‘You are not yourself’: Exploring masculinities among heterosexual African men living with HIV in London☆

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Abstract

It is now clear that gender is an essential factor shaping the narratives of men as well as women. However, there have been few studies of the daily lives or sexual activities of heterosexual men. Hence, strategies developed to prevent the spread of the HIV virus are rarely based on detailed knowledge of the men whose behaviours they are intended to change; this is especially evident in the developing world where the epidemic is most severe. Nor do we know very much about those men who have already been diagnosed as HIV positive. Around 13 million men are now living with HIV of whom around 96% are in low or middle income countries. Migrants from developing countries also make up the majority of positive people in a number of developed countries. In the UK, for example, heterosexual activity is now responsible for about half of all new HIV diagnoses with the majority of those involved being of African origin. But almost nothing is known about the ways in which different constructions of masculinity affect their experiences of illness. This study used qualitative methods to explore the experiences of a sample of black African men who defined themselves as heterosexual and were receiving treatment for HIV and/or AIDS in London. It explored their feelings, their needs, their hopes and their desires as they negotiated their lives in the diaspora.

Section snippets

Introduction: masculinities in a global context

The last few years have witnessed a growing recognition that gender shapes the narratives of men just as it does those of women. Much has been written about the social and cultural construction of masculinity (Connell, 1995, Segal, 1990, Whitehead, 2002). But there are still few detailed studies of the daily lives of heterosexual men. Instead, they are sketched in as shadowy background figures against which women's lives are painted in much greater detail.

This is especially true in the context

Research methodology

For the purposes of this study, the participants were identified as ‘African men ’and indeed most of the participants referred to themselves in these terms at some point in their interview. But of course, this broad categorisation conceals diversity in characteristics such as countries of origin, ethnicity, religion, and immigration status (Aspinall & Chinouya, 2008). All of these differences could not be reflected in a study of this kind. However, the sample was chosen to reflect the country

Findings from the study: an overview

Twenty-six of the men were married or living as married and 38 had children but only 15 were living with them. Eight were working full time and ten part time with eleven undertaking some form of study, and the rest volunteering or not working. Twenty-eight had at least secondary level education while fifteen had either university level or post-graduate qualifications. This made them considerably better educated than the UK population in general.

The participants showed a wide range of responses

Beginning the journey with HIV: diagnosis and disclosure

Because they were in the UK, the men in this study had more opportunities than their countrymen ‘back home’ to be tested for HIV. But they did not take them up. None were diagnosed as a result of routine testing and some were only tested after their partners had already been diagnosed. Some reported that it was women in their lives who encouraged them to go. Most were already experiencing symptoms before they consulted a doctor.

‘After about four weeks I was very, very ill. I couldn't sleep, I

Economic challenges: work, money and masculinity

Around half the participants were currently employed but many were in jobs well below their original qualifications. Amongst people living with HIV in London, even when controlling for migration status, black Africans have been shown to have disproportionately high rates of unemployment and poverty (Ibrahim, Anderson, Bukutu, & Elford, 2008). Unemployment and low status work caused much distress not just because of the poverty that often ensued but also because of the way it challenged their

Heterosex and HIV: challenging the myths

The stereotype of the ‘promiscuous black African male’ has a long history and was reinvigorated with the spread of the HIV pandemic (Caldwell, Caldwell, & Quiggin, 1989). However, this notion of ‘dangerous African sexuality’ has been critically reviewed by a number of commentators (Campbell, 2004, Hunter, 2005, Lindsay and Miescher, 2003, Morrell, 2001, Noone and Stephens, 2008, Reid and Walker, 2005, Simpson, 2005). They have explored the importance of historical developments in shaping

Paradoxes of parenthood

Another gap in the existing literature on heterosexual men relates to parenting and experiences of fatherhood (Marsiglio, Day, & Lamb, 2000). While work on this topic has been growing in the developed countries, it has been sparse in other parts of the world. However, recent historical developments in South Africa in particular have brought issues of fatherhood to the fore (Richter & Morrell, 2006).

A number of studies have shown that most South African men want the status of fatherhood but many

Support and survival strategies

Many of the participants described how their illness made life very lonely. Single men in particular talked about their isolation and the barriers they faced in social interaction. Their location outside a moral network of reciprocal duties and responsibilities left many with no one to call upon for practical care and personal support.

