Social constructions of manhood have strong effects on men’s and women’s health. They affect women directly, for example, via male violence against them causing physical and psychological harm, and indirectly through men’s risky behaviour increasing their female partners’ vulnerability to sexually transmitted diseases. And they also affect men, for whom expectations of risk-taking and taboos around health seeking heighten exposure to injury and illness.
Although attitudes are changing, many South Africans of both sexes see men as superior to women and believe that men should dictate many decisions that affect health, including sexual decisions.
Gender roles are not set in stone, however, and there is evidence from South Africa and other countries that efforts to increase gender equality can have significant effects on health by promoting more gender-equitable attitudes. Involving men in such programmes is now seen as vital to success.
HIV/AIDS infection rates are higher among women, in part due to gender-driven behaviour. Gender norms allow men to dictate the terms of sex, including whether or not to use condoms. Levels of rape are among the highest in the world (and conviction rates among the lowest), while domestic violence is widespread. Constructions of masculinity also encourage men to have multiple concurrent sexual partners, which increases the risk of HIV infection both for their casual and long-term partners as well as for men themselves.
Much innovative work has been done in South Africa and elsewhere to shift these gender norms and thereby improve the health of men and women. ‘Stepping Stones,’ a community training and dialogue programme, has worked in multiple countries to reduce the acceptability of violence and promote discussion and awareness of HIV/ AIDS. Sonke Gender Justice Networks ‘One Man Can’ campaign uses a human rights framework to help men and boys take action to stop domestic and sexual violence, halt the spread of HIV/AIDS and promote healthy, equitable relationships. These programmes have had significant impacts on behaviour and attitudes, with men becoming more involved in family health care and parenting as well as less likely to commit violence and more likely to protect themselves from health threats. They have found men willing to become more gender-equitable and to share the health care burden with women. Much of the work with men on gender and health has been small-scale, however; expanding it will have large benefits for the health of all members of society.