Addressing Masculinity as a Strategy to Reduce HIV/AIDS Related Risky Sexual Behavior among Young Men

About half of all the new infections in India are in the age group 15-24 years. Statistics from the Joint United Nations Program on HIV/AIDS (UNAIDS, 2000), indicate that the HIV prevalence among youth (ages 15-24) in India, is between 0.4-0.8 percent for females and between 0.1-0.6 percent for males. According to one study in Mumbai, the largest number of clients visiting STD clinics and sex workers are college going students and young men of ages up to 25 years (Rangaiyan, 1998).

The magnitude of the problem from a national perspective can be gauged by the fact that some 282 million (28% of the population) people in India are aged 10-24. Not only is knowledge about HIV/AIDS low among youth, but very few young people see themselves as vulnerable. Recent research in one Indian state showed that only 35% of University students believed that they are at risk (UNAIDS 2002). It is important to remember that the epidemic among youth remains largely invisible, both to young people themselves and to society as a whole. Young people often carry HIV for years without knowing that they are infected. As a consequence, the epidemic spreads beyond high-risk groups to the broader population of young people, making it even harder to control (Population Report 2002). With over 50% of all new HIV cases in the country among this age group, there is a desperate need to develop effective youth-oriented HIV/STD prevention programs.

There are a variety of physical, social, psychological and economic attributes that contribute to making young people vulnerable to HIV/AIDS. They are frequently economically dependent and socially inexperienced and as a result have very marginal access to competent health care (UNAIDS 1999, UNAIDS 2000). Health care facilities have a poor record of serving youth, particularly in the reproductive health realm (FOCUS 2000). Youth frequently lack necessary knowledge and skills and often do not know how to protect themselves from infection. Societal norms, values and policy contribute to the problem by taking the view that youth should not be (are not) involved in sexuality and other behaviors that can transmit infection and that programs that address these risk behaviors of youth will force the society to recognize that such behaviors exist and/or through recognition, provide societal sanction for such behaviors.

It is the perspective of this proposed project that the origins of anxieties and risky behavior for South Asian men begin in youth at a time of increasing sexual interest and sexual maturation and sexual anxiety. These anxieties are further exacerbated by a cultural context that validates the negative consequences of perceived improper behavior. Programs, which seek to prevent HIV transmission among men needs as well to focus on the period of youth were behaviors begin and where personality formation and sexual identity develop. The post puberty period for male youth in South Asia is characterized by relatively strict segregation of males and females, leading to the formation, reinforcement and perpetuation of masculine and feminine stereotypical norms, traits and behaviors. During this period little or no sex education or cultural institutions exist that could possibly enculturate male or female youth into knowledge of sexuality and appropriate gender relations. Sex is rather considered a socially tabooed issue and includes strong precepts and misinformation against self-stimulation. These perceptions and misinformation are often responsible for enormous burden of sexual related guilt and anxieties. A majority of youth therefore begin their sexual career on a conflicting note, characterized by engagement in self-stimulation on one hand and heavy sense of guilt, shame and fear on the other. With significant restrictions on male-female contact, young men show a significant pattern of male-to-male sexuality (Verma and Lhungdim, 2002), which in absence of proper information and education can further contribute to guilt and concerns about masculinity and sexual health.

Although there is a general agreement on the role of "masculinity", there is very little systematic information to help guide the development of intervention in India. For example very little is known on the social construction of masculinity and the process thru which they are acquired, reinforced and enacted in young men's life. We also do not know what alternative constructions would be acceptable to young men and the support systems that would be necessary to support and sustain change.

The overall objective of this intervention research is to reduce HIV/AIDS risk behavior among youth and young adults aged 16-25 by developing and testing community-based strategies in three Mumbai slum communities. Specific aims include the following:

• Understand the cultural, social and psychological constructions of masculinity
• Examine the sources (family, school, media, peer networks and others) and the processes through which the constructs of masculinity are acquired and reinforced among the young men
• Test the proposition more negative social and psychological constructions of masculinity among young men produce higher degree of sexual health anxieties, sexually risk behavior and therefore greater occurrence of possible symptoms of sexually transmitted infections (STIs)
• Demonstrate that a change in constructs of masculinity can lead to a reduction in the HIV/AIDS related sexually risky behavior.

This project is funded by the Population Council of New Delhi with funds from the European Community for the grant period April 1, 2003 - March 31, 2006. Ravi K. Verma and G. Rama Rao of IIPS are the principal investigators. The co-PIs are Stephen L. Schensul and Bonnie K. Nastasi.

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