PL04.2 Where are the men? STI and sexual health services for men

Abstract

This presentation describes why men are invisible and do not seek sexual health services, mainly STI care and treatment. The review examines1 (i) how masculinity promotes STI/HIV infections; (ii) why men avoid seeking care and services and (ii) what are the means and ways through which services can reach men. The analysis attempts to answer the pathways of how social norms influence roles, behaviours and expectations and reinforce conditions on men through masculinity norms. In addition, it also describes structural barriers such as predominant 'Feminised- clinic spaces that inhibit men to seek services and adopt preventive behaviours. Culture and social norms influence men's and women's risk through gender roles and relationships and ultimately determine whether, with whom and how various preventive technologies and sexual health services may or may not be used. Dominant masculinity norms and restrictive legal environments preclude men to reveal their sexual identities and preferences creating vulnerabilities to both men and women. Men-s sexual health practices have been linked to diverse enactments of masculinities that can both negatively and positively influence men-s wellbeing. Hegemonic masculinity idealises men-s bodies as robust and resilient (Charles and Walters 2008) and are more amenable to self-management than to seeking help from healthcare providers. Many men who engage in sex with other men are married in countries like India. Men's perception of risk from such behaviours is also often low - especially if one is the “penetrator”. Men who engaged in extramarital sex (whether with other women or men) were six times more likely to report wife abuse than those who did not. Yet, gender norms perpetuate women's submission to coercive sex in marriage and prevent frank discussions about sexuality and risk. While the introduction of microbicides may act as a catalyst, more encompassing gender transformative strategies were needed to reduce men's and women's risk of HIV and STI. The review also opens up the ways of finding an alternative means which can open up the possible route for them to utilise the services.