NFIMyanmarworkshop copy

www.nfi.net
Advocacy, policy and support on male sexualities
Gender, Sexualities,
and Masculinities -
An NFI experience
PSI Myanmar workshop
8-10 February 2006

Advocacy, policy and support on male sexualities
Surveillance/study location
Percent HIV+
(number tested)
Bangladesh Central, 2004
Phnom Penh, Cambodia, 2000
Beijing, China, 2002
Dili, East Timor, 2003
Mumbai, India, 2003
Jarkata, Indonesia, 2002
Bangkok, Thailand, 2003
Thailand, 4 provinces
Ho Chi Minh City, Vietnam, 2004
Karachi, Pakistan, 2004
Kathmandu, Nepal, 2004
Manila, Philippines
MSM
0% (399)
12.8% (166)
3.1% (481)
0.9% (110)
18.8% (NA)
3.29% (529)
17.3% (1,121)
9.6% (519)
8% (600)
4% (409)
4% (275)
0% (261)
Transgender
0.2% (405)
36.7% (40)
From the MAP 2005 Report
2

Advocacy, policy and support on male sexualities
Why work with ‘MSM’
Why we should work with male-to-male sex and HIV prevention, care and
support?
Because:
• It is the right thing to do on humanitarian grounds.
• It is the right thing to do epidemiologically.
• It is the right thing to do from a public health perspective.
3

Advocacy, policy and support on male sexualities
Males who have sex with males (MSM) whether their self-identity is linked to
their same sex behaviour or not, have:
• The right to be from violence and harassment;
• The right to be treated with dignity and respect;
• The right to be treated as full citizens in their country;
• The right to be free from HIV/AIDS;
MSM who are already infected with HIV have the right to access appropriate
care and treatment equally with everyone else, regardless of how the virus was
transmitted to them.
4

Advocacy, policy and support on male sexualities
What is sex?
People will define sexual activity
according to the meaning and
significance they give to it. Further
social values will also be relevant.
For many sexual intercourse means
only vaginal sex. Anything else, such
as oral sex, anal sex, or thigh sex will
not be significant or meaningful
enough to be defined as sex!
5

Advocacy, policy and support on male sexualities
Example
In some parts of South Asia, husbands define sex
with their wives as DUTY
While wives define sex with their husbands as
WORK
While non-vaginal sex is defined as PLAY/MISCHIEF
6

Advocacy, policy and support on male sexualities
Gender
A term used to describe:
• What sex we are born - as female,
male, intersexed
• How society treats us from birth
• What rules apply as a result - social,
legal, economic, cultural - at society
level in organisations and families
• How we dress, behave, work, play,
have sex, etc.
7

Advocacy, policy and support on male sexualities
Gender
Gender includes differences in
the way we are treated by
society, based on whether we are
men, women, or transgender
Gender is about culture and
society, and not just individual
identity - it is a system
8

Advocacy, policy and support on male sexualities
Masculinities
A term used to think about men and
how it is expected that they should
behave.
What does it mean to be a male?
What does it mean to be a man?
What does it mean to be masculine?
What does it mean to be an
“effeminate” man?
9

Advocacy, policy and support on male sexualities
Sexualities
A term to describe a number of things-
• Sex of a person (male, female, intersex)
• Sexual orientation/desire (same sex, other sex, both sexs)
• Sex acts (what we do when we have sex)
• Sexual attraction (types of partners)
• Sexual interests (monogamy, sex outside, etc.)
• Sexual rules and laws
• Cultural and historical influences
10

Advocacy, policy and support on male sexualities
Thinking about sexualities
Sexualities act on three levels
Individual: what we like and do in sex, what we want sexually,
whom we want sexually, what our bodies can do sexually
Relationships: us and our partners, how our relationships happen,
what we enjoy sexually with others together, what risks we face in
sex with others
Society: what is ‘okay’ or ‘not okay’ sexually, how vulnerable we
are in sex as a result of society’s rules and ideas
11

Advocacy, policy and support on male sexualities
To a great extent gender, masculinity, and sexuality
are framed by performance.
We also need to think in pluralities
Gender variance, masculinities and sexualities
(also femininities)
12

Advocacy, policy and support on male sexualities
Why males, and not men?
The word MAN is a culturally loaded
term, and carries significant beyond
that of biological age and
performance. It also is host to
concepts of adulthood and
personhood, social obligations and
family duty.
A kathoey does not define himself as a
man.
An adolescent male is not defined as a
man.
13

