 2009, http://www.bridge.ids.ac.uk.
(30) Esplen, E., ‘Gender and care. Overview report’, University of Sussex – Institute of Development Studies, BRIDGE Cutting Edge Pack series, February 2009, http://www.bridge.ids.ac.uk.
(31) Connell, R. W. and Messerschmidt, J.W., 2005. Hegemonic masculinity: Rethinking the concept. Gender & Society, 19(6), pp. 829-859.
(32) Connell, R.W., 2000. The Men and the boys. University of California Press: Berkeley.
(33) As stated: “A number of initiatives have been successful in getting fathers and future fathers more involved in caring for their children.” Nevertheless, it has to be emphasised that the focus is on preventing mother-to-child transmission and the orphaning of the children, rather than achieving intra-household gender equality. ‘Men make a difference. Men and AIDS – a gendered approach. 2000 World AIDS Campaign’, UNAIDS Secretariat, March 2000, http://data.unaids.org.
(34) Bujra, J., 2000. Targeting men for a change: AIDS discourse and activism in Africa. Agenda Feminist Media, 44, pp. 6-23.
(35) Esplen, E., ‘Gender and care. Overview report’, University of Sussex – Institute of Development Studies, BRIDGE Cutting Edge Pack series, February 2009, http://www.bridge.ids.ac.uk.
(36) ‘Men make a difference. Men and AIDS – a gendered approach. 2000 World AIDS Campaign’, UNAIDS Secretariat, March 2000, http://data.unaids.org.
(37) Bujra, J., 2000. Targeting men for a change: AIDS discourse and activism in Africa. Agenda Feminist Media, 44, pp. 6-23.
(38) Barker, G. and Ricardo, C., 2006. “Young men and the construction of masculinity in Sub-Saharan Africa. Implications for HIV/AIDS, conflict and violence”, in Banon, I. and Correia, M.C. (eds.). The other half of gender. Men’s issues in development. The World Bank: Washington, D.C.
(39) Jolly, S., ‘Why the development industry should get over its obsession with bad sex and start to think about pleasure’, University of Sussex – Institute of Development Studies, Working Paper No. 283, May 2007, http://citeseerx.ist.psu.edu.
(40) Molyneux, M., 2006. Mothers at the service of the new poverty agenda: Progresa/Oportunidades, Mexico’s conditional transfer programme. Social Policy and Administration, 40(4), pp. 425-449.
(41) Wilson, K., 2012. Race, racism and development: Interrogating history, discourse and practice. Zed Books: London.