Archives of Sexual Behavior

, Volume 47, Issue 2, pp 507–515 | Cite as

The Association Between Men’s Concern About Demonstrating Masculine Characteristics and Their Sexual Risk Behaviors: Findings from the Dominican Republic

  • Paul J. Fleming
  • Clare Barrington
  • Wizdom Powell
  • Ann Gottert
  • Leonel Lerebours
  • Yeycy Donastorg
  • Maximo O. Brito
Original Paper

Abstract

Quantitative analyses exploring the relationship between masculinities and men’s sexual risk behaviors have most commonly used one dimension of masculinities: men’s gender ideology. Examining other dimensions may enhance our understanding of and ability to intervene upon this relationship. In this article, we examined the association between gender role conflict/stress (GRC/S)—men’s concern about demonstrating masculine characteristics—and three different sexual risk behaviors (having two or more sex partners in the last 30 days; never/inconsistent condom use with non-steady partners; and drinking alcohol at last sex) among a sample of heterosexual men in the Dominican Republic who were participating in an HIV prevention intervention (n = 293). The GRC/S Scale we used was adapted for this specific cultural context and has 17 items (α = 0.75). We used logistic regression to assess the relationship between GRC/S and each sexual behavior, controlling for sociodemographic characteristics. In adjusted models, a higher GRC/S score was significantly associated with increased odds of having two or more sex partners in the past 30 days (AOR 1.33, 95 % CI 1.01–1.74), never/inconsistent condom use with non-steady partners (AOR 1.45, 95 % CI 1.04–2.01), and drinking alcohol at last sex (AOR 1.56, 95 % CI 1.13–2.17). These results highlight the importance of expanding beyond gender ideology to understanding the influence of GRC/S on men’s sexual risk behaviors. Interventions should address men’s concern about demonstrating masculine characteristics to reduce the social and internalized pressure men feel to engage in sexual risk behaviors.

