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Culture, Health & Sexuality: An
International Journal for Research,
Intervention and Care
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Men’s moralising discourses on gender
and HIV risk in rural KwaZulu-Natal,
South Africa
Deborah L. Mindrya, Lucia Knightb & Heidi van Rooyenc
a Department of Psychiatry and Behavioural Sciences, UCLA
Center for Culture and Health, NPI-Semel Institute for
Neuroscience, Los Angeles, USA
b School of Public Health, University of the Western Cape, South
Africa
c Human Sciences Research Council, Durban, South Africa
Published online: 23 Apr 2015.
To cite this article: Deborah L. Mindry, Lucia Knight & Heidi van Rooyen (2015): Men’s moralising
discourses on gender and HIV risk in rural KwaZulu-Natal, South Africa, Culture, Health & Sexuality:
An International Journal for Research, Intervention and Care, DOI: 10.1080/13691058.2015.1027877
To link to this article: http://dx.doi.org/10.1080/13691058.2015.1027877
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Men’s moralising discourses on gender and HIV risk in rural
KwaZulu-Natal, South Africa
Deborah L. Mindry
a
*, Lucia Knight
b
and Heidi van Rooyen
c
a
Department of Psychiatry and Behavioural Sciences, UCLA Center for Culture and Health, NPI-
Semel Institute for Neuroscience, Los Angeles, USA;
b
School of Public Health, University of the
Western Cape, South Africa;
c
Human Sciences Research Council, Durban, South Africa
(Received 29 August 2014; revised 20 February 2015; accepted 7 March 2015)
Various interventions have resulted in increased rates of HIV testing. However,
encouraging men to acknowledge their risk for HIV, to test and link to treatment
remains a challenge. In this study, we examine men’s perspectives on navigating HIV
risk in rural KwaZulu-Natal, South Africa. Qualitative interviews were conducted at
four intervals over a three-year time period with a baseline cohort of 126 men and
women. We found that men navigated HIV risk in their sexual relationships mainly by
monitoring their partner’s behaviour. Men expressed concerns about female
respectability, invoking discourses on hlonipha rooted in Zulu cultural ideals and
Christian ideals about women staying close to home. In the post-apartheid era, these
concerns were inflected by anxieties over changing gender norms and the high rates and
risks of infection in the region. HIV prevention discourses on behaviour intersected
with men’s efforts to assert their masculinity through the monitoring and controlling of
women’s behaviour. The potential negative impacts of this should be addressed.
Prevention efforts need to focus on men’s vulnerability to infection in terms of their
own behaviour as well as the contexts in which they live.
Keywords: South Africa; HIV/AIDS; men; relationships; community interventions
Introduction
South Africa has one of the most rapidly growing HIV epidemics, rising from a less than
1% prevalence rate in 1990 to almost 30% in 2011 (National Department of Health
2012). The country now has the largest population of people living with HIV, estimated
at 6.4 million (UNAIDS 2014). Given high rates of HIV infection and the regular
occurrence of funerals for people who have died of AIDS, people in South Africa live
with an acute awareness of HIV (Fassin 2007; Niehaus 2007). Despite initial gains in
knowledge of HIV transmission and prevention strategies, household surveys have
shown declining HIV-related knowledge since 2008 (Simbayi et al. 2014). Various
interventions, including the study on which this paper is based (Project Accept HPTN
043), have revealed increased rates of testing for HIV (Coates et al. 2014; Maman et al.
2014). However, men’s testing rates lag well behind those of women (April et al. 2009;
Mills et al. 2012).
Project Accept HPTN 043 was a community-based intervention focused on improving
uptake of voluntary counselling and testing for HIV. In the study, we asked participants
how they perceived and dealt with the risk of HIV infection. In this paper, we focus on
men’s reports in rural Kwa-Zulu-Natal regarding their perceived risk of contracting HIV
q2015 Taylor & Francis
*Corresponding author. Email: dmindry@ucla.edu
Culture, Health & Sexuality, 2015
http://dx.doi.org/10.1080/13691058.2015.1027877
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and how they sought to avoid these risks. As men navigate their sexual relationships, they
are influenced by gender norms and relationship dynamics that are shaped by tradition,
colonial history and changing political, social and economic environments.
