Challenging machismo: promoting sexual and reproductive health with Nicaraguan men

Exploring sexual awareness and Decision-making among adolescent girls and boys in rural Nicaragua: A socio-ecological approach

OBJECTIVE

To explore how individual, relational, and social contexts influence adolescents' sexual awareness and decision-making in rural Nicaragua.

METHODS

Eighteen semi-structured interviews were conducted with adolescent boys and girls aged 15 to 19 years. Thematic analysis identified patterns of meaning applying a socio-ecological approach. A thematic map illustrates how the themes are organized according to the socio-ecological model and suggests their interactions.

RESULTS

Six main themes emerged as (1) Adolescence - a period of life changes, (2) Fears as a pathway to awareness and decision-making, (3) Awareness about protective measures, (4) Relational influences on adolescents' sexual health, (5) Service provision and institutional influences on awareness and decision-making and (6) Sociocultural determinants on adolescent sexual health. Informants of both genders expressed concern in several issues of their sexuality. They identified fear of pregnancy, STIs, and their impact on future goals, family communication, and school-based sexual education as protective factors for their sexual decision-making. Adolescents of both genders are challenging social and cultural norms by developing sexual agency.

CONCLUSION

These findings imply that personal and societal factors in rural Nicaragua produce a multi-dimensional effect on adolescent sexual self-efficacy. Our study is relevant for a wider discussion about sexual awareness to promote positive development and health outcomes particularly among adolescents' girls and boys living in rural settings.

Intimate Partner Violence Against Indigenous Women in Sololá, Guatemala: Qualitative Insights Into Perspectives of Service Providers

Over a third of women in Guatemala are subjected to intimate partner violence (IPV). Indigenous Mayan women are particularly vulnerable, due to the intersection of race, gender, and poverty. However, no research exists into the causes of IPV among this group. Our pioneering study addresses this knowledge gap. Our results from in-depth interviews with service providers in Sololá highlight four interlinked causes of IPV: rigid gender roles, lack of awareness of women's rights, use of alcohol by men, and poor reproductive health. From these, we draw implications for service provision to victims of IPV.

Where boys don't dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices

Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women’s rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women’s rights language, notably for causing violations of women’s right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women’s rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women’s rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women’s capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps.

Preliminary Findings of the Links Between Gender Role Attitudes and Sexual Behaviors in Mexican American Early Adolescent Boys

This study explored the relations between Latino gender role attitudes (traditional machismo attitudes and caballerismo attitudes) and sexual behaviors among 242 Mexican American early adolescent boys in the southwest United States. Specifically, a multiple mediator model estimated the association between gender role attitudes and sexual activity through a mediational pathway connecting substance use, sexual motives, and peer influence. Results from analyzing this structural equation model indicated that traditional machismo attitudes were not associated with sexual behaviors. Caballerismo gender role attitudes, however, were indirectly linked with reduced sexual motives and substance via peer influence. This study underscores the importance of social context, behavior, and psychological motivations in explaining differences in sexual motives and substance use among young Mexican American adolescent boys who hold different kinds of beliefs about their gender.

"Regardless, you are not the first woman": an illustrative case study of contextual risk factors impacting sexual and reproductive health and rights in Nicaragua

Background

Rape, unintended pregnancy, and abortion are among the most controversial and stigmatized topics facing sexual and reproductive health researchers, advocates, and the public today. Over the past three decades, public health practicioners and human rights advocates have made great strides to advance our understanding of sexual and reproductive rights and how they should be protected. The overall aim of the study was to understand young women’s personal experiences of unintended pregnancy in the context of Nicaragua’s repressive legal and sociocultural landscape. Ten in-depth interviews (IDIs) were conducted with women ages 16–23 in a city in North Central Nicaragua, from June to July 2014.

Case presentation

This case study focuses on the story of a 19-year-old Nicaraguan woman who was raped, became pregnant, and almost died from complications resulting from an unsafe abortion. Her case, detailed under the pseudonym Ana Maria, presents unique challenges related to the fulfillment of sexual and reproductive rights due to the restrictive social norms related to sexual health, ubiquitous violence against women (VAW) and the total ban on abortion in Nicaragua. The case also provides a useful lens through which to examine individual sexual and reproductive health (SRH) experiences, particularly those of rape, unintended pregnancy, and unsafe abortion; this in-depth analysis identifies the contextual risk factors that contributed to Ana Maria’s experience.

