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... but are they also the elephant in the room?. Dr David T Evans RN BA(Hons) MPhil EdD Senior lecturer in sexual health Considering outcomes from poor.

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Presentation on theme: "... but are they also the elephant in the room?. Dr David T Evans RN BA(Hons) MPhil EdD Senior lecturer in sexual health Considering outcomes from poor."— Presentation transcript:

1 ... but are they also the elephant in the room?

2 Dr David T Evans RN BA(Hons) MPhil EdD Senior lecturer in sexual health Considering outcomes from poor male engagement with sexual health

3 It’s a man’s world...

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5 1) males are frequently treated stereotypically, as though ‘all men are the same’, with same needs, attitudes, behaviours and practices Evans, D. T. (2004). "The trouble with men is... Raising the profile of men's sexual health." Nursing in Practice Journal 2004(17): Poster: Greg King, CISH 2011

6 2) many men fail to make full use of the various self-help and health promotion initiatives, which could maximise their health and well-being, and prevent the development of disease Evans, D. T. and L. Stapley (2010). "Sexual health issues in men - part 1." Practice Nurse (17 September 2010): Poster: Loraine Stapley, CISH 2010

7 3) many men leave health problems until they are too late; consequently, the treatment is either radical or unsuccessful Roberts, C. and D. T. Evans (2007). Chapter: Male Health. Nurse Practitioner Manual of Clinical Skills. S. Cross and M. Rimmer. Edinburgh & London, Elsevier Publications: Poster: Eleonora Assenova, CISH 2010

8 It’s like searching for the “invisibilised”, something we all know is there but not speaking about or addressing effectively... the “presence of an absence” (Jean Paul Satre) an apophasis  ’  “absent presence”  Slavoj Žižek)... the “whole [sic] at the centre of discourse” (Lee et al. 2008). Serrant-Green conceptualises the result as “screaming silences”

9 Interpersonal Institutional Cultural Internalised

10 Genders, sexualities, sexual health & well-being Unprotected sex & infections Unprotected sex & “family planning”

11 Genders, sexualities, health and well-being What makes a man a man? Males often miss out on ‘usual’ health promotion initiatives “Contraceptive mentality” (Evans 2005) Viagra phenomenon (Tiefer 2006) Unprotected sex and infections Epidemiology – what the science says and doesn’t say Sexually acquired infections (SAIs) and HIV (www.hpa.org.uk) UNAIDS said “48% of people with HIV are women” Unprotected sex and “family planning” Unplanned / (un)wanted conceptions: role and responsibilities (or not): abortion / pregnancy / “fathering” a child (French 2009a; Papworth 2011) Expectations & regret at intercourse (French 2009b) From the youth to the old man! (Roberts & Evans 2007)

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15 Poster: Steve Malone, CISH 2012

16 May 2013Accessed on

17 Poster: Vicky Papworth, CISH 2009 Poster: Angela Wake, CISH 2010

18 Skolbekken (2008)

19 Non-medical ‘problems’ become seen as illnesses, disorders, pathologies and deviancies, which need to be prevented and / or treated. Non-medical ‘problems’ characterise the discursive shift in the west’s post- Enlightenment emphasis onto the scientia sexualis as opposed to the ars erotica (Foucault 1984, History of Sexuality volume 1) The result is an increase in all forms of surveillance and governmentality (Pryce 2001), especially around “policing desire” (Watney 1993) and the construction / reconstruction of the notions of deviance and the “pathologisation of normality” (Skolbekkken 2008).

20 If it’s not on, IT’s not on! If it’s not on, IT’s not on! Ambition: Prioritise prevention

21  Build a sexual health culture that prioritises prevention and supports behaviour change  Ensure that people are motivated to practise safer sex, including using contraception and condoms  Increase availability and uptake of testing to reduce transmission  Increase awareness of sexual health among local healthcare professionals and relevant non-health practitioners, particularly those working with vulnerable groups. p 22

22 Poor ‘coping’ mechanisms Alcohol & drugs Rage and aggression Violence, bullying and abuse Low Self Esteem Poor condom use Mental health sequelae Hyper- masculinised identities

23 ‘Savile’ effect CSW Masculine identities Asylum & Torture Regret MRSA Victim & cycle of abuse Transpeople Homeless boys & men

24 “Women have borne the symbolic burden of man’s imperfections, his grounding in nature. Menstrual blood is the stain, the birthmark of original sin, the filth that transcendental religion must wash from man.” (Paglia 1990: 11)

25 “Woman is the primeval fabricator, the real First Mover. She turns a gob of refuse [semen] into a spreading web of sentient being, floating on the snakey umbilical by which she leashes every man”. (Paglia 1990: 12) “Woman is the primeval fabricator, the real First Mover. She turns a gob of refuse [semen] into a spreading web of sentient being, floating on the snakey umbilical by which she leashes every man”. (Paglia 1990: 12)

26 So many of the indices such as mortality and morbidity figures compare male against female, when it would be more appropriate to focus instead on ‘preventable’ versus ‘inevitable’, and very few poor statistics for men would actually then come out inevitable. Evans, D. T. (2004). “The trouble with men is... Raising the profile of men's sexual health.” Nursing in Practice Journal 2004(17):

27 The needs of boys and young men are different to that of girls and this should be acknowledged. It is important that issues such as relationships, consent, contraception and infections are considered from a young man’s perspective. p. 15 All young people’s sexual-health needs – whatever their sexuality – are comprehensively met. p. 17

28 The new duties require a significant change in policy and practice and what has been described as ‘gender mainstreaming’. This means fully integrating an awareness of male and female health needs strategically and operationally throughout an organisation. It means moving beyond the assumption that ‘gender’ is limited to occasional awareness campaigns on sex-specific issues.

29 The Equality Act requires health organisations to develop and deliver effective work to improve men’s health on a wide-ranging and systematic basis. While some organisations have a good track record in this area, for many it represents a new area of activity that will require significant support.

30 BSc(Hons) “top up” degree in sexual health ie 120 level 6 on top of DipHE BSc(Hons) “top up” degree in sexual health ie 120 level 6 on top of DipHE PGCert & Masters in sexual health PGCert & Masters in sexual health Courses: as outlined in the current CPD prospectus Courses: as outlined in the current CPD prospectus

31 Beatrice Kungwengwe General Practice Awards 2011 “runner up” General Practice Awards 2012 “nominee” Sue Myers General Practice Awards 2011 “runner up” Kay Elmy UK Sexual Health Awards 2012 – winner Prof Kathryn Abel, Dr David Evans & Dr Roxane Agnew-Davies UK Sexual Health Awards 2012 – “finalists” Baroness Gould of Potternewton Honorary doctorate in sexual health (2011) Colin Roberts FRCN Former honorary lecturer Well over 2,000 on Sexual Health Skills Dr Kathy French First edited book on sexual health

32 Dr David T Evans Senior lecturer in sexual health


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