An exploratory study of constructions of masculinity, sexuality and HIV/AIDS in Namibia, Southern Africa.
ABSTRACT The goal of the current study was to explore notions of masculinity and their linkages to HIV/AIDS among Owambo men and women in Namibia, where an estimated one-fifth of 15-49 year-olds have acquired HIV. Thirteen open-ended interviews and three focus groups were conducted with 50 male and female participants aged 19-50 in rural and urban Namibia. Qualitative analysis revealed six central themes: the evolving meanings of masculinity, power dynamics between men and women, women as active agents, the tension between formal and informal education and HIV transmission, alcohol and masculinity, and the blending of masculinity and explanations of HIV and AIDS. The findings suggest both direct and indirect linkages between notions of masculinity and AIDS, and highlight the need for prevention efforts that focus on providing alternative avenues for attaining culturally recognized markers of masculinity.
- SourceAvailable from: Moses Kelly Kumwenda[Show abstract] [Hide abstract]
ABSTRACT: Men's healthcare-seeking delay results in higher mortality while on HIV or tuberculosis (TB) treatment, and implies contribution to ongoing community-level TB transmission before initiating treatment. We investigated masculinity's role in healthcare-seeking delay for men with TB-suggestive symptoms, with a view to developing potential interventions for men.BMC Public Health 10/2014; 14(1):1053. · 2.08 Impact Factor
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ABSTRACT: Background: To date, whilst there have been many published studies exploring the links between masculinity and HIV, not much work has been done to explore how an HIV-positive diagnosis impacts men's sense of masculinity and contextualizing the masculinities as fluid and changing. Objective: To explore how human immunodeficiency virus (HIV) impacts the lives of men and their constructions of masculinity through interviews with 18 men living with HIV. Design: Qualitative study involving conveniently and purposively selected black South African adult men who lived with HIV. In-depth interviews were conducted with 18 men who resided in Johannesburg and Mthatha, South Africa. Results: Our analysis suggests that the performance of risky masculinity may influence the acquisition of HIV. Yet, it also reveals that HIV can have a significant effect on men and their masculinities. Men's constructions of harmful notions of hegemonic masculinity pre-HIV diagnosis negatively affected their help-seeking behavior and coping and adjustment to living with HIV, post-diagnosis. The dominant discourse that men are strong and healthy visibly presented challenges for men when faced with an HIV-positive status. They interpreted HIV diagnosis as a loss, a sign of failure as a man, and evidence of an inability to retain control. Being sick undermined their ability to perform roles expected of them, and this led to feelings of powerlessness, worthlessness, and distress. Conclusions: Interventions with men living with HIV need to provide safe spaces for men to critically explore gender and constructions of social identities and the pressures these place on men and implications for their health. With this approach, harmful constructions of masculinities may be challenged and mitigated, and this process may render men amenable to change.Global Health Action 01/2014; 7:24631. · 2.06 Impact Factor
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ABSTRACT: This study explores socio-structural factors that influence uptake of antiretroviral treatment (ART) in Zambia and assess differences between men and women. We conducted a case-control study nested in a community- and health facility-based survey, between September 2010 and February 2011. Cases were defined as HIV-positive individuals who, while eligible, never started ART and controls were HIV-positive individuals who were on ART. Cases and controls were matched by place of residence. We performed a conditional logistic regression analysis using a discrete logistic model stratified by sex. Overall, a significantly larger proportion of men (32.7%) than women (25.6%) did not uptake ART (Pearson χ(2) = 5.9135; p = 0.015). In the crude analysis, poor health status and low self-efficacy were common factors associated with non-uptake in both sexes. After adjusting for covariates, men were more likely than women to refuse ART even though men's self-rated health was lower than women's. In general, the adjusted analysis suggests that HIV status disclosure affects uptake in both sexes but women's uptake of ART is largely hampered by poverty-related factors while for men, side effects and social pressure, probably associated with masculinity, are more important barriers. Alarmingly men's health seems to deteriorate until they start treatment, in contrast to women. Understanding gender differences in uptake and attitudes to ART is a crucial component to providing effective and appropriate health care to both men and women living with HIV/AIDS in Zambia.AIDS Care 03/2014; · 1.60 Impact Factor
Psychology, Department of
Faculty Publications, Department of
University of Nebraska - LincolnYear
An exploratory study of constructions of
masculinity, sexuality and HIV/AIDS in
Namibia, Southern Africa
∗University of Nebraska - Lincoln, firstname.lastname@example.org
†University of Nebraska - Lincoln
‡University of Nebraska - Lincoln, email@example.com
This paper is posted at DigitalCommons@University of Nebraska - Lincoln.
