Men, Masculinities and Sexual and Reproductive Health in Botswana
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Men, Masculinities and Sexual and Reproductive Health in Botswana By Serai Daniel Rakgoasi A Thesis Submitted in fulfillment of the requirements of the Degree of Doctor of Philosophy University of Witwatersrand March 2010 i Men, Masculinities and Sexual and Reproductive Health in Botswana DECLARATION Except where indicated, this thesis is based upon original research conducted by the author as a scholar at the University of the Witwatersrand from November 2005 to November 2009 Serai Daniel Rakgoasi September 30, 2010 ii Men, Masculinities and Sexual and Reproductive Health in Botswana SPONSORSHIP ACKNOWLEDGEMENT I am deeply thankful to the University of Botswana for generously funding my studies, and for allowing me time off work to purse this degree. I will always be grateful for your support during the four years that was my leave. I am also thankful to the Fogarty Foundation for the pre-doctoral award, which came at a time of great uncertainty about how I was going to finance the last stages of my thesis preparation. The award was timely and allowed me the space and peace of mind to complete my studies without undue worry about financial matters. iii Men, Masculinities and Sexual and Reproductive Health in Botswana ACKNOWLEDGEMENTS I thank God, the omnipresent, the unknowable, and unnamable for the life, guidance and protection and all the blessings in my life, and most of all for uplifting my spirit through numerous challenges. Many people contributed towards this work and I owe mountains of gratitude each one of them. I would like to especially thank my supervisor Professor Clifford Obi Odimegwu for his constant support, encouragement and direction. I thank you Prof for your constant encouragement during many difficult moments when it would have been much easier to give up than to persevere. You were always there to nurture my belief and allowed me space to develop confidence in my abilities. Words cannot adequately express just how much you inspired me or the gratitude I feel for your mentoring. My sincerest thanks go to the University of the Witwatersrand Research Ethics Board, for your inputs and advice on the ethical issues of this study. My thanks also go to the Human Research Ethics Committee of the Ministry of Health in Botswana for reviewing and advising on the study tools and methodology. To the staff of the Department of Demography and Population (Wits) and the Department of Population Studies (UB), thanks for allowing me the time and providing the resources necessary for this work. I also wish to express gratitude to my colleagues at the University of Botswana who motivated and encouraged me through their insights and criticism to pursue this study. To my fellow PhD candidates at the University of the Witwatersrand, thanks for the camaraderie. To my colleagues and business partner, Joe Pitso, thanks for holding the fort during my absence, and for going through the difficulties that arose as a result of my prolonged absence. The only way I can pay you back is to ensure that ICRE sours and reaches the heights that we know it is going to reach soon! Thanks for the support and words of wisdom through the ages mate! iv Men, Masculinities and Sexual and Reproductive Health in Botswana I wish to express the deepest and heartfelt gratitude to Rose, my wife, friend, confidante and companion, for holding the fort and keeping our family together during many challenging times when I was absent from home and the kids. Your dedication and resiliency in supporting my studies while at the same time taking care of the needs of the family made all the difference, and in the end, was the life line that allowed me to focus on my work. The challenges that we have experienced together will make us stronger. Thanks for 17 blissful years, it feels like 17days. I’d do it all over again! You are the rose in my life and I love you. To all my children, Gomolemo, Lame and Leatile, thanks for being an inspiration in my life. To all of you, I recognize the sacrifice you made during the weeks and months that I was away from home and couldn’t be there to help with your school work or play tennis, basketball or soccer together! To my siblings, Susan, Gatote, Pule and Happy – I love you all, and thanks for being there for my family during my absence. To my nieces and nephews, you are a blessing in my life and a constant source of inspiration. To my parents, George and Lizzie - I couldn’t ask for a better blessing than to have you two as my parents. You have inspired every aspect and stage of my life through your presence, patience and love. The peace and serenity that pervades your union even in the midst of life’s challenges are a constant inspiration in my life, my marriage and as a father to my children. To my other three dads, Ramogolo Reuben (Chechi)[God bless his soul] and Keoreketswe (Socks BBX), to my aunts, Mamogolo Queen and Mmangwane Joyce