Keywords

Masculinity Condoms Alcohol Gender Sexual concurrency HIV 

Notes

Acknowledgments

We would like to thank Martha Perez, Miriam Nova, Riqui Rosario, and Nicolas González for their assistance in recruitment and data collection. This project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000050. We are grateful to the Carolina Population Center for training support (T32 HD007168) and for general support (R24 HD050924). P.J. Fleming was supported by the UNC STD/HIV training Grant (T32AI007001) and subsequently by a NIDA training Grant (T32DA023356). Fieldwork was generously supported by the Explorations in Global Health Award from the UNC Institute for Global Health and Infectious Disease, UNC Carolina Population Center’s Research Residency Award, the Mellon Dissertation Fellowship from UNC’s Institute for the Study of the Americas, and the Koch Travel Award from the Gillings School of Global Public Health at UNC.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. Anderson, J. E. (2003). Condom use and HIV risk among US adults. American Journal of Public Health, 93, 912–914. doi: 10.2105/AJPH.93.6.912.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Archer, J. (2010). Derivation and assessment of a hypermasculine values questionnaire. British Journal of Social Psychology, 49, 525–551. doi: 10.1348/014466609x471525.CrossRefPubMedGoogle Scholar
  3. Barker, G., Ricardo, C., Nascimento, M., Olukoya, A., & Santos, C. (2010). Questioning gender norms with men to improve health outcomes: Evidence of impact. Global Public Health, 5, 539–553. doi: 10.1080/17441690902942464.CrossRefPubMedGoogle Scholar
  4. Barrington, C. (2007). Social networks, norms, and the HIV-related behaviors among the male partners of female sex workers in La Romana, Dominican Republic. Unpublished doctoral disseration, Johns Hopkins University, Baltimore, MD.Google Scholar
  5. Barrington, C., & Kerrigan, D. (2014). Debe cuidarse en la calle: normative influences on condom use among the steady male partners of female sex workers in the Dominican Republic. Culture, Health & Sexuality, 16, 273–287. doi: 10.1080/13691058.2013.875222.CrossRefGoogle Scholar
  6. Barrington, C., Latkin, C., Sweat, M. D., Moreno, L., Ellen, J., & Kerrigan, D. (2009). Talking the talk, walking the walk: Social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic. Social Science and Medicine, 68, 2037–2044. doi: 10.1016/j.socscimed.2009.03.009.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42(2), 155–162. doi: 10.1037/h0036215.CrossRefPubMedGoogle Scholar
  8. Bowleg, L. (2004). Love, sex, and masculinity in sociocultural context: HIV concerns and condom use among African American men in heterosexual relationships. Men and Masculinities, 7, 166–186. doi: 10.1177/1097184X03257523.CrossRefGoogle Scholar
  9. Bowleg, L., Teti, M., Massie, J. S., Patel, A., Malebranche, D. J., & Tschann, J. M. (2011). ‘What does it take to be a man? What is a real man?’: Ideologies of masculinity and HIV sexual risk among Black heterosexual men. Culture, Health & Sexuality, 13, 545–559. doi: 10.1080/13691058.2011.556201.CrossRefGoogle Scholar
  10. Brito, M. O., Caso, L. M., Balbuena, H., & Bailey, R. C. (2009). Acceptability of male circumcision for the prevention of HIV/AIDS in the Dominican Republic. PLoS ONE, 4(11), e7687. doi: 10.1371/journal.pone.0007687.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Brito, M. O., Lerebours, L., Volquez, C., Basora, E., Khosla, S., Lantigua, F., … Bailey, R. C. (2015). A clinical trial to introduce voluntary medical male circumcision for HIV prevention in areas of high prevalence in the Dominican Republic. PLoS ONE, 10(9), e0137376. doi: 10.1371/journal.pone.0137376.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Brito, M. O., Luna, M., & Bailey, R. C. (2010). The feasibility and acceptability of male circumcision among men, women, and health providers of the Altagracia Province, Dominican Republic. AIDS Care, 22, 1530–1535. doi: 10.1080/09540121.2010.484455.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Connell, R. W. (1987). Gender and power. Stanford, CA: Stanford University Press.Google Scholar
  14. Connell, R. W. (1995). Masculinities. Berkeley: University of California Press.Google Scholar
  15. Copenhaver, M. M., Lash, S. J., & Eisler, R. M. (2000). Masculine gender role stress, anger and male intimate abusiveness: Implications for men’s relationships. Sex Roles, 42, 405–414. doi: 10.1023/A:1007050305387.CrossRefGoogle Scholar
  16. Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science and Medicine, 50, 1385–1401. doi: 10.1016/S0277-9536(99)00390-1.CrossRefPubMedGoogle Scholar
  17. de Moya, E. A. (2003). Versiones y subversiones de la masculinidad en la cultura dominicana. Perspectivas Psicológicas, 3, 184–190.Google Scholar
  18. de Moya, E. A. (2004). Power games and totalitarian masculinity in the Dominican Republic. In R. Reddock (Ed.), Interrogating Caribbean masculinities: Theoretical and empirical analyses (pp. 68–102). Kingston: University of West Indies Press.Google Scholar