Gender norms and power relations are brought into sharp focus by the risks associated
with HIV transmission. One of the most notable changes in relationships in South Africa is
the significant reduction in formal (either traditional, Christian or common law) rates of
marriage, which have consistently declined since the 1950s, when African women became
increasingly economically independent (Budlender, Chobokoane, and Simelane 2004;
Posel and Rudwick 2013) as well as socially capable of heading households (Muthwa
1995; Preston-Whyte and Zondi 1989; van der Vliet 1991). Hosegood, McGrath and
Moultrie (2009) found that in 2006, only 31% of women and 23% of men in KwaZulu-
Natal reported ever being married. Researchers have also argued that it is extremely
difficult for African men of lower income to secure marriages due to the continued practice
of ilobolo (bridewealth) transactions and the increasing likelihood that such payments are
the sole responsibility of the man without support from his father or patrilineage (Hunter
2007; Posel and Rudwick 2013). These changes are reflective of ongoing transformations
and contestations in gender relations (Hunter 2010; Posel 2005; Shefer et al. 2008).
Given low formal marriage rates, many individuals in coupled relationships are often
unsure of the seriousness of the commitment (Hunter 2010; Mindry et al. 2011; Preston-
Whyte and Zondi 1989; van der Vliet 1991). Within this uncertain relationship landscape,
men and women have to assess when they may be at risk of HIV infection. Research
reports high rates of sexual partner concurrency, gender-based violence and lack of trust in
relationships (Dunkle et al. 2004; Montgomery et al. 2008; Ndinda et al. 2007), focusing
largely on men as routinely engaging in concurrent sexual relationships and as perpetrators
of gender-based violence (Dunkle et al. 2004). In much of the literature, men are portrayed
as perpetrators of violence, while their female partners are constituted as victims at risk of
infection from their male partners (see critique Mindry 2010). Understanding these
constructions of masculinity in terms of violence and risk requires careful attention to how
men navigate the changing terrain of gendered power (Gibbs, Sikweyiya, and Jewkes
2014; Shefer et al. 2008; Walker 2005). To date, we have a limited understanding of men’s
perspectives on their risk of HIV infection and how they manage this (exceptions are
Anderson, Beutel, and Maughan-Brown 2007; MacIntyre et al. 2004). How do men think
about risk, particularly in relation to women and the risks female sexual partners may pose
to them? And how do men seek to avoid the risk of HIV infection? And, how do gendered
norms shape men’s efforts to assess and control HIV risk in their everyday lives? We
explore these questions in this paper.
Methods
This paper is based on qualitative data from the National Institutes of Mental Health-
funded Project Accept study (Khumalo-Sakutukwa et al. 2008) gathered between 2005–
2009 in 48 communities in four countries (South Africa, Zimbabwe, Tanzania and
Thailand). One aspect of the study entailed conducting in-depth qualitative interviews
with a stratified random sample of 656 (all sites) individuals who participated in the
baseline behavioural survey. Interviews were conducted at four points during the study
(baseline, 6, 15 and 30 months). The study procedures were reviewed and approved by
ethical review boards at the University of California, Los Angeles, and the University of
the Witwatersrand, South Africa.
2D.L. Mindry et al.
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We stratified the baseline survey sample into a combination of eight demographic
categories according to site, gender, age (18 – 24 years and 25 –32 years), partner status
(single or coupled
1
) and control or intervention sites. Participants were randomly selected
and may or may not have participated in the community-based voluntary counselling and
testing programmes available in their community. The in-depth interviews were semi-
structured, based on a standard field guide used across all sites. Trained local interviewers
conducted 30– 60-minute interviews in the local language at the individual’s home;
whenever possible interviewers were of the same gender as the interviewee. The
interviews were audiotaped, transcribed and translated into English. They were then coded
using Atlas.ti software. Thematic data analysis included indexing the data through the
application of topical codes, also called descriptive codes (Miles and Huberman 1994;
Ryan and Bernard 2003).