Published in Culture, Health, and Sexuality, 7:6 (November/December 2005), pp. 585–598. Copy-
right © 2005 Taylor & Francis. Used by permission. DOI: 0.1080/13691050500250198
An exploratory study of constructions of masculinity,
sexuality and HIV/AIDS in Namibia, Southern Africa
Jill Brown, James Sorrell, & Marcela Raffaelli
University of Nebraska–Lincoln and University of Nebraska Medical Center
Correspondence: Jill Brown, Department of Psychology, University of Nebraska, Lincoln, NE
68588-0380, USA. Email: firstname.lastname@example.org
Abstract: The goal of the current study was to explore notions of masculinity and their linkages
to HIV/AIDS among Owambo men and women in Namibia, where an estimated one-fi fth of 15–
49 year-olds have acquired HIV. Thirteen open-ended interviews and three focus groups were con-
ducted with 50 male and female participants aged 19–50 in rural and urban Namibia. Qualitative
analysis revealed six central themes: the evolving meanings of masculinity, power dynamics be-
tween men and women, women as active agents, the tension between formal and informal educa-
tion and HIV transmission, alcohol and masculinity, and the blending of masculinity and explana-
tions of HIV and AIDS. The fi ndings suggest both direct and indirect linkages between notions of
masculinity and AIDS, and highlight the need for prevention efforts that focus on providing alter-
native avenues for attaining culturally recognized markers of masculinity.
Résumé: L’objectif de cette étude était d’explorer les notions de masculinité et leurs liens avec le
VIH/sida chez les hommes et les femmes Owambo de Namibie, où l’on estime que un cinquie`me
des personnes de 15 à 49 ans sont infectées par le VIH. Treize entretiens ouverts et trois groupes
focus ont été menés avec 50 participants de sexe masculin et féminin, aˆgés de 19 à 50 ans et vi-
vant dans des zones rurales et urbaines de la Namibie. Une analyse qualitative fait ressortir six
thèmes centraux: l’évolution des signifi cations de la masculinité, la dynamique de pouvoir entre
hommes et femmes, le rôle actif des femmes en tant qu’intermédiaires, la tension entre l’éducation
formelle, informelle, et la transmission du VIH, l’alcool et la masculinité, la combinaison entre la
masculinité et les explications sur le VIH/ sida. Les résultats suggèrent à la fois des liens directs et
indirects entre les notions de masculinitéet le sida, et soulignent les besoins en efforts de préven-
tion concentrés sur des alternatives permettant d’acquérir des marqueurs de la masculinité culturel-
Resumen: El objetivo de este estudio fue analizar las nociones de masculinidad y sus vínculos
con VIH/sida entre los hombres y las mujeres Owambo de Namibia, donde aproximadamente una
quinta parte de la población entre 15 y 49 años es seropositiva. Se llevaron a cabo trece entrevistas
abiertas y tres grupos de discusión con 50 participantes masculinos y femeninos, con edades com-
prendidas entre 19 y 50 años de zonas rurales y urbanas de Namibia. Los análisis cualitativos sac-
aron a la luz seis temas centrales: los cambios de signifi cado de masculinidad, dinámicas de pod-
er entre hombres y mujeres, mujeres en el rol de representantes activas, la tensión entre educación
formal e informal, la transmisión de VIH, el alcohol, la masculinidad, la fusión entre la masculin-
idad y las explicaciones acerca de VIH y sida . Los resultados indican que existen vínculos direc-
tos e indirectos entre las nociones de masculinidad y el sida y señalan que es necesaria la preven-
ción enfocada en ofrecer vías alternativas para alcanzar marcadores culturalmente reconocidos de
Keywords: Masculinity, HIV/AIDS
586 Brown, Sorrell, and Raffaelli in Culture, Health & Sexuality 7 (2005)
Transmission of HIV, the virus that causes AIDS, happens in the most meaningful and
emotionally charged moments of life, including the shared experience of sexual relation-
ships (Bolton 1995). The activities that lead to HIV transmission are central to who we are
as men and women. Because of this, efforts to stem the spread of HIV are increasingly fo-
cused on understanding how culturally constructed notions of gender and sexuality shape
and constrain individuals’ behaviour as they negotiate changing social and economic real-
ities. The importance of these efforts is perhaps most clearly evident in sub-Saharan Afri-
ca, which has been disproportionately affected by the HIV pandemic.
It is estimated that 29 million (70%) of the 40 million individuals currently living with
HIV live in sub-Saharan Africa (UNAIDS 2003). With limited treatment and a lack of ef-
fective prevention programmes in many countries, there is a need to rethink intervention
approaches (Parker et al. 2000). In a review of regional considerations for HIV prevention
programmes, culturally defi ned gender roles were identifi ed as points of concern for Af-
rica (Raffaelli and Pranke 1995). As is true in many parts of the world, prevention efforts
have failed to reduce HIV rates in most African countries, in large part because of men’s
resistance to behavioural change (Schoeff 1995). In response, recent efforts have focused
on education and empowerment of women (Heise and Elias 1995), leading in turn to clos-
er examinations of men’s role in the AIDS epidemic (Bujra 2002). Men have been identi-
fi ed as both ‘the solution’ and the origin of the problem—in one author’s words, ‘the HIV
epidemic is fuelled by men’ (Foreman 1999: viii). It has become important to examine the
theoretical underpinnings of masculinity, its assorted meanings in the midst of the HIV
crisis, and its relations to HIV and AIDS. The current research is based on the belief that
better understanding of the psychological and social realities of men is an important fi rst
step to designing effective programmes. This study explores how evolving masculinities
are related to HIV and AIDS in a unique setting in sub-Saharan Africa. As background for
our study, we review the literature on masculine identity, masculinity in southern Africa,
and the Namibian context.