Conclusions

Far too many women experience their sexuality in the context of individual and structural violence. Ana Maria’s case provides several important lessons for the realization of sexual and reproductive health and rights in countries with restrictive legal policies and conservative cultural norms around sexuality. Ana Maria’s experience demonstrates that an individual’s health decisions are not made in isolation, free from the influence of social norms and national laws. We present an overview of the key risk and contextual factors that contributed to Ana Maria’s experience of violence, unintended pregnancy, and unsafe abortion.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0771-9) contains supplementary material, which is available to authorized users.

A qualitative view of the HIV epidemic in coastal Ecuador

In 2013 approximately 37,000 people were living with HIV in Ecuador (prevalence 0.4%), representing a generalized epidemic where most new infections arise from sexual interactions in the general population. Studies that examine attitudes towards people living with HIV (PLWH), individual risk perception of acquiring HIV amongst Ecuadorians, and the ways in which levels of risk perception may affect risk behaviors are lacking. This qualitative study aimed to fill this gap in the literature by investigating these issues in the rural, coastal community of Manglaralto, Ecuador, which has among the highest incidence of HIV in Ecuador. We conducted interviews with 15 patients at Manglaralto Hospital. Analysis of interview transcripts revealed widespread negative attitudes towards PLWH, prevalent risk behaviors such as multiple sex partners and lack of condom use, and low individual risk-perception of contracting HIV. These findings underscore the need for increased efforts to prevent further growth of the HIV epidemic in Ecuador.

Mexican Men's View of Vasectomy

The present study explored the views of Mexican men concerning vasectomy. One hundred and five men who had not had a vasectomy were asked to complete the following phrase "If you no longer wanted to have more children and a vasectomy was suggested, you would react with . . . or you would think . . . " with at least five different answers. Participants then had to rank each of their answers according to how well they describe the participant's feelings in the hypothetical situation. The results were analyzed using the Natural Semantic Networks Technique. The most common words used by participants with a limited educational background were reject, followed by fear and anger, and they did not use any words that implied acceptance of vasectomy. In contrast, the most common words used by participants with higher education were curiosity, followed by acceptance and interest; however, they also used the words fear and insecurity. The most frequent attitudes reported by men with limited education were negative, whereas participants with a higher education reported more ambivalent attitudes. These findings are discussed in light of sociocultural features and could be helpful in designing reproductive health programs with more effective counseling to diminish negative views about vasectomy.

The Explanatory Role of Relationship Power and Control in Domestic Violence Against Women in Nicaragua

This study offers a feminist psychology analysis of various aspects of relationship power and control and their relative explanatory contribution to understanding physical, psychological, and sexual violence against women. Findings from structured interviews with 345 women from rural Nicaragua ( Mage = 44) overwhelmingly demonstrate that measures of power and control reflecting interpersonal relationship dynamics have the strongest predictive power for explaining violence when compared in multivariate analyses to several of the more commonly used measures. These findings have implications for future research and the evaluation of interventions designed to decrease levels of violence against women.

Focus group discussions in community-based participatory research to inform the development of a human papillomavirus (HPV) educational intervention for Latinas in San Diego

The purpose of this paper is to demonstrate the usefulness of formative focus groups as a community-based participatory research (CBPR) method in developing cancer education programs. Two focus groups were conducted according to CBPR principles, in order to develop a community-competent human papillomavirus (HPV)/cervical cancer educational program for Latinas living in the USA/Mexico border region. Focus group participants were 18 female Mexican American community health advisors. Participants reported that there is limited information and many myths about HPV and the vaccine in the Latino/Latina community, along with many barriers to acceptance of HPV/cervical cancer-related information. Furthermore, participants discussed their recommendations for the development of a culturally appropriate HPV educational program. From these data, we have a better understanding of the HPV/cervical cancer educational approach that will be most accepted in the community and what key information needs to be provided to women who participate in the program, which reinforces the importance of the CBPR approach to the formative phase of cancer education program development.