The analysis was based on the coded data sets from the baseline, 6-, 15- and 30- month
interviews conducted between July 2005 and July 2009. Since we were most interested in
individuals’ perceptions of HIV risk, our analysis drew on the data topically coded as ‘HIV
discussions with partner’, ‘personal perceptions of risk’ and ‘personal risk-reduction
strategies’. These codes highlighted discussions regarding the interviewee’s perceptions of
personal risk of acquiring HIV and their risk-reduction strategies as well as discussions the
interviewee had had with his/her partner regarding HIV. In this paper, we focus on men’s
interviews from the eight rural communities in Vulindlela, KwaZulu-Natal, where we
found men invoked moralising gendered discourses in their discussions of HIV risk
(Table 1).
Findings
Fears of Infection: Gendered norms and trust
Participants in Vulindlela expressed anxieties regarding their risks of acquiring HIV,
invariably raising concerns about trust in relationships. Men were expected to be
untrustworthy and to have other partners ‘on the side’, while women were expected to be
monogamous. Although there was awareness that women could ‘misbehave’ and have
other partners ‘on the side’, this was not viewed as normative or as desirable female
behaviour. One of the key factors fuelling distrust of partners was a concern about physical
distance, noting that it was impossible to know how their partner was behaving when they
lived far apart. Thulani,
2
who had not yet had sex with his partner, explained:
P: I also do not trust her, it’s better to speak the truth. I just really do not trust that one.
I: Why do you say you do not trust her?
P: Ei, you see, my brother, just a person who is mainly from the township and I am here in the
rural area. And, she stays in a place that I do not trust a lot, kwaMashu [urban township]. (30
years, single, 6-month interview).
Men in rural Vulindlela were particularly suspicious of women who lived in urban or peri-
urban townships:
P: It’s that the one who stays at the location [township] I do not trust well because things are
always happening [in that] place.
I: When you say ‘things are happening’ what do you mean?
P: At the location [township] when I pass there at night there are always people who are
holding each other on the streets. And now I do not have an assurance that she is only looking
at me alone. And I don’t live with her. (Sipho, 18, single, 6-month interview)
Culture, Health & Sexuality 3
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Another factor fuelling distrust in relationships was the high rates of HIV infection in the
region:
Yes, we once talked ... about HIV. It means it was just the two of us, saying that no, you see
this misbehaviour is not a good thing because now there are many diseases. Besides, this
disease [HIV] is widespread ... and also you find that a person has it but they do not know.
You find that they are just okay and they are telling themselves that you are in love with a
person because you ... he is a good guy, whereas he has this disease. (Bongani, 22, coupled,
6-month interview)
Men in our study acknowledged that even if their partner appeared to be someone they
could ‘trust’, they could never truly be sure whether she had partners ‘on the side’; she may
only appear to be faithful:
I: In our last interview you told me that you did not see yourself at risk of getting infected with
HIV from this partner of yours who is regular. You are saying now you are no longer sure. Can
you clarify there?
P: Yes, actually, my brother, as I am saying at that time I was telling myself that, okay, you
can trust a person. But at this current moment, according to the circumstances [referring to the
HIV epidemic] it has come to my mind that you should never trust a person. Because they will
sleep and toss and turn around [change their minds], today it’s this tomorrow it’s that. You
will not be really, really certain of a person. (Themba, 21, coupled, 6-month interview)
Relationships, trust and condom use
In a context where HIV infection and deaths from AIDS are part of everyday lived
experience, it is not surprising that men were acutely aware of the risks of infection and
recognised the need to be tested for HIV. Some participants noted that the only way they
could protect themselves was to use condoms. When asked if there was anything else he
could do to minimise the risk of infection, Thabo said:
Actually I can say that if maybe it happens, my brother, this thing is just that way with
everyone because you cannot trust a person, eish [expression of frustration] ... you [can]
rather trust a stone. And just use this thing [condom] just to protect everyone straight away or
otherwise just say, ho [stop], let it just stop there. (25, coupled, 6-month interview)
Men endorsed the socially normative gendered expectations that men will have
multiple partners. For example, when asked if he had other partners besides his primary
partner, Thabo told us, ‘On the side? Actually that is [the] lifestyle [for] us men, that one’.