  19. DIGECITSS. (2014). El Estado Epidemico del VIH en Republica Dominicana [The state of the HIV epidemic in the Dominican Republic]. Santo Domingo: DIGECITSS.Google Scholar
  20. Dunkle, K. L., & Jewkes, R. (2007). Effective HIV prevention requires gender-transformative work with men. Sexually Transmitted Infections, 83, 173–174. doi: 10.1136/sti.2007.024950.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Dworkin, S. L., Fleming, P. J., & Colvin, C. J. (2015). The promises and limitations of gender-transformative health programming with men: Critical reflections from the field. Culture, Health & Sexuality, 17(Suppl. 2), S128–S143. doi: 10.1080/13691058.2015.1035751.CrossRefGoogle Scholar
  22. Dworkin, S. L., Fullilove, R. E., & Peacock, D. (2009). Are HIV/AIDS prevention interventions for heterosexually active men in the United States gender-specific? American Journal of Public Health, 99(6), 981–984. doi: 10.2105/AJPH.2008.149625.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Dworkin, S. L., Treves-Kagan, S., & Lippman, S. A. (2013). Gender-transformative interventions to reduce HIV risks and violence with heterosexually-active men: A review of the global evidence. AIDS and Behavior, 17, 2845–2863. doi: 10.1007/s10461-013-0565-2.CrossRefPubMedGoogle Scholar
  24. Eisler, R. M., & Skidmore, J. R. (1987). Masculine gender role stress: Scale development and component factors in the appraisal of stressful situations. Behavior Modification, 11, 123–136.CrossRefPubMedGoogle Scholar
  25. Fleming, P. J., Barrington, C., Pearce, L. D., Lerebours, L., Donastorg, Y., & Brito, M. O. (2016a). “I feel like more of a man”: A mixed methods study of masculinity, sexual performance, and circumcision for HIV prevention. Journal of Sex Research. doi: 10.1080/00224499.2015.1137539.PubMedPubMedCentralGoogle Scholar
  26. Fleming, P. J., Barrington, C., Perez, M., Donastorg, Y., & Kerrigan, D. (2014). Amigos and amistades: The role of men’s social network ties in shaping HIV vulnerability in the Dominican Republic. Culture, Health & Sexuality, 16, 883–897. doi: 10.1080/13691058.2014.919028.CrossRefGoogle Scholar
  27. Fleming, P. J., DiClemente, R. J., & Barrington, C. (2016b). Masculinity and HIV: Dimensions of masculine norms that contribute to men’s HIV-related sexual behaviors. AIDS and Behavior, 20(4), 788–798. doi: 10.1007/s10461-015-1264-y.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Fleming, P. J., Harris, K. M., Halpern, C. T. (2016c). Description and evaluation of a measurement technique for assessment of performing gender. Sex Roles. doi: 10.1007/s11199-016-0657-3.
  29. Gilmore, D. D. (1990). Manhood in the making: Cultural concepts of masculinity. New Haven, CT: Yale University Press.Google Scholar
  30. Glanz, K., & Schwartz, M. D. (2008). Stress, coping, and health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (pp. 211–236). San Francisco, CA: Jossey-Bass.Google Scholar
  31. Gottert, A., Barrington, C., Pettifor, A., McNaughton-Reyes, H. L., Maman, S., MacPhail, C., … Lippman, S. A. (2016). Measuring men’s gender norms and Gender Role Conflict/Stress in a high HIV-prevalence South African setting. AIDS and Behavior, 20(8), 1785–1795. doi: 10.1007/s10461-016-1374-1.
  32. Gupta, G. R. (2000). HIV/AIDS: The what, the why and the how. Paper presented at the International AIDS Conference, Durban, South Africa. Retrieved from http://siteresources.worldbank.org/EXTAFRREGTOPGENDER/Resources/durban_speech.pdf
  33. Jakupcak, M., Lisak, D., & Roemer, L. (2002). The role of masculine ideology and masculine gender role stress in men’s perpetration of relationship violence. Psychology of Men & Masculinity, 3, 97–106. doi: 10.1037/1524-9220.3.2.97.CrossRefGoogle Scholar
  34. Jewkes, R., Sikweyiya, Y., Morrell, R., & Dunkle, K. (2011). Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: Findings of a cross-sectional study. PLoS ONE, 6(12), e29590. doi: 10.1371/journal.pone.0029590.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., & Jooste, S. (2007). Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: Systematic review of empirical findings. Prevention Science, 8, 141–151. doi: 10.1007/s11121-006-0061-2.CrossRefPubMedGoogle Scholar
  36. Levant, R. F., Hirsch, L. S., Celentano, E., & Cozza, T. M. (1992). The male role: An investigation of contemporary norms. Journal of Mental Health Counseling, 14, 325–337.Google Scholar
  37. Lippa, R. A., & Connelly, S. (1990). Gender diagnosticity: A new Bayesian approach to gender-related individual differences. Journal of Personality and Social Psychology, 59, 1051–1063. doi: 10.1037/0022-3514.59.5.1051.CrossRefGoogle Scholar
  38. Mah, T. L., & Halperin, D. T. (2010). Concurrent sexual partnerships and the HIV epidemics in Africa: Evidence to move forward. AIDS and Behavior, 14, 11–16. doi: 10.1007/s10461-008-9433-x.CrossRefPubMedGoogle Scholar
  39. Malebranche, D. J., Gvetadze, R., Millett, G. A., & Sutton, M. Y. (2012). The relationship between gender role conflict and condom use among Black MSM. AIDS and Behavior, 16, 2051–2061. doi: 10.1007/s10461-011-0055-3.CrossRefPubMedGoogle Scholar