Masculinity has been defi ned as a set of role behaviours that most men are encouraged
to perform. Gilmore (1990) studied masculinity cross-culturally and found it to be an
achieved status which almost universally includes toughness, aggressiveness, stoicism
and sexuality. Scholars now discuss masculinity as a collective gender identity, one that
is fl uid and socially constructed, rather than a natural attribute (Courtenay 2000). With-
in any society multiple masculinities exist, refl ecting factors like race, class, age, religious
affi liation, and geographic location (Morrell 2001). But although the pluralistic nature of
masculinities has been identifi ed, not all masculinities are equal. Instead, cultural groups
construct ideal notions of masculinity. This hegemonic masculinity (Connell 1987) is the
ideal that men measure themselves against, and are measured against by others.
Recognizing the multidimensional nature of masculinity, several aspects have been
identifi ed, operationalized, and measured. Relevant to sexual behaviour, men’s health be-
haviours often demonstrate a denial of weakness, virility, the appearance of being strong,
and emotional and physical control. It is often in the pursuit of power and privilege that
Masculinity, sexuality and HIV/AIDS in Namibia 587
men are led to harm themselves (Courtenay 2000). In addition, perceived inability to meet
cultural benchmarks of normative masculinity may result in anxiety, depression and hos-
tility (McCreary et al. 1996). Changes in the dominant masculine identity within a specif-
ic culture, and varying access to hegemony, creates heightened opportunities for role con-
fl ict and stress that are highly relevant to other areas of functioning, including sexuality,
as men often express and experience masculinity through sexuality (Campbell 1997, Seal
and Ehrhardt 2003).
Masculinity in Southern Africa
Morrell (2001: 338) has described the construction of masculinities in southern Africa as
both ‘a local and a global process’. Globalization reshapes the arena in which notions of
masculinity are expressed, necessitating an in-depth examination of transformations that
are occurring in particular contexts. In times of change, men demonstrate a reactive, ac-
commodating or progressive response.
Past research in sub-Saharan Africa has revealed linkages between notions of mascu-
linity and sexuality. For example, Price and Hawkins (2002) reported that young men in
Zambia talked about sexual relationships as central to their self esteem and social status.
Similarly, in a Xhosa township in South Africa, the number of girlfriends a boy has is a
defi ning feature of what it means to be a man (Wood and Jewkes 2001). Deeply-held no-
tions of male privilege in the domains of sexual negotiations and family decision-making
have been reported among post-independent migrant workers in South Africa (Campbell
and Williams 1996).
The implications of notions of masculinity for sexual behaviour change have also been
explored. Campbell (1997) has reported that masculine role expectations limited interven-
tion programme effectiveness among South African mine workers, who endorsed
(a) a heightened sexual desire driving them to seek multiple partners; (b) a lack of caution
in high risk situations; (c) a need for pleasure of ‘fl esh on fl esh sex’; and (d) the desire to
father many children. Other research fi nds that condom use mitigates against young men’s
notions of masculinity in South Africa (Abdool-Karim et al. 1992). The need for men
to engage in sex with multiple partners, combined with negative attitudes towards con-
doms and the primacy of fertility, place their sexual health at risk (MacPhail and Camp-
bell 2001). Critical to this research is the link between the multidimensional and evolving
nature of masculine identity in an African community and continuing high-risk sexual be-
haviour despite widely dispersed information about HIV and AIDS.
At the year 2000 International AIDS conference in Durban, South Africa, multiple pre-
senters highlighted alcohol misuse as a behavioural risk factor for HIV transmission (e.g.,
Mufune et al. 2000). It has been well documented that alcohol consumption is strongly as-
sociated with failure to use condoms and higher HIV seropositivity in sub-Saharan Africa
(Mbulaiteye et al. 2000, Myer et al. 2002). Men tend to drink more than women and have
more alcohol-related problems (Parry et al. 2002, Wojcicki 2002). Social identities form
around whether men are ‘drinkers’ or ‘church-goers’ in Zimbabwe (Pattman 2001). This
literature suggests that in some contexts at least alcohol may represent a key factor to con-
sider in understanding linkages between masculinity and HIV in sub-Saharan Africa.
588 Brown, Sorrell, and Raffaelli in Culture, Health & Sexuality 7 (2005)
The Namibian context
Namibia is rich in diversity with 13 different ethnic groups and half of the population
speaking Oshiwambo. Namibia gained its independence in 1990 after more than a centu-
ry of colonial rule, fi rst by Germany and then by South Africa. Currently, rural and urban
lifestyles coexist. Mining accounts for 25% of the gross domestic product and many men
migrate to work in mines, while others seek work in cities. Over two-thirds of the popula-
tion continue to live traditional rural lifestyles in the rural North, where 50% of the popu-
lation depends on agriculture.