Men often acknowledged they had a primary partner with whom they were unlikely to use
condoms (especially if they already had children with this partner), whereas they would be
more likely to use condoms with casual partners:
P: The mother of my child I should be safe in [not using a condom with] her. With other
girlfriends I should use a condom, my brother, you see. I need to buy the lovers plus condoms.
(Vusi, 21, coupled, 6-month interview)
Table 1. Sample characteristics.
Baseline
interview
6-month
interview
15-month
interview
30-month
interview
Number of male
participants
62 43 42 31
Coupled/single 35/27 23/20 24/18 16/15
Age (18-24/25-32) 33/29 20/23 23/19 16/15
4D.L. Mindry et al.
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Condom use was generally tied to use in casual relationships or when men felt that
circumstances challenged trust in their partner. Men typically expected their female
partners to be monogamous and not have partners ‘on the side’. They were more likely to
assess whether or not their partner could be trusted to behave according to the expected
female gender norms or whether they were women who ‘misbehaved’, defying gender
norms by having other sexual partners.
Over the course of the study, some men noted that one could never be sure what one’s
partner was doing and insisted that condom use was the only way to protect themselves:
I should know, my brother, I will find something, if I will be stung by the bees or not, I have to
look after myself and be good [both laugh] and fix myself, and say wear this thing [condom].
(Thabo, 25, coupled, 6-month interview)
Men monitoring women’s behaviour to manage HIV risk
When asked about ways in which they might reduce their risk of HIV infection, men
frequently spoke about monitoring their partner’s behaviour to determine whether or not
they were engaged in sexual relationships with other men. When men initiated discussions
about HIV with their partners, they more often focused on their partner’s behaviour,
exhorting their female partner to ‘behave well’:
I do talk with my child’s mother. I advise her about the life nowadays, and that a person must
behave herself because people are dying, and I am also behaving myself. I always beg her to
behave herself. ... I ask her if she is behaving herself when I am not next to her, as I am living
here in E. She always tells me that she is behaving well, because even at her place they tell me
she stays at home and looks after her grandmother. (Bheki, 23, coupled, baseline interview)
Men predicated their use of condoms and their need to test for HIV on gender
stereotypical assumptions regarding their female partner’s behaviour. They focused their
attention on monitoring women’s behaviour as a means of managing their own risk of
infection, including assessing whether a woman was respectable, had a ‘‘grand’
appearance’ or whether they were women seeking material support from men.
Men reported closely observing their female partners to assess whether they were
‘respectable’, monogamous women often defined as those who stayed close to home:
I am the one who is going to take the blood so that she can know my [HIV] status as she was
just seated at home and not dating. So then as she was not dating she just wishes to know my
results then I also know her she was well-behaved and also a worshipper. (Sibosiso, 29, single,
15-month interview)
When asked if he saw himself at risk of infection from his current partner Sifiso said:
She is someone who stays at home. She does not loaf around. I see myself as being safe.
Chances of becoming infected, I do not see them existing. (29, single, 30-month interview)
Some men reported that they chose partners who were church-going, using this as a proxy
for respectability and monogamy. Sipho told the interviewer that he did not see himself at
risk for contracting HIV because:
My brother, this one [main partner] is a person who is very close to God. So now things like
that [having multiple partners] she is not really fond of them, things that have to do with being
silly. (18, single, 6-month interview)
He went on to explain that although he had used a condom the first time he had sex with
her, he no longer did so since he did not see himself at risk for HIV infection. He explained
that his partner was using birth control but they were not using condoms.
Men devised various strategies for checking up on their partner’s whereabouts.
Bongani explained how he minimised his risk of infection:
Culture, Health & Sexuality 5
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P: I am a person who knows her, how she lives as a person. So, when I see maybe she is
changing on the things I can then see that I can be infected.
I: Just what kind of change?