Advocacy, policy and support on male sexualities
Feminised males
Masculine males
Teachers
Students
Relatives
Street males
Prisoners
Males in occupational groups:
truck drivers, boatmen, fishermen,
taxi drivers, etc.
Politicians
Bureaucrats
Labourers
Farmers
Male sex workers
Males in uniformed services
Male friends
Foreigners
Adolescent males
What distinguishes these men from each other?
14

Advocacy, policy and support on male sexualities
Why do males have sex with males?
• Desire for other males – gender or
orientation
• Desire for specific acts – anal/oral
• Pleasure and enjoyment from
discharge – “body heat” – also play and
curiosity
• Wives do not do anal or oral sex –
ashamed to ask
15

Advocacy, policy and support on male sexualities
• Males are easier to access
–females are more socially policed
and can be more difficult to access
• Protecting a girls virginity –
maintaining chastity
• For money, employment, favours
• Anus is tighter than vagina and
gives more pleasure
• No marriage involvement
• Its not real sex
16

Advocacy, policy and support on male sexualities
Frameworks of male-to-male sex
•Gendered framework
Male to male desire based on feminised gendered roles
an identification - sexual acts based on gender roles, i.e.
man/not-man
•Discharge framework
Male to male sexual behaviours arising from immediate
access, opportunity, and “body heat”. They involve
males/boys/men from the general male population
17

Advocacy, policy and support on male sexualities
Many males from the general male population will also
access feminised-identified males or boys for anal/oral
sex . These males do not see themselves as “homosexuals”, or
even their behaviour as “homosexual”, since they take on the
“manly” penetrating role in male to male sex. Nor do their partners
see themselves as homosexuals because they either see
themselves as “not men”, or they are involved in play - not sex.
18

Advocacy, policy and support on male sexualities
Emergent gay framework
Male to male desire framed by sexual orientation.
Primarily used by middle and upper classes. Such
gay identified men usually seek other gay identified
men as sex partners.
19

Advocacy, policy and support on male sexualities
And of course not to forget, males/men in all male
institutions, such as prisons, the uniformed forces,
colleges, university, schools, religious institutions,
And just places where males congregate
20

Advocacy, policy and support on male sexualities
•Most male-to-male sexual behaviours are invisible and
not gay/homosexual/kathoey/apwint identified
•Sexual/gender identities tend to be based on class,
education, and sex roles
•Many males involved in male-to-male sex will also often
have sex with wives/other women
•Male-to-male sex is not uncommon and involves males
across the economic and social spectrum, rural and urban
•MSM then is no an exclusive category or “target group” –
it reflects a behaviour which may be relatively common
The issue is risk and vulnerability
21

Advocacy, policy and support on male sexualities
Vulnerability and risk
Stigma and discrimination: who is stigmatised?
Partner rates
Penetrating, being penetrated, or both?
STI : anal/penile
Rectal damage
Gender roles
Legal/Social
Female partners
Wives
22

Advocacy, policy and support on male sexualities
Strategic plan for Cambodia
Target ‘MSM’ sub-populations
Long hairs
Male sex workers
Street males
23

Advocacy, policy and support on male sexualities
Strategic plan for Cambodia
Strategies would include
Safe meeting spaces - drop-in centres
Development of appropriate IEC materials - innovative approaches and
locales for education and distribution
Distribution of condoms/lubricant in non-traditional locales
Safer sex skills building
VCTC centres
Hotline - a 24 hour service
STI treatment clinics - training of service providers
Working with ‘MSM’ who use drugs, including needle use
24

Advocacy, policy and support on male sexualities
Strategic plan for Cambodia
Building an enabling environment
Vocational training for long hairs and ‘MSW’ in small business management
Development of small business loans
Support education development
‘Life skills’ training
Establish long hair unions for advocacy
Hire advocates for legal issues
Advocacy work with police and community leaders
For street children this included:
provide free education and board
scholarships to universities
adoption programmes
25

Advocacy, policy and support on male sexualities
Community approaches: key questions
• What do we mean by community?
• Why is a community approach more effective in HIV prevention?
• Does such an ‘MSM’ community exists where you implement an HIV
intervention?
26

Advocacy, policy and support on male sexualities
Community approaches
What do we mean by community?
27

Advocacy, policy and support on male sexualities
Community approaches
What do we mean by community?
• affiliation to a shared consensus
• shared/common behaviours and gender performance
• solidarity as a “community:
• mutual support mechanisms
• social support services
• shared ideologies and social characteristics
• shared socialising frameworks
• mutual concerns
• shared needs
• shared rituals
28

Advocacy, policy and support on male sexualities
Community approaches
Building community - how?
Community development - how?
And what about the missing men/males?
29