Good sex/bad sex: the individualised focus of US HIV prevention policy in sub‐Saharan Africa, 1995–2005

Abstract

The expanding reliance on the health sciences to address social problems is well documented, as are the effects of the social construction of public (health) problems on ‘target’ populations, intervention design and broader social systems. Less attention has been given in the literature to the cultural meanings that configure public health efforts themselves. This study demonstrates how the cultural understandings of sex and sexuality that inform US human immunodeficiency virus (HIV) prevention policy in sub‐Saharan Africa shape policy recommendations. Based on an analysis of 119 US policy documents, a relatively stable and highly gendered narrative of sexual risk was found across the Clinton and (G.W.) Bush administrations. This narrative locates HIV risk in (what is constructed to be) the inevitable clash between women’s sexuality and men’s sexuality, and delineates HIV risk by the form of relationship in which sex occurs. The two narratives diverge at this point, offering different definitions of ‘bad’ sex and ‘good’ sex. This divergence helps to explain the different prevention foci of the administrations – condoms during the Clinton era and abstinence‐outside‐of‐marriage during the Bush administration. In both cases, the sexual risk narrative points to individual targeted prevention strategies, even as the policy identifies structural factors as driving global HIV epidemics.

Gendered health institutions: examining the organization of health services and men’s use of HIV testing in Malawi

“…Men's representation improved slightly when excluding publications dedicated to children, women and prevention of motherto-child transmission (PMTCT), however, even in "gender neutral" documents, women were still twice as likely to be mentioned as men (7,719 vs. 3,697 times). Similarly, among 119 policy documents from the President's Emergency Plan for AIDS Relief, men were rarely mentioned, and when they were, men were often portrayed as perpetrators of the epidemic [11]. Men's absence from international guidelines is important because such documents largely shape national policies, and in turn, the structure of HIV services in local health facilities [12,13].…”

Ideals as Anchors for Relationship Experiences

“…Since the onset of the AIDS epidemic, young people in sub-Saharan Africa are coming of age in a context of heightened risk that encompasses both the biological risk of HIV infection and the social risks accompanying high levels of relationship instability (Angotti et al 2014; Esacove 2012). Despite these risks, the centrality of romantic relationships to the pursuit of a good life remains pronounced (Cole and Thomas 2009).…”

“…Across the globe, young adults pursue romantic relationships that carry possibilities of positive outcomes (e.g., intimacy, social esteem, and financial stability) as well as risks of negative outcomes (e.g., sexually transmitted infection, unwanted pregnancy, and emotional anguish). Since the onset of the AIDS epidemic, young people in sub-Saharan Africa are coming of age in a context of heightened risk that encompasses both the biological risk of HIV infection and the social risks accompanying high levels of relationship instability (Angotti et al 2014; Esacove 2012). Despite these risks, the centrality of romantic relationships to the pursuit of a good life remains pronounced (Cole and Thomas 2009).…”

“…In both industrialized and developing contexts, young adults’ aspirations, perceptions, and decisions about romantic relationships are conditioned by shared cultural models, which vary by social class (Cole and Thomas 2009; Hamilton and Armstrong 2009; Hunter 2010), political climate (Esacove 2012; Schalet 2011; Swidler 2001), religious affiliation (Regnerus 2007; Trinitapoli and Weinreb 2012), and the micro-level normative environment of schools, peer groups, and neighborhoods (Harding 2007; Meier 2007; Poulin 2007). In the United States, short- and long-term emotional consequences of sex are conditional on people’s cultural beliefs and moral or religious standards.…”

Parents, peers and pornography: the influence of formative sexual scripts on adult HIV sexual risk behaviour among Black men in the USA

“…Traditional models and theories of behaviour in public health often emphasise individuallevel influences and rational decision-making and, as a result, many HIV-prevention and education programmes focus on changing attitudes, knowledge and skills, often without considering larger structural contexts (Adimora and Auerbach 2010; Barnett and Parkhurst 2005;Esacove 2012;Ogden et al 2011). Sociocultural influences such as masculinity ideology (men's beliefs about the importance of adhering to culturally defined standards for male behaviour) may also have a significant impact on HIV-related sexual-risk behaviours, particularly among Black Americans (Adimora and Schoenbach 2002;Cochran and Mays 1993).…”