‘I do my things alone…I just do my thing, I get up, nobody knows where I'm going…that is the life. HIV is something that has taught me a lesson, taught me a real

Conclusion: crisis in masculinity or potential for progress?

As we have seen, the men in this study faced serious challenges in their lives. They had moved around the world, either to escape threats in their home countries or to better their lives and those of their families. At the same time, they had to negotiate the realities of a serious condition that could threaten their survival.

One of the most important challenges faced by the participants was how to combine living with HIV with their own ideas about ‘manliness’ but also with those held in the

References (60)

  • F. Burns et al.

    Access to HIV care amongst migrant Africans in Britain: what are the issues?

    Psychology Health and Medicine

    (2006)
  • S. Burris et al.

    The case against criminalization of HIV transmission

    JAMA

    (2008)
  • J. Caldwell et al.

    The social context of AIDS in sub-Saharan Africa

    Population and Development Review

    (1989)
  • T. Calin et al.

    Disclosure of HIV among black African men and women attending a London clinic

    AIDS Care,

    (2007)
  • C. Campbell

    Migrancy, masculine identities and AIDS: the psychosocial context of HIV transmission on the South African gold mines

  • T.R. Chadborn et al.

    The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000–2004)

    AIDS

    (2006)
  • R. Connell

    Masculinities

    (1995)
  • W. Courtney

    Constructions of masculinity and their influence on men's wellbeing: a theory of gender and health

    Social Science & Medicine

    (2000)
  • N. Crepaz et al.

    Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review

    JAMA

    (2004)
  • J. Denison et al.

    HIV voluntary counseling and testing and behavioural risk reduction in developing countries: a meta-analysis 1990–2005

    AIDS Behaviour

    (2008)
  • C. Dodds et al.

    Grievous harm? Use of the offences against the person act 1861 for transmission of HIV

    (2005)
  • C. Dolan

    Collapsing masculinities and weak states: a case study of Northern Uganda

  • L. Doyal et al.

    “I want to survive, I want to win, I want tomorrow”: An exploratory study of African men living with HIV in London

    (2005)
  • L. Doyal et al.

    “Elvis died and I was born”: black African men negotiating same-sex desire in London

    Sexualities

    (2008)
  • J. Elford et al.

    HAART, viral load and sexual behaviour

    AIDS

    (2005)
  • J. Elford et al.

    Sexual behaviour of people living with HIV in London: implications for HIV transmission

    AIDS

    (2007)
  • J. Elford et al.

    Disclosure of HIV status: the role of ethnicity among people living with HIV in London

    Journal of Acquired Immune Deficiency Syndromes

    (2008)
  • P. Galdas et al.

    Men and health help-seeking behaviour: literature review

    Journal of Advanced Nursing

    (2005)
  • A. Gielen et al.

    Women's lives after an HIV positive diagnosis: disclosure and violence

    Maternal and Child Health Journal

    (2000)
  • M. Hunter

    Cultural politics and masculinities: multiple partners in historical perspective in KwaZuluNatal

    Culture, Health and Sexuality

    (2005)

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    ☆

    The study was only possible because so many men from African backgrounds were prepared to share complex and often painful life stories. Thank you all for taking the time to explain so much to us and for the insights that you have provided. Thanks also to all the clinicians and staff at the Department of Sexual Health, Homerton University Hospital NHS Foundation Trust; The Greenway Centre, Newham General Hospital; the Andrewes Unit, St Bartholomew's Hospital, and the Graham Heyton Unit, The Royal London Hospital, who introduced patients to the project, and also made space and time to accommodate researchers and study participants. The project advisory group was made up of representatives from The African HIV Policy Network, the Greater London Authority, The Organisation of Positive African Men, The Rain Trust, The Terence Higgins Trust and the U.K. Coalition and included Walter Gillgower, Fred Kamugwiina, Clement Musonda, Balthazer Mutuli, Rhon Reynolds, Max Sesay and Cheikh Traore who generously gave their time, support and advice. Funding, without which none of this work would have been possible, was provided by the trustees of The Derek Butler Charitable Trust.

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