  40. Matser, A., Heiligenberg, M., Geskus, R., Heijman, T., Low, N., Kretzschmar, M., & van der Loeff, M. S. (2014). The importance of partnership factors and individual factors associated with absent or inconsistent condom use in heterosexuals: A cross-sectional study. Sexually Transmitted Infections, 90(4), 325–331. doi: 10.1136/sextrans-2013-051087.CrossRefPubMedGoogle Scholar
  41. Messner, M. A. (1997). Politics of masculinities: Men in movements. Lanham, MD: Altamira Press.Google Scholar
  42. Montano, D. E., & Kasprzyk, D. (2008). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In K. Glanz, B. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research and practice (4th ed., pp. 67–96). San Francisco, CA: Jossey-Bass.Google Scholar
  43. O’Neil, J. M. (2008). Summarizing 25 years of research on men’s gender role conflict using the Gender Role Conflict Scale: New research paradigms and clinical implications. The Counseling Psychologist, 36, 358–445. doi: 10.1177/0011000008317057.CrossRefGoogle Scholar
  44. O’Neil, J. M. (2015). Men’s gender role conflict: Psychological costs, consequences, and an agenda for change. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  45. O’Neil, J. M., Helms, B. J., & Gable, R. K. (1986). Gender-Role Conflict Scale: College men’s fear of femininity. Sex Roles, 14, 335–350. doi: 10.1007/BF00287583.Google Scholar
  46. Padilla, M. (2008). Caribbean pleasure industry: Tourism, sexuality, and AIDS in the Dominican Republic. Chicago, IL: University of Chicago Press.Google Scholar
  47. Pleck, J. H. (1981). The myth of masculinity. Cambridge, MA: MIT Press.Google Scholar
  48. Pleck, J. H. (1995). The gender role strain paradigm: An update. In R. F. Levant & W. S. Pollack (Eds.), A new psychology of men (pp. 11–32). New York, NY: Basic Books.Google Scholar
  49. Pulerwitz, J., & Barker, G. (2008). Measuring attitudes toward gender norms among young men in Brazil: Development and psychometric evalutation of the GEM Scale. Men and Masculinities, 10, 322–338. doi: 10.1177/1097184X06298778.CrossRefGoogle Scholar
  50. Pulerwitz, J., Michaelis, A., Verma, R., & Weiss, E. (2010). Addressing dender dynamics and engaging men in HIV programs: Lessons learned from Horizons research. Public Health Reports, 125, 282–292. doi: 10.2307/41434782.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Reidy, D. E., Brookmeyer, K. A., Gentile, B., Berke, D. S., & Zeichner, A. (2016). Gender role discrepancy stress, high-risk sexual behavior, and sexually transmitted disease. Archives of Sexual Behavior, 45, 459–465. doi: 10.1007/s10508-014-0413-0.CrossRefPubMedGoogle Scholar
  52. Smiler, A. P., & Epstein, M. (2010). Measuring gender: Options and issues. In J. C. Chrisler & D. R. McCreary (Eds.), Handbook of gender research in psychology: Gender research in general and experimental psychology (Vol. 1, pp. 133–157). New York: Springer.Google Scholar
  53. Tate, C. C., Betergarcia, J. N., & Brent, L. M. (2015). Re-assessing the role of gender-related cognitions for self-esteem: The importance of gender-typicality for cisgender adults. Sex Roles, 72, 221–236. doi: 10.1007/s11199-015-0458-0.CrossRefGoogle Scholar
  54. Thompson, E. H., & Pleck, J. H. (1986). The structure of male role norms. American Behavioral Scientist, 29, 531–543. doi: 10.1177/000276486029005003.CrossRefGoogle Scholar
  55. Thompson, E. H., Pleck, J. H., & Ferrera, D. L. (1992). Men and masculinities: Scales for masculinity ideology and masculinity-related constructs. Sex Roles, 27, 573–607. doi: 10.1007/BF02651094.CrossRefGoogle Scholar
  56. Van den Berg, W., Hendricks, L., Hatcher, A., Peacock, D., Godana, P., & Dworkin, S. (2013). ‘One man can’: Shifts in fatherhood beliefs and parenting practices following a gender-transformative programme in Eastern Cape, South Africa. Gender & Development, 21, 111–125. doi: 10.1080/13552074.2013.769775.CrossRefGoogle Scholar
  57. Verma, R. K., Pulerwitz, J., Mahendra, V., Khandekar, S., Barker, G., Fulpagare, P., & Singh, S. K. (2006). Challenging and changing gender attitudes among young men in Mumbai. India. Reproductive Health Matters, 14(28), 135–143.CrossRefPubMedGoogle Scholar
  58. Williams, D. R. (2003). The health of men: Structured inequalities and opportunities. American Journal of Public Health, 93, 724–731. doi: 10.2105/AJPH.93.5.724.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior, 27, 539–565. doi: 10.1177/109019810002700502.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Paul J. Fleming
    • 1
    • 2
  • Clare Barrington
    • 2
  • Wizdom Powell
    • 2
  • Ann Gottert
    • 3
  • Leonel Lerebours
    • 4
  • Yeycy Donastorg
    • 5
  • Maximo O. Brito
    • 6
  1. 1.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA
  2. 2.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  3. 3.Population CouncilWashingtonUSA
  4. 4.Clinica de FamiliaLa RomanaDominican Republic
  5. 5.HIV Vaccine Trials UnitInstituto Dermatológico y Cirugía de PielSanto DomingoDominican Republic
  6. 6.Division of Infectious DiseasesUniversity of Illinois at ChicagoChicagoUSA

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