HIV is endemic in Namibia, with an estimated prevalence rate of 21.3% among 15–
49 year-olds (UNAIDS 2003). Ongoing public health initiatives and a functional public
health system are in place, resulting in high levels of awareness and knowledge about HIV
and AIDS. Prevention programmes in Namibia, as elsewhere in the developing world,
have followed the KABP model (knowledge-attitudes-beliefs-practises) that assumes that
health related decisions are based on knowledge and attitudes (Fitzgerald et al. 1999).
Nevertheless, even people with high levels of knowledge about HIV/AIDS often engage
in high-risk sexual behaviours (Campbell and Williams 1996), emphasizing that informa-
tion is just one determinant in the complex process of bringing about behavioural change.
To date, in-depth research on masculinity, sexuality and HIV has not been conducted in
Namibia. However, Mufune (2003) has reported a weakening of the link between commu-
nity morals and sexual behaviour, resulting in more liberal sexual attitudes. In addition,
poverty, work migrancy, and inequitable gender relations have been highlighted as critical
factors in the rapid increase in HIV prevalence rates in Namibia (Mufune et al. 2000, Le-
Beau et al. 1999).
With little published literature available on Namibia, this qualitative study represents
a fi rst step in understanding the social and psychological factors contributing to the HIV
pandemic. The overarching goal was to explore notions of masculinity and their linkages
to HIV among Owambo men and women in Namibia, Southern Africa. We addressed two
primary research questions. First, what are the meanings of masculinity in Owambo soci-
ety? Second, what are the linkages between notions of masculinity and HIV/AIDS?
Participants and procedures
Qualitative research involving semi-structured key informant interviews (n = 13) and
three focus groups (n = 37) was conducted during March of 2001. In addition, numerous
informal talks and observations were made during the fi rst author’s extended stays in Na-
mibia. Interviews and focus groups were conducted at three sites of varying urbanicity
and size: Eenhana (pop. 600), Ongwediva (pop. 30,000) and Windhoek (pop. 200,000+).
Through prior work on HIV prevention in Namibia, the fi rst and second authors identifi ed
local and national leader key informants. Key informants in the north (Eenhana, Ongwed-
iva) consisted of male and female young people (aged 19–30), health care workers, teach-
ers, clergy, traditional headmen, and government leaders. In Windhoek, key informants
included university faculty, United Nations agency representatives, and male and female
young people (aged 19–30). Two single gender focus groups (12 women aged 21–49, 13
men aged 18–35) were recruited from the Eenhana community centre and local bars. A
third mixed gender focus group was recruited from Ongwediva Teacher’s College (n =
Masculinity, sexuality and HIV/AIDS in Namibia 589
12, men and women aged 23–49). Participants averaged 32.8 years of age (SD = 9.2); 30
(60%) were males and 20 (40%) female; over half reported their primary residence as ru-
ral (n = 29, 58%) and the rest urban (n = 21, 42%).
Following procedures approved by the Institutional Review Board at the University of
Nebraska Medical Center, participants gave verbal informed consent for study participa-
tion. Prior to data collection, the fi rst and second author introduced the goals of the re-
search and emphasized the exploratory nature of the work. Interviews and focus groups
were conducted in English with an Oshiwambo interpreter present. Interviews lasted
about one hour and responses were hand written by the researcher. Focus groups lasted
approximately 1.5 hours and responses were audio-taped when possible. Interviews and
focus groups were discussed by the researchers and translator at the end of each day look-
ing for meaning and insight. This ongoing interpretation allowed additional exploration of
Key informant interview and focus group protocols consisted of open-ended questions on
four main topics: gender norms and masculinity, alcohol use, sexuality, and HIV/AIDS.
Topics were identifi ed from the existing literature as well as prior experience in Namibia.
Sample questions included: ‘What does it mean to be a man?’, ‘How has that changed?’,
‘What is the role of alcohol in your community?’, ‘What are the obstacles to practicing
safer sex?’, and ‘What is men’s responsibility for HIV/AIDS?’. Additional questions were
asked to follow-up specifi c responses.
Coding and data analysis. The written and audio-taped responses were transcribed in
English by the fi rst author and analysed for themes following a qualitative approach (Cre-
swell 2003). Transcripts were reviewed by the fi rst author and a trained undergraduate re-
search assistant to identify emergent themes. First, the two coders worked independent-
ly to locate segments of the transcripts that corresponded to questions about masculinity
and HIV. Next, secondary theme codes were generated. Codes were compared and the re-
searchers discussed discrepancies until a consensus was reached.
Themes described in this paper met the following requirements: (1) both men and wom-
en had discussed the theme, and (2) the theme was mentioned by more then half of all par-
ticipants. This information has been compiled with the understanding that individuals will
vary in the extent to which they adhere to societal norms and expectations. We encountered
instances of contradictions, and negative case analysis is presented in these instances.
Six major themes emerged from the analyses that are directly relevant to our central ques-
tions: ‘what are the meanings of masculinity?’ and ‘what are the linkages between notions
of masculinity and HIV/AIDS in Namibia?’