Choosing between Traditional Medicine and Allopathy During Pregnancy: Health Practices in Prenatal and Reproductive Health Care in Ecuador

Research and programmes to date have addressed the prevalence of maternal morbidity and mortality in many developing countries. Literature has explored the direct and indirect factors influencing maternal risk, and programmes have attempted to mitigate many of the persistent factors. While addressing health system factors and socioeconomic barriers is imperative, understanding women’s perceptions within the cultural context in which they live is a necessary step for improving interventions aimed at reducing maternal morbidity and mortality. This study seeks to contribute to the existing evidence regarding Ecuadorian women’s prenatal health care seeking perceptions and behaviours. The paper will explore and describe the perceptions and experiences of pregnant women attending the antenatal intercultural clinic regarding the care they receive from both midwives and obstetricians. It will also provide recommendations for improving current strategies being implemented in Ecuador in the domain of prenatal and reproductive health care, with a special focus on indigenous people and intercultural health.

'We do the impossible': women overcoming barriers to cervical cancer screening in rural Honduras--a positive deviance analysis

Cervical cancer is the leading cause of cancer death for women in Honduras, and sexual behaviour and low screening uptake are two major factors contributing to high rates of morbidity and mortality. A qualitative study was conducted to investigate barriers that prevent rural Honduran women from engaging in screening and ways that women overcome those barriers. This study examined examples of positive deviance, or individuals engaging in the uncommon but beneficial practise of screening. Amor por sí misma (self-love), and social support were identified as two constructs women employed to overcome barriers to screening. Participants defined self-love as the act of displaying care and concern for oneself and one's health and suggested that it compels women to participate in screening. Social support was defined as receiving tangible aid and advice from others that facilitated women's screening participation. Findings suggest that the concept of self-love could be used in future screening promotion efforts and that integrating social support would also be beneficial. Engaging men in sexual and reproductive health programming is suggested in order to ensure male partners offer social support for screening and to challenge the cultural, gender and sexual norms that place women at higher risk for cervical cancer.

Reducing cultural and psychological barriers to Latino enrollment in HIV-prevention counseling: initial data on an enrollment meta-intervention

Aspects of Latino culture (e.g., machismo, marianism) can act as barriers to enrollment in HIV-prevention programs. To lift these barriers, a culturally appropriate meta-intervention was designed to increase intentions to enroll in HIV-prevention counseling by Latinos. Latino participants (N=41) were recruited from the community and randomly assigned to either an experimental or control meta-intervention condition that varied the introduction to a HIV-prevention counseling program. Following the meta-intervention, participants were issued an invitation to take part in HIV-prevention counseling. The outcome measure was the intention to enroll in a HIV-prevention counseling session. Findings indicated that enrollment intentions were higher in the experimental meta-intervention condition (96%) than in the control meta-intervention condition (53%). In addition, the effects of the meta-intervention were comparable across genders and participant ages. Findings suggest that the use of a culturally appropriate meta-intervention may be an effective strategy for increasing Latino enrollment in HIV-prevention programs. These promising findings warrant further investigation into the efficacy and effectiveness of this meta-intervention.

Mexican beliefs and attitudes toward hysterectomy and gender-role ideology in marriage

One hundred and sixty-one Mexican respondents completed a questionnaire that measured beliefs and attitudes toward hysterectomy and another that measured gender-role ideology in marriage (GRIMQ). The participants were divided into two groups according to the GRIMQ: "high machismo/marianismo" and "low machismo/marianismo" groups. The participants belonging to the first group showed the most negative attitudes toward hysterectomy. In this group, men showed more negative attitudes toward hysterctomy and were less likely than women to believe that hysterectomy has positive aspects. The findings are discussed in light of male dominance and female subordination that prevail in certain cultural groups of Mexico.xs.

Sexuality and risk behavior among men who have sex with men in León, Nicaragua: a mixed methods approach

INTRODUCTION

HIV prevalence among men who have sex with men (MSM) is 38 times higher than among the general population in Nicaragua. There are little data about the sexuality and sexual behaviors of MSM. It is essential to gain a better understanding of this understudied population.

AIMS

The nature of sexual relationships among MSM, their reasons for engaging in risky sexual behaviors, and the sociocultural context in León, Nicaragua, were investigated through in-depth interviews. Our findings resulted in a structured overview of sociodemographic characteristics and HIV-related knowledge, attitudes, and risk behaviors.

