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Immediate, Likely and Meaningful: A framework for understanding and responding to the sexual health risk-taking behaviours of young men. Dr Mark Limmer.

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Presentation on theme: "Immediate, Likely and Meaningful: A framework for understanding and responding to the sexual health risk-taking behaviours of young men. Dr Mark Limmer."— Presentation transcript:

1 Immediate, Likely and Meaningful: A framework for understanding and responding to the sexual health risk-taking behaviours of young men. Dr Mark Limmer Lancaster University 1 st November 2012 International conference on Challenges for Health and Healthcare in Europe Aalborg University

2 Hegemonic Masculinity “the configuration of gender practice....which guarantees (or is taken to guarantee) the dominant position of men and the subordination of women” (Connell, 1995 p77) Gender Practice implies performance and requires and audience – “other men” (Kimmel, 1994) Relational – Difference from, and superiority over, women. Often manifest through sex (Holland et al, 1998) Background

3 Multiple meanings that vary over time and space: Pleasure and status (McDowell, 2003; Wight, 1998) An embodiment of masculinities - note impact of pornography on aesthetic and expectation (Segal, 1997; Holland et al, 1998) Explicitly heterosexual (Richardson, 2010) Closely linked to homophobia – homosexuality equated with femininity and ‘lesser’ masculinities (Kimmel, 1994) Meanings of sex for young men

4 Young working class masculinities – “Fighting, fucking and football” (Mac An Ghaill, 1994) Rejection of education, embracing risk taking, violence and homophobia (McDowell, 2003) Exclusion and deprivation linked to sexual ill-health (Wellings et al, 2001) Masculinities linked to exclusion and deprivation

5 Sample:46 young men aged 15-17 22 defined as socially excluded 24 defined as socially included All defined themselves as white british The study from which these data were drawn... The impact of masculinities and social exclusion on young men’s sexual risk taking

6 5 focus Groups (3 with SE young men, 2 with SI young men) 46 individual semi-structured interviews Focus group incorporated a live drama element and a structured exercise Thematic analysis Sex Exclusion Masculinities Methodology

7 1.Aspirations “Job, house, nice house, nice car, promotion prospects and stuff like that. I always want to be moving up with what I’m doing. I always want to have goals until I reach right to the top and everything is done, everything is alright and I can just settle down with a wife and stuff. Just be happy with myself.” (Terry, aged 15) While the aspiration was universal the belief that it would transpire and the strategies for achieving it were far stronger in the socially included cohort 2.Relational - Not female - Not gay Results 1: Definitions of masculinities and the importance of sex

8 3. As attributes Different young men were able to draw on different attributes. For socially included young men these included academic achievement, status in school, sporting achievement, acceptance by social institutions and sense of maturity. For the socially excluded young men the attributes they could draw on were more limited, essentially sex, fighting and the active rejection of the above. 4. As a performance with an audience For included young men a range of audiences For excluded young men, mainly peers “Someone who is trusting, someone who is understanding, someone you can talk to about stuff, someone who watches your back all the time and helps you, someone who cares about you as much as you care about them – because it’s your mate, isn’t it” (Keith, aged 15)

9 The socially excluded young men articulated masculinities built on a very narrow base, essentially on the residue that pertains to all men by dint of the social construction of their gender and it is performed under the metaphorical gaze of a very narrow audience – most of whom are equally marginalised. In the hierarchy of men these young men are relatively powerless and isolated. Avoiding rejection from the peer group, from the only affirmation of their masculinities, provides a powerful driving force behind the young men’s attitudes and behaviours.

10 1.Expertise and leadership - Mechanistic - Lack of communication (Leader and led) Knowledge sources varied: Socially Included young men a range including school and family Socially Excluded young men mainly peers and pornography “Honest to god boys, you learn off your yer mates, yer learn off yer mates, boys. You can’t just discover it; it can’t just come in to yer head, can it? Yer learn off yer mates” (Alex, aged 16) Sexual expertise valued as it leads to further opportunities “If you bang a bird an’ their lovin’ it, they go round and tell their mates that you’re mint an’ that, do they not – an’ they come back, an’ they come back for more” (Darren, aged 16) Results 2: Approved sexual masculinities

11 2. Voracious – not rejecting a sexual opportunity Closely tied to the fear of being labelled gay Relates not just to sex with a partner but masturbation, talk and pornography But.... 3. Sex with the right partner “If the girl is minging you get bothered for it, don’t you? But if they are nice everyone is buzzing, everyone thinks ‘well, he’s a man, he’s done that with her.” (Terry, aged 15)

12 Label based on:Sexual history “shagged around a bit” Quantity of sexual partners Too assertive or experimental Dress Attractiveness Personal hygiene Most commonly used as a short-hand for a greater likelihood to pass on a sexually transmitted infection – which were believed to be visible “You can tell because if they have got scabs and everything, not all the time you can’t but most of the time you can. Some of the diseases are inside but some of them are not some of them are on the outside. Most of the diseases are on the outside not on the inside. It comes out like green stuff and things like that and it is hanging.” (Gary, aged 17) Results 3: Universal belief in a “dirty/clean” dichotomy relating to young women (cf: Hyde et al, 2009; Waldby et al, 1993)

13 Linked to poverty and place – especially by the socially included young men for whom poverty and place were key markers of their own masculinities status. “You’ll not [find clean girls] round 'ere where everyone's been fucked up an' that, corrupted an' that. You want to go out of the area - fresh people. Fresh meat an' that.” (Alex, aged 16) Labels were applied by young men and reinforced by peers – they could also be taken away or changed to suit the needs of the group and enable them to maintain control over the nature and value of the sexual encounter.