‘To be a man’: Past and present
There was widespread agreement among respondents about what constituted traditional
and contemporary ideals of Owambo masculinity. Across focus groups and interviews,
both men and women identifi ed having more than one wife as a right and a necessity. One
man said, ‘It is about wealth, you may have as many wives as you can support’. Men typ-
590 Brown, Sorrell, and Raffaelli in Culture, Health & Sexuality 7 (2005)
ically spoke about the need for children and wives, often citing that their strength depend-
ed on having more than one wife and many children. Women agreed:
If you had many wives, many children will come your way … that is most important
and that is how you became a man. I knew a man in Omusati region with 100 children.
People threw him a very big party when the number 100 was born. (Woman, KI, rural)
Other indicators of traditional masculinity included what men owned. When Owambos
were primarily agriculturalists, cattle were a currency by which people traded goods and
services (e.g., bride price). Similarly, the size of a man’s millet fi eld was often identifi ed
as the mark of a strong man.
Being a man, in our tradition, one needs more than one wife. You are lucky if you are
the fi rst. That is for sure. Also, a big mahango (millet) fi eld, many cattle, and many,
many children. The work is not easy but with more women and children the man’s
fi elds will be cared for and he will have much food. (Woman, single-sex FGD, urban)
Informants recalled past ideals of masculinity with reverence as well as an acknow-
ledgement that change was happening. A few respondents spoke about fathers and un-
cles but most described grandfathers and old head men as examples when asked what it
used to mean to be a man. In contrast, a wider range of possessions is now needed to ful-
fi l the defi nition of manhood. Respondents living in rural areas continued to report cattle
and a large omahango fi eld when asked what it means to be a man, but expanded the defi -
nition to encompass western ideals of status. As one rural man said, ‘Being a man is hav-
ing money, many girlfriends, and a car. We are behaving like other cultures like on televi-
sion but not using the best of those cultures, only the worst’.
As migration moves people from their homes in the North to urban areas, men move
between the urban and rural life, at times with ease, and at time with apprehension and
pressure. Successful men often carry the burden of a family in the city and a large extend-
ed family in the rural North. One male informant said ‘it doesn’t stop. I am it. The only
one to make any money. I am caring for Memekulu (grandmother), I am providing and
For urban men, current defi nitions of masculinity encompass an array of modern posses-
sions. In the words of one urban woman, ‘I believe the times have changed. Today you need
girlfriends and property, like your own business, a car, money. These are not always easy’.
The diffi culty of obtaining these markers of masculinity was noted by one urban man: ‘I
think I will buy a Toyota, but the problem is there is no money so I just dream of it’.
‘The worst is to be afraid of the ladies’: Girlfriends and power
Several informants noted that in Owambo culture the road to marriage allowed men the
liberty to have several sexual partners; after marriage, polygamy also permitted men to
have multiple sexual partners. An important element of contemporary masculinity, which
may represent a reinterpretation of these traditional practises, is the importance of having
girlfriends and non-marital sexual partners:
Multiple sexual partners are part of tradition and to have just one suggests poverty, low
status, and weak manhood. If I can support many women I am strong and rich. (Man,
single-sex FGD, rural)
Masculinity, sexuality and HIV/AIDS in Namibia 591
Key informants and focus group participants agreed that men typically have girlfriends
away from home. Examples included teachers who have wives in the capital and girlfriends
in the community where they work. Similarly, men working in urban areas will have girl-
friends in the city while maintaining a home and a wife in the village. Participants agreed
that having many girlfriends represents one way of achieving high status as a man:
You need to have the ability to get girls and to have children. Perhaps you are hand-
some then that is a good thing. Perhaps you have money. That is also good. The worst
insult is to be afraid of the ladies, they call you a woman, or HIV positive. (Woman,
mixed-sex FGD, urban)
Women recognized the importance of multiple partners in defi ning manhood. However,
some women expressed ambivalence and anger about this practise, in light of the HIV/
AIDS epidemic. One women complained:
In Eenhana the men never turn up for the AIDS meetings they are probably with their
girlfriends during the AIDS meetings. Only women turn up. (Woman, KI, rural)
There was recognition among participants that traditional gender roles favoured men.
Both rural and urban men generally agreed they held and were free to exercise power in
sexual situations. As one man said:
Men and boys strongly believe we are superior to women and girls and that we can
show it in the sexual act. There is no secret about it ‘be a man’ means to have sex.