METHODS

Fifteen participants recruited by purposive sampling completed an in-depth interview that was then thematically analyzed. An additional 104 participants were surveyed by means of an interviewer-administered questionnaire.

MAIN OUTCOME MEASURES

The in-depth interview guide and the survey covered topics related to sociodemographics, childhood, social and sexual relationships, knowledge and attitudes toward HIV and AIDS, identity, and networks.

RESULTS

The resulting ecological model explored sexuality and behaviors in four categories. It showed that despite a homophobic and heterosexist society, there is an increasing gay community and greater social acceptance of homosexuality. Nevertheless, interpersonal and intrapersonal factors continue to negatively influence MSM behavior. Quantitative findings demonstrate a satisfactory understanding of HIV transmission among this population, 75% of whom reported concerns of becoming infected with HIV in the future. Approximately one-half claimed that they always used condoms when having sex with men, but only one-third of the time with women, indicating inconsistent condom use. Negative attitudes toward HIV/AIDS were seldom heard.

CONCLUSIONS

This study is the first mixed methods approach in a Nicaraguan context that shows the interrelations among sex, sexuality, and identity at various levels of MSM life, and how they influence the sexual risk behaviors of individuals. Engaging in unprotected sex and postponing HIV testing are seen as cognitive dissonances.

Masculinity scripts and abstinence-related beliefs of rural Nigerian male youth

This study interrogates the direct perspectives of rural Nigerian male youth regarding the preventive practice of "abstinence until marriage." The study shows that norms of masculinity suffuse Nigerian male youth narratives surrounding the benefits and hazards of abstinence. Key gender norms that frame male youth views of the consequences of abstention included those that cast men as strong-willed and resolute, represent sexual activity as a central marker of malehood, depict male sexuality as naturally dominant and aggressive, emphasize male sexual potency, associate maleness with power and leadership, and portray sexual activity as normal, proper, and permissible for males. Inattention to the norms and scripts that organize sexual behavior, especially among male youth, portends danger for abstinence-until-marriage programs.

Predictors of unprotected sex among young sexually active African American, Hispanic, and White MSM: the importance of ethnicity and culture

Despite the recognized need for culturally tailored HIV prevention interventions for gay, bisexual, and questioning youth, few studies have examined if predictors of unprotected sex vary for youth from different ethnic groups. This study reports on a sample of 189 gay, bisexual, and questioning youth (age 15-22) from three racial/ethnic backgrounds (African American, Hispanic, and White) recruited in Chicago, IL and Miami-Dade and Broward Counties, Florida. For African American youth, being in a long-term relationship, having been kicked out of the home for having sex with men, and younger age at initiation of sexual behavior were associated with unprotected sex. For Hispanic youth, higher ethnic identification and older age at initiation of sexual behavior were associated with unprotected sex. For White youth, no predictors were associated with unprotected sex. Our findings point to the importance of understanding the varying predictors of unprotected sex and integrating them into tailored prevention interventions.

Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in León, Nicaragua: implications for HIV prevention

There are few peer-reviewed studies of HIV/AIDS-related knowledge, attitudes, beliefs and practices among adolescents in Central America. A population-based cross-sectional survey was conducted among 246 adolescents in León, Nicaragua, where there is reason for concern about a rise in HIV infections. In many respects, León adolescents were typical of those in other Latin American countries, with a mixture of correct and incorrect knowledge about transmission of HIV and sexually transmitted infections, a higher proportion of males than females reporting having had sex or using condoms, and inconsistent condom use. While some sexual attitudes conformed to the ideology of machismo, others did not, providing an opening for prevention interventions. Some dimensions of HIV/AIDS stigma were high, and most adolescents disapproved of same-sex sexual behaviour. Intervention against homosexuality-related stigma is particularly urgent because a concentrated HIV epidemic may be emerging in Nicaragua among men who have sex with men. Personal religious beliefs did not appear to pose a barrier to condom use. In a multivariate model, being out of school was a significant correlate of having had sex and of insufficient HIV/AIDS-related knowledge. Accordingly, HIV prevention interventions must reach adolescents both in and out of school. A multi-component approach to prevention is needed, including programmes based in schools, communities, the mass media and health facilities.