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Making space for young heterosexual males: gender and HIV/AIDS prevention education.

Healthy sexuality initiatives for young adults, including those aimed at HIV/AIDS and sexually transmitted infection (STI) prevention, have been in place for decades. (1) However, the majority of these initiatives were designed for and directed toward young heterosexual females and gay males. (2) In fact, most Canadian sexual health campaigns and interventions geared toward the prevention of HIV infection fail to include young heterosexual males. (3-5) This is problematic since Health Canada statistics show an increase in HIV infection among females from unprotected sexual contact with HIV-infected male partners. (6)

Current research demonstrates that young Canadians are now less knowledgeable about HIV/AIDS and ways of protecting themselves against sexually transmitted infections than they were in the late 1980s. (1) It is therefore essential that we seek new and innovative ways of providing healthy sexuality education and resources for all youth, especially young heterosexual males.

The Buddy Study, a Nova Scotia-based two-year qualitative study funded by the Canadian Foundation for AIDS Research (CANFAR), was designed to explore and contextualize young heterosexual males' perceptions of sexual behaviours, roles, and responsibilities, and to determine obstacles and gaps in their sexual health decision-making. A series of 30 one-on-one interviews and 9 focus group discussions were held over a two-year period (2003-2004) with young males and females. Thirteen additional in-depth interviews were held with sexual and reproductive health educators to draw from their experiences working with youth. Sessions were audio-taped, transcribed verbatim, then analyzed thematically to identify patterns in the data.

Analysis of the first-year interviews and focus groups with young males and sexual health service providers brought to light some of the complex, underlying constraints on some young males in talking about sex and sexuality. Interviews and focus groups with young females in the second year of the project brought a broader perspective to the relationship between sexual partners, social taboos, and barriers to healthy sexuality.

Gender was a key determinant of sexual health among study participants: (1) the nature and extent of risk-taking behaviours are linked to gender; (2) sex and sexuality are taboo, and socio-cultural comfort levels and restrictions around taboo topics differ according to gender; and (3) roles, responsibilities, and expectations (e.g., sexual behaviours in general, safer sex, contraception, and disease prevention) are often unequally divided between male and female partners within the context of a heterosexual relationship.

Here are some of our key findings:

* Young men were less likely than young women to talk openly about sex or to seek accurate sexual health information because of embarrassment or a fear of feeling foolish, stupid, or unmanly.

* Most participants did not regularly use condoms.

* Young women were more likely than their male partners to take responsibility for safer sex because they felt they would face greater personal consequences from pregnancy or sexually transmitted infections.

* Most participants believed that "society" puts more pressure on young women than on young men to be responsible and practise safer sex.

* The greatest sexual health priority for the participants was preventing pregnancy.

* Most of the participants believed they were not at risk of coming into contact with HIV through unprotected sex, even when the sexual partner is not well known to them.

These findings indicate a relationship between gender-based normative sexual behaviours, pervasive socio-cultural paradigms that regulate and normalize sexual beliefs, and attitudes and understandings of responsibility among participants. All the participants in this study provided scenarios in which gender imbalances related to responsibility for safer sex, contraception, disease prevention, and sexual behaviours played a significant role in sexual health decision-making processes.

Recommendations

For practitioners:

* Develop accessible, youth-friendly, gender-appropriate, sexual and reproductive health facilities;

* Ensure that adequate, detailed information about HIV and other STIs is provided to both young males and females in a gender-sensitive manner; and

* Provide condoms in locations that are easily accessed by all youth, including youth in more rural or remote areas.

For policy makers:

* Focus on primary health care for all Nova Scotians as a means of improving overall health and wellness and reducing HIV infection among youth;

* Focus on gender-based sexual norms in developing HIV prevention messages and intervention strategies by conducting gender-based analyses; and

* Create a forum for youth to discuss gender differences in sexual decision-making and sexual health education needs in an effort to increase open dialogue.

Gender continues to play a central role in shaping sexual behaviours, roles, and responsibilities among young adults. In order to address the sexual health needs and concerns, including HIV prevention, of young heterosexual males, educators and service providers must first address the close connection between gender norms and sexual behaviours. Building capacity across the sexual and reproductive health spectrum, including enhancing the involvement of young heterosexual males, will ultimately improve HIV/AIDS prevention education programming and services for all young Canadians.

For a copy of the full report, visit: www.acewh.dal.ca/eng/reports/Buddy_Study_Report.pdf

NOTES

(1.) Council of Ministers of Education. Canadian Youth, Sexual Health and HIV/AIDS Study: Factors Influencing Knowledge, Attitudes and Behaviours. Toronto: CMEC, 2003.

(2.) Stephenson JM, Strange V, Forrest S, Oakley A, et al. Pupil-led sex education in England (RIPPLE study): Cluster-randomised intervention trial. Lancet 2004;24(July):338-346.

(3.) Canadian Public Health Association. Critical Issues in HIV Prevention. A Discussion of Heterosexual Men and HIV Prevention. Ottawa: Canadian HIV/AIDS Clearinghouse, 2001.

(4.) Maticka-Tyndale E. Sexual health and Canadian youth: How do we measure up? Canadian Journal of Human Sexuality 2001;10:1-17.

(5.) Planned Parenthood Federation of Canada. Safer sex education for heterosexual males: An oxymoron? Ottawa: PPFC, 2001.

(6.) Public Health Agency of Canada. HIV/AIDS Epi Update--May 2004. HIV and AIDS among Youth in Canada. Ottawa: Surveillance and Risk Assessment Division. Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2005.

Jacqueline Gahagan, Laura Barbour, and Susan McWilliam, Dalhousie University
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Author:Gahagan, Jacqueline; Barbour, Laura; McWilliam, Susan
Publication:Research Bulletin
Geographic Code:1CANA
Date:Sep 22, 2006
Words:969
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