(Man, single-sex FGD, rural)
Women who spoke about the power differential with more apprehension and at times
It is how women are thought to be. We do not have an equal say but that is the way it
is. I am telling you, this is not a good thing and we see that in other places it is not this
way. If you have a boy you are a good wife and you know that boy will be treated the
best by the father. (Woman, single-sex FGD, rural)
‘But, a woman can kill a cat’: Women as agents
The powerlessness of women may be exaggerated when individuals speak about what it
means to be a man. Thus, we looked for examples where women are not merely victims of
oppression. Owambos have a saying that comes up when discussing women’s weakness,
‘But, a woman can kill a cat’. It assumes that women have their own ways of asserting
power and can at times be more sly and powerful than a cat. Men told stories about wom-
en’s power to rape men, although most women felt the stories were ‘made up to even things
out’. However, examples of women’s agency did emerge in the data, and provide insight
into the extent to which Owambo women can exert control over their sexual lives. For ex-
ample, one young woman described the circumstances surrounding her decision to get an
HIV test based on the fear that her boyfriend had other girlfriends and was HIV positive:
He said he would marry me. He said he had to have me. In the light of the day I know
he is just speaking nonsense, but in the dark I just close my eyes and feel that what he
says is true. I am making the decision to fool myself. (Woman, KI, rural)
592 Brown, Sorrell, and Raffaelli in Culture, Health & Sexuality 7 (2005)
A woman in Ongwediva told the story of being involved in an HIV prevention programme
for out-of-school youth. She met with groups of young people on a weekly basis knowing
she was pregnant and HIV positive. She said:
This is what I am choosing now, to be strong and teach my peers about the tricks of
men and this horrible disease. Before I listened to his sweet words but I have to make
my choices now. (Woman, KI, urban)
These examples illustrate how women were able to make choices; however, these choic-
es were based on a limited sense of agency in reaction to negative experiences with
men. One rural man summed up the issue of power and gender as follows: ‘‘Men are
more powerful from birth, more important. Today women are on the move, but it is not
Education, tension and an answer
Education is often held up as a potential solution to improving social conditions. Both
male and female participants stressed education as the path to getting a job, ‘To have an
education in this country is very good. A job might or might not follow but you are put-
ting yourself in the position’ (Man, KI, urban).
Indeed, education and a job were seen as indicators of a strong man, in part because
they allow access to material goods. As one woman said, ‘Men now, in the cities have
many girlfriends, and education, and a job. They may also have a traditional home in
the North’. In this way, education was seen as associated with the ‘urban lifestyle’. Per-
haps because of this, focus groups and interviews with students at the teachers college
were marked with tension about how education might affect ideas of masculinity. Teach-
ing men to change behaviour was identifi ed as an important step by all women and a mi-
nority of men. But, the role of education in achieving the goal was controversial, because
formal education further consolidated what it was to be a man:
It is the educated men that have traditional wives in the village and many girlfriends in
the town and believe it is their right to both that are the problem for HIV/AIDS in the
country. (Woman, KI, urban)
Another woman stressed:
We should be the leaders. We made it to further education and men are not being role
models. They are afraid of changing. (Woman, FGD, urban)
Respondents also spoke of the value of religious education. Two rural men offered ideas
for change that were fuelled by religion. Religion was identifi ed as a map to follow in
tough times, and referred to as the ‘only hope’ for cultural change in the face of HIV. Reli-
gion was also spoken about as ‘something for the women and children to do’. Women not-
ed that the majority of the church is fi lled with women and children: ‘The men are scarce
on Sunday. I ask myself, ‘‘Where are they?’’’
‘It’s only omuloudu’: Masculinity and alcohol
Prior research in sub-Saharan Africa has identifi ed alcohol use as a crucial factor linked to
the transmission of HIV (e.g., Mbulaiteye et al. 2000). The relationship between mascu-
linity and alcohol was complex, perhaps because alcohol use has changed in recent times.
Masculinity, sexuality and HIV/AIDS in Namibia 593
Appropriate drinking in Owamboland refl ects rules about both what to drink and who can
drink. Traditional alcohol had both age and gender rules associated with its use; however,
these norms appear to be changing, leading to the identifi cation of alcohol as a major so-
In general, male key informants identifi ed alcohol as a symbol of masculinity, stating ‘if
you are serious about your drink, you are a man’. In contrast, female informants reported
more tenuous linkages between alcohol and masculinity, with most women reporting that
a man who does not drink is highly valuable to women.
Women like men who do not drink at all or know the moderate way to use alcohol. If
they only drink omuloudu (traditional millet beer) they are most probably ok. If they
drink the Squadron [rum] one has big problems. He thinks he is a big man. (Woman,
single-sex FGD, rural)
Several men reported only drinking traditional beer (omuloudu) and vehemently refut-
ing ‘Western drinks’. ‘Oumuloudu makes you strong and Tafel (bottled beer) makes you
weak’. Cucu shops (selling Western alcohol) were labelled as ‘houses of no good’ by some
respondents, because men lose other things they value if they frequent them. In addition,
alcohol was seen by both men and woman as unfettering traditional sexual regulations:
When a man drinks it is for many reasons. But this man’s fi rst and foremost reason soon
turns to the ladies. If he sees a lady drinking it is known that she wants to have sex. She
may not but he is already drunk so he assumes. (Man, FGD, rural)
The alliance of masculinity and HIV
A fi nal theme was the joining together of masculinity and HIV/AIDS. Not many years
ago, Namibians could be heard stating that AIDS did not exist, or ‘I will believe AIDS
is here when someone dies from it and I see it with my own eyes. Until then let’s dis-
cuss other things’ (man, KI, rural). This is no longer the case; none of the participants
in this study expressed the idea that AIDS did not exist. People knew that AIDS is a vi-
rus and condoms are the best prevention. When asked why men and women were not us-
ing condoms, explanations focused on the need for ‘fl esh on fl esh contact’ and the ‘waste
of time’ to use condoms. However, when asked more specifi c questions about what oth-
ers thought of AIDS, several cultural myths emerged. Several informants expressed the
following ideas: ‘AIDS is a punishment from God’, ‘AIDS is caused by a curse or witch-
craft’, ‘Sex with a child or virgin can cure men of AIDS’. Women described men as not
wanting to die alone so they try to infect as many people as possible; one urban woman
said, ‘I have heard that some men will purposefully try to get you to die with them. They
are afraid, I know, but they are cowards, too’.