P: Just the change, let me say, maybe as a person just when I need her, I find her. So now if I go
to her place I can find her. If I send a child and say, ‘Can you please call her to come up here
for me’, they will go and come back with her. So maybe if they said she has been to town, I’ll
call her and ask, ‘Where are you?’ She says, ‘I’m in town’. So, if I go looking for her [and]
now I don’t find her, I will see then that I can be infected. Maybe if I go to check on her now
[when] I find her maybe she does not drink, she knows that I don’t drink. Even if we are going
to Durban, I tell her we are going there, even if there are celebrations she does drink. If I can
find her having taken alcohol I can see then that I can be infected, because I know alcohol it
impacts you, other things can be influenced by it. I will then need to be careful. For now, no I
haven’t seen anything. (22, coupled, 6-month interview)
Although he did not currently see any problems in his partners’ behaviour to suggest that
he was at risk of contracting HIV, Bongani laid out some of the strategies he would employ
to check on her to determine whether he was at risk. If he could not find her at home or
found she was out drinking alcohol, then he would consider himself at risk of infection
because she may have been with another man. Bongani’s report was a common response
among men in Vulindlela. Vusi told us that he would follow his female partner to monitor
her behaviour with other men:
Because I always follow a woman, my brother, to find out what kind of a person she is and
whenever I find her cheating I leave her ... if I find her walking together with a man I do not
care whether that was the case. I do not listen to such stories. (21, coupled, 6-month interview)
Men also soughtout reports from friends inthe community on whether their partner stayed
close to home (considered good behaviour) or went out to parties or drinking (bad behaviour),
attended church (good behaviour) or accepted proposals from other men (bad behaviour). The
latter would sometimes entail men checking on their female partners by asking friends to
propose love to their girlfriend to see her response. ‘Proposing love’ or ukushela referred not
to marriage, but to welcoming a man’s attentions, becoming his girlfriend, which also often
implied an agreement to a sexual relationship. Thabo explained how his views about
respectful female behaviour had resulted in the decision to end his relationship:
The thing that caused the relationship to end was respect, not respecting each other. ... I can
mention the behaviour of a person ... going for instance to parties the whole night. You do
not know what this person is doing, and not take care of herself (akaziphathi kahle)asa
woman. I am talking about being careful ... that she is dressed smart ... not seeing her, and
you find her concentrating on alcohol. So it means that person does not respect herself. That
person is actually [available] for anyone. (25, coupled, 6-month interview)
Thabo said he looked for a woman who takes care of herself (oziphatha kahle), in the sense
of behaving respectfully (ohloniphayo), and he judged this by how his partner was dressed
and took care of herself and whether she went out partying and drinking. He did not want a
woman who drinks and parties.
Men also reported judging their risk by examining a woman’s body shape and size,
using it as a measure of good behaviour. They read the body as a sign of good health and
wellbeing, hence of not having HIV and not posing a risk:
She is a person, what can I say, she has gained weight in her body. She is maybe bigger than
you. ... I will see if you have AIDS, I will tell her that you would not confuse me [when you
have AIDS]. (Lindani 27, coupled, baseline interview).
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However, Dumisani spoke about his discussion of HIV risk with his partner and the
dangers of judging a partner’s behaviour based on her having a ‘grand’ (i.e., a healthy, big
body) appearance:
Maybe you were going to church nearby. Now you find that this person is grand [fine
appearance]. But you know that you do that under risk. You know that this person is going to
suffer [with HIV] with me not knowing. That is why, maybe, I say, yes, I agree with you
[indicating agreement with his partner] when she speaks about [HIV] to me. And I also see
that it is true. But maybe in the long run maybe the issue of not doing as she had advised [will
put my life at risk]. I am just imagining myself judging someone on her body’s structure,
saying she is grand [not HIV-positive]. (29, coupled, baseline interview)
Men reported talking to their partners about the dangers of chasing after men for
money. In an environment of high unemployment and poverty, women were generally
expected to be tempted by men with money. Some men reported that their discussions with
their partners focused on telling her to ‘behave herself’ and avoid chasing after men with
money:
Because, you see, nowadays I am requesting you to behave yourself and do not be confused by
another person and your friends, girls, you know. They deceive her by saying, ‘no, leave that
boy because he is not working, let us go and look for the ones who are working who have
money’. Yet they do not know that they are hurting themselves. (Mandla, 23, coupled,
baseline interview)
Thulani explained why he felt his current partner could not be trusted:
I do not trust her but I just cannot explain the reasons why I do not trust her. I would be telling
lies if I say because of these particular reasons. The thing is she is just a person who likes
money a lot. But just that thing. She is also a person from the township. I do not know who she
was dating previously. (30, single, 6-month interview)
Xolani talked about going to drinking taverns and finding sexual partners:
It is obvious that once they have drunk there is no way they are not going to engage in sex.