14 Less concerned with risks that emanate from their performance of masculinities, more concerned about risks to their performance of masculinities. A Framework for understanding young men’s perception of sexual risk Immediate LikelyMeaningful For risk to have an impact on behaviour it must be perceived as......

15 Immediate:Must impact on something that is in their immediate purview, not necessarily something that is happening very soon, but impacting on something that is of concern to them at this particular point in time (cf the impact of alcohol). Likely:Must be perceived as likely to happen. What is considered likely is dependent on the perceived credibility of the message and the messenger. Meaningful:The consequence of the risk must be something that is meaningful, something that the young man is bothered about at this point in time.

16 Case Study 1 – Gary (aged 17) Gary had sex for the first time when he was 14, did not use condoms then or subsequently, he was unemployed at the time of the interview and estranged from his family. Gary was aware of the risks of STIs and conception but was more concerned that he was seen by his peers to be sexually active and to have sex with the ‘right’ young woman. He saw his reputation with his peers as largely reliant on his sexual behaviours and the most immediate risk for him was their negative judgement. Gary did not see infection as being a likely consequence of his activities because he only had sex with “quite nice girls” and anyway his experience of sex without condoms had created the belief that infections would not happen to him. I have never wore a johnny in my life. I will be honest I have never and never caught nothing in my life. I have been with about 14 [girls] or something it is not that much but it is in my eyes (Gary, aged 17) Neither conception nor infection constituted meaningful risks to Gary, the former could be denied - “It’s not mine. I shoot blanks me”- and the latter dismissed. His only meaningful sexual risk at this point in time related to the judgement of his peers.

17 Case Study 2: Josh (aged 17) Josh had sex for the first time when he was 16 and used condoms on this and subsequent occasions. At the time of interview he was completing his ‘A’ levels with a view to continuing his studies at University. Josh was very aware of the risk of pregnancy which he perceived would have an immediate impact on his ability to go away to university and would damage his relationship with his parents. He had no immediate concerns about his sexual performance and when asked what his key message to other young men would be, replied “Don’t worry if it’s crap, use a condom and make sure it’s what you both want”. Josh identified conception as a likely risk, a message that had been picked up and reinforced through his sex education at school. The consequences of pregnancy were more meaningful to him than any concerns about what his peers might think – “your friends are not going to bother if you are crap in bed”.

18 As aspects of Gary and Josh’s lives, circumstances and aspirations change, so too will their personal definition of risk which is understood as fluid and contextual, in stark contrast to the fixed, stolidity of risk as expressed in terms of the concrete outcomes of infection and conception beloved by policy makers

19 Some implications for policy and practice Need to understand young men’s sexual health risk-taking as rooted in masculinities. Addressing masculinities rather than what emanates from them should be the priority. Current policy preoccupation with infection and conception as the risks has little or no resonance with many young men. Interventions need to be rooted in young men’s own perception of risk. Credibility gap between what young men are told and the reality as they experience it. A need for a more honest and nuanced dialogue. Alcohol has a significant impact on risk decision making – alcohol needs to be addressed as a root cause of wider risk taking as well as a risk in its own right For many young men their peers are the most accessible and credible sources of information and values – utilising peers as a health promotion resource needs further exploration – but....

20 References Connell, R (1995) Masculinities Polity, Cambridge Holland, J; Ramazanoglu, C; Sharpe, S; Thomson, R (1998) The male in the head; young people, heterosexuality and power London; Tufnell Press Hyde, A, Drennan, J; Howlett, E; Brady, D (2009) Young Men’s Vulnerability in Constituting Hegemonic Masculinity in Sexual Relations American Journal of Men’s Health 3:3 pp 238-251 Kimmel, M (1994) Masculinity as homophobia: Fear, shame and silence in the construction of gender identity. In Whitehead, S; Barrett, F (eds) The Masculinity Reader Blackwell: Oxford Mac An Ghaill, M (1994) The Making of Men Buckingham, OUP McDowell, L (2003) Redundant Masculinities? Employment Change and White Working Class Youth. Blackwell Publishing: Oxford Richardson, D (2010) Youth Masculinities: Compelling male heterosexuality British Journal of Sociology 61:4 pp737-756 Segal, L (1997) The Belly of the Beast: Sex as Male Domination? In Whitehead, S and Barrett, F (eds) The Masculinities Reader Polity, Cambridge Waldby, C; Kippax, S; Crawford, J (1993) Cordon Sanitaire: ‘Clean’ and ‘unclean’ women in the AIDS discourse of young heterosexual men. In Aggleton, P (ed) Facing the second decade. Social aspects of AIDS Oxford, England Wellings, K; Nanchahal, K; MacDowell, W; McManus, S; Erens, B; Mercer, C; Johnson, A; Copas, A; Korovessis, C; Fenton, K, Field, J (2001) Sexual behaviour in Britain: Early heterosexual experience The Lancet 358 pp 1843- 1850 Wight, D (1994) Boys’ thoughts and talk about sex in a working-class locality of Glasgow. Sociological Review 42 pp 703-737

21 Thanks for listening! Dr Mark Limmer Lecturer in Public Health Division of Health Research Furness, Rm C03 Lancaster University Lancaster LA1 4YG +44 1524 593015

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