In addition, several explanations of HIV encompassed notions of masculinity. The
spread of HIV was also attributed to the military, alcohol use, and the prevalence of mul-
tiple partners due to culture and migrant labour; these are almost entirely male activi-
ties. The resilience of a notion of masculinity emphasizing virility and a denial of health
concerns persists in current narratives regarding AIDS. In the words of one respondent,
‘AIDS is different, but a long time ago, a man that did not have syphilis was not a man’
(male, single-sex FGD, rural). Several key informants retold adages currently circulating
in Owamboland regarding HIV, such as, ‘AIDS didn’t come to Africa for dogs, it came for
594 Brown, Sorrell, and Raffaelli in Culture, Health & Sexuality 7 (2005)
men’ (man, KI, urban). A rural women retold a saying she heard men using, ‘If you do not
die of AIDS you are not a man’. Not once did participants allude to femininity or include
women in their understanding of HIV/AIDS. Explanations of HIV and AIDS thereby in-
tegrated the acquisition of the disease with the meaning of masculinity, extending what it
means to be a man into the grave.
Despite high rates of HIV/AIDS in Namibia, little published literature exists on local fac-
tors contributing to the epidemic. Thus, our goal in this study was to explore evolving
masculinities, attitudes, and behaviours related to HIV/AIDS among speakers of Owam-
bo, the largest language group in Namibia. Two over-arching questions were addressed.
The fi rst centred on the meanings of masculinity in contemporary Owambo society, and
the second on potential linkages between notions of masculinity and HIV. Thematic anal-
ysis of open-ended responses from key informant interviews and focus group discussions
provide initial answers to these questions, and highlight directions for future research and
Cultural groups construct ideal notions of masculinity that represent models for behav-
iour, even if not all individuals adhere to them. When asked what it means to be a man, re-
spondents showed widespread agreement on what constituted traditional and contempo-
rary ideals of masculinity. Scholars have criticized the categorization of constructs into
‘traditional’ and ‘modern’ (e.g., Dilger 2003); however, because our participants charac-
terized masculinity as having a ‘traditional’ and a ‘contemporary’ component, we chose to
report this dichotomy and examine which aspects of masculinity show continuity with the
past, and which have changed. In describing both traditional and contemporary notions
of masculinity, participants identifi ed having multiple sexual partners and fathering many
children as critical attributes. Other indicators of masculinity were markers of material
possessions. In the past, and currently in rural settings, agricultural wealth (e.g., cattle and
a large millet fi eld) was emphasized. However, modern markers of wealth have replaced
or been added to those traditionally associated with masculinity, particularly in urban ar-
eas; now, one must also have a car, money, education, and a job. Similarly, in Zambia a
girl’s ideal boyfriend has been reported as someone who has the ‘four C’s’ (car, crib, cash,
and a cell-phone) (Price and Hawkins 2002). As Waetjen (2004) argues that a rural and ur-
ban masculinity exists, our fi ndings allude to markers of masculinity that are more salient
depending on place of residence.
These notions of masculinity can be linked to the HIV epidemic directly and indirect-
ly. The most direct linkages emerged in the way HIV was characterized in everyday life.
Luyt (2003) discussed the social representations of masculinity among South African men
by examining metaphorical language. He described metaphor as a way to understand un-
familiar concepts in terms of existing explanatory systems. Similarly, the Owambo say-
ing, ‘AIDS didn’t come to Africa for dogs, it came for men’ may be a creative way for
men to express their masculinity against the novel threat of HIV/AIDS and gain control
over an otherwise uncontrollable disease by relating it to existing gender norms of male
domination and power. In keeping with this notion, respondents described sexually trans-
mitted infections as a marker of manhood (syphilis in the past, HIV in the present). An-
other linkage between HIV and masculinity stems from deeply held notions equating mas-
culinity with sexual prowess and fatherhood, which may contribute directly to the HIV
epidemic by encouraging individuals to engage in unprotected sex. These fi ndings extend
Masculinity, sexuality and HIV/AIDS in Namibia 595
the argument that multiple sexual partners are a feature of masculinity in the midst of the
AIDS epidemic as well as an important marker of manhood into the grave.
Some evidence of changing attitudes and behaviour did emerge from our research. For
example, women expressed concern and anger at the risk posed by their partners, and ex-
amples were given of resistance by women. In addition, the potential role of education in
stemming the epidemic was emphasized by some participants, although respondents es-
poused contradictory views about the value of education. Some blamed the spread of HIV
on educated men, whose education leads to high-paying jobs and access to the materi-
al possessions that allow them to attract sexual partners. A recent qualitative study of sec-
ondary school students in Botswana revealed that boys and girls are aware of the dispar-
ities in the opportunities for girls in the education system as well as in life (Commeyras
and Montsi 2000). Similar to the narratives of participants in this study, the authors con-
clude that education in Africa is both a place where gender equity is taught and a place
where boys become more socialized to oppress women. Thus, despite inklings of change
the equation of masculinity with sexual prowess appears to be persistent. Work in other
African nations highlights the challenge such attitudes will likely pose to promoting be-
haviour change (e.g., Abdool-Karim et al. 1992, Campbell 1997).
Ideals of masculinity also defi ne avenues for achieving manhood. Scholars have pro-
posed that men exaggerate elements of their masculinity to gain approval when they do
not naturally fi t the cultural ideal (Thompson and Pleck 1986, Courtenay 2000). Thus, the
extent to which men are able to meet contemporary notions of masculinities may have an
indirect impact on the HIV epidemic. There is ample evidence that many men in Namibia
do not have access to the material possessions they associate with ’being a man’. For ex-
ample, according to the 2000 Demographic Health Survey (2000), Namibia reports unem-
ployment rates as high as 68%. Moreover, while 85% of children attend primary schools,
in 1998 only 11% of Grade 12 students passed the standardized tests for graduation at
Haimbili Haifi ku Secondary School in Eenhana, with similar numbers found in more ur-
ban areas. Finally, car ownership rates are low: 77.8% of households in rural areas of Na-
mibia do not own a car. These statistics indicate that meeting certain defi nitions of mascu-
linity may be a daunting endeavour.
In light of these barriers, alternative masculinities may gain increased importance
(Wood and Jewkes 2001). Our study indicates that in contemporary Namibia, sexual ac-
tivity and alcohol use are important ways of attaining manhood. Having multiple partners
and fathering many children were at the core of descriptions of what it means to be a man
in Owambo society. Alcohol has been identifi ed as an important factor in understanding
HIV transmission in Africa (Mufune et al. 2000, Wojcicki 2002), and our fi ndings sup-
port the notion that alcohol use and social problems resulting from alcohol are linked to
changing notions of masculinities. In the absence of alternative pathways to masculinity,
it would not be surprising if Owambo men increasingly turned to sexual activity and alco-
hol use as ways of expressing their manhood.
Limitations, implications, and future directions
A number of limitations should be kept in mind when interpreting the results of this explor-
atory study. While purposive sampling was used to select people who represented a vari-
ety of opinions, the full range of views and beliefs may not be refl ected. In addition, data
was collected by ‘outsider’ researchers with the aid of a Namibian translator, which might
pose a problem if participants are unwilling to share information with unfamiliar research-
596 Brown, Sorrell, and Raffaelli in Culture, Health & Sexuality 7 (2005)
ers. Although the fi rst author had three years prior experience working and living in North-
ern Namibia, hiring local interviewers might be useful. Finally, focus groups may not be
the best method to explore sensitive topics like gender and sexuality; individual interviews
may provide additional insight in future research. Despite these caveats, the current study
provides novel information about masculinity and HIV/AIDS within an under-studied pop-
ulation, and the fi ndings can be used to guide future research and intervention efforts.
Programmatic implications. The fi ndings from this study can also be used to make pro-
gramme-related recommendations. Interventions that address alcohol abuse are needed,
given the observed relations between contemporary forms of alcohol use, sexual disin-
hibition, and domestic problems. Schools also appear to offer potential opportunities for
educating the country’s future leaders but a need exists to understand the nuances of ed-
ucation as it relates to gender relations. Another approach would be to build on Morrell
(2001), who groups men’s responses to change in South Africa into three categories: reac-
tive, accommodating and progressive. Many of the voices heard in our study were of a re-
active nature: in an effort to reassert power, men are trying to reverse change. Men exhib-
iting accommodating and progressive responses may serve as role models for change in
intervention efforts. Given that masculinity in Namibia is so strongly equated with multi-
ple sexual partnerships and fatherhood (behaviours that directly contradict typical risk re-
duction messages), successful HIV prevention efforts will likely involve fostering chang-
es in notions of masculinity and providing alternative avenues for attaining manhood.
More specifi cally, the involvement of male peers into HIV prevention programmes would
be helpful. Programmes might, for example, identify and train those men who endorse
and display progressive responses to the crisis and who also possess the markers of social-
ly desired masculinity. Programmes may emphasize the other aspects of masculinity, like
education, and entrepreneurship, while de-emphasizing sexual prowess. To fully achieve
these ends, however, broad-based efforts that directly address economic, structural, and
cultural barriers to change will be needed.
This research was supported by a grant to J. Sorrell from the College of Medicine, Uni-
versity of Nebraska Medical Center. Research assistance was provided by Peter Hangu-
la and Cecelia Nakamwe in Namibia, and Lisa Darveau and Jason McClaren in the USA.
Manuscript preparation was partially supported by a Faculty Development Fellowship to
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