And in that situation once you are now engaged in sex you find that this female person engages
in it anyhow ...you also know that if you have money everything goes fast. If I arrive with
money I buy for you and we drink. If we finish drinking ‘in fact, baby, let us go home.’ We
then go home. Once they go home, there is nothing else [except sex]. (18, single, 30-month
interview)
Mutual responsibility for managing HIV risk
Some men recognized that they too needed to ‘behave’ themselves and act in a less risky
way; what they did ‘behind the scenes’ could also put them at risk:
As you are asking, it can now only be her who knows what she does behind the scenes. What I
do also depends on me, to make sure how I behave ... if things can go bad for me, they are
also going to go bad for her as well. (Lungile, 25, coupled, baseline interview)
Although men reported varied strategies for trying to assess their relative risk of
infection by assessing their partner’s behaviour, over the 30-month period of data
collection we found fewer reports by men focused exclusively on women’s behaviour.
More men reported discussions with their female partners regarding both of their
behaviour and an increasing awareness that men also had to monitor their own risky
behaviour:
We talk about life, that if you do not behave well as a woman or as a man, there are these
things and these things that eventually at the end you will see that ... you can see that as a
woman she feels happy that we are discussing these things because she sees that actually it
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means this person that I am dating is someone who is serious about life. He is not just anyone.
She has hope that in our relationship, there is future that lies ahead. (Nhlanhla, 26, single, 30-
month interview)
More men reported open discussions of HIV risk with their partners and discussions about
their future together. In this context, men were more open to testing for HIV. Zibonele
described his discussion with his partner following HIV testing:
I: Why did you decide to discuss it [HIV test results] with your partner?
P: Since it means trust, I can say that it exists. Also you know then women ... especially if you
really found someone who is determined about their future, they make you ... become very
focused on things. She is able to encourage you and say go [and test for HIV]. When you are still
relaxing, she will say go and test [for HIV]. Now it means that it’s just [about] trusting each other
that makes it. Even when I have a problem and she also comes to me. I also go to her.
I: So when you look at the number of your conversations about HIV/AIDS with your partner
how is it like?
P: Actually, it is just okay, it is increasing since it’s something that we always discuss ....
Since if we just have children also, it can be bad to hear that I have brought this disease, or she
has brought this disease, we will die. It’s death. We advise each other, it’s just something that
we always talk about. (25, coupled, 30-month interview)
Over time, some men expressed greater awareness of the risks in their relationships and
these men were more likely to report addressing risks of HIV infection with their partner
rather than simply trying to monitor her behaviour or warn her about her behaviour.
Discussion
Participants were deeply concerned about whether or not they could trust their partners to
be sexually faithful. While women (and men) generally expected (and often accepted) that
men were likely to have partners ‘on the side’, men expected their female partners to be
monogamous. This was not surprising and is very much in line with gendered norms not
only in South Africa, but in other societies (Bhana and Pattman 2011; Smith 2007).
In order to assess their relative risk of HIV infection, men reported a number of different
strategies they employed to monitor their female partner’s behaviour. These included
checking on whether or not their female partner attended church, stayed close to home, did
not go out drinking and had a healthy body size.
One of the striking things in the qualitative data was that men’s discourses on
managing HIV risk focused on women’s respectability. What appeared at first to be
outdated, conservative discourses on womanhood, invoking precolonial ideals regarding
hlonipha (respect as a makhoti or new bride) by a woman toward her husband’s mother,
her husband and patriarchal authority, still held traction (Ngobese 2009). These ideals,
often articulated in terms of ‘self-respect’ (uphatha kahle) by men in our study, were
considered vital to women maintaining a good/respectable