thanks for your love, guidance and protection during those times when I didn’t even know myself. I have a great balance in life because of the nurturing of my three dads and three moms. Who could ask for more? My paternal aunts Rakgadi Morwadi, Mma Bushy, MmaStokie, you are all truly special, thanks for your love and confidence in me. My maternal aunts MmaThandi and MmaDuu, I love you dearly. v Men, Masculinities and Sexual and Reproductive Health in Botswana ABSTRACT This thesis investigates the role of masculinities on men’s sexual and reproductive health in Botswana. Botswana is currently in the throes of a severe heterosexually driven HIV/AIDS epidemic that has eroded some of the developmental gains the country had achieved since independence. A unique feature of Botswana’s HIV epidemic is the rapid and phenomenal increase in infection and prevalence rates in the face of good levels of knowledge of HIV prevention and an early and comprehensive HIV prevention strategy that guaranteed access to free HIV prevention and treatment services, including ARV treatment. The lack of effectiveness of the country’s HIV efforts and subsequent increase in infection rates have been blamed on men’s risky sexual behavior and lack of support of their partners’ decisions to utilize these services. In fact, quantitative studies on men’s sexual behavior and HIV such as the Botswana AIDS Impact Surveys show that men are less likely to use VCT services and more likely to engage in risky sexual behavior that increases risk of HIV infection to themselves and their partners. While studies provide the evidence that implicates men in the rapid growth Botswana’s HIV epidemic, the studies provide little or no explanation of factors that motivate men’s behavior in reproductive health. This lack of insights on factors that motivate men’s behavior leads to stereotypes about male promiscuity and may contribute to the lack of effectiveness of HIV prevention strategies. The current HIV epidemic has thus thrust heterosexual masculinities at the centre of HIV prevention efforts and provides an opportunity for research to interrogate the role of heterosexual masculinities in reproductive health, especially HIV transmission and prevention. The thesis employs qualitative data to provide in-depth appreciation of the prevalent masculine norms and beliefs and to highlight contextual factors and processes that shape and give rise to various masculinities. It further uses quantitative data to provide measures of levels of men’s masculine and gender role beliefs that may influence HIV prevention and transmission and to test the association between masculinities and men’s sexual and reproductive health attitudes and practices. The results show that men’s sense of identity is socially constructed, and revolves around the notion of superiority to women, independence and having and being in control of the family. However, men face many challenges to the realization of this masculine ideal. Men’s perceived difficulty or failure to live up to socially constructed vi Men, Masculinities and Sexual and Reproductive Health in Botswana notions of masculinities affects their experience of sexual and reproductive health programs, especially women’s empowerment and HIV prevention programs. By their nature, these programs tend to challenge men’s dominance of women’s decision on sexuality, and are therefore experienced as a threat to some men’s sense of identity. Quantitative results indicate an association between masculinities and sexual and reproductive health. While men’s sense of masculinities is not the overriding factor determining their sexual and reproductive health attitudes and practices, the results show a strong association traditional masculine beliefs and negative sexual and reproductive health beliefs and practices. However, there is also strong evidence that men and masculinities are responding to contextual factors, such as the HIV epidemic, which has become a specific stress on the local construction of masculinities. In focus group discussions, many men challenged traditional masculine norms, beliefs and practices that increase their vulnerability to HIV infection and those that either encourage or condone violence within intimate relationships. Significantly high proportions of men had positive attitudes towards HIV prevention programs. It is evident that now more than ever (and thanks to the HIV/AIDS epidemic) many men are ready to question the predominant masculine norms, beliefs and practices that increase their vulnerability to infection and disease. These voices of change represent a window of opportunity for research and programs can meaningfully engage with men and masculinities on issues of sexuality, gender roles, sexual and reproductive health and HIV/AIDS prevention and transmission. There is need for future research and interventions to move away from focusing exclusively on individual models of preventive health behaviors to more multilevel, cultural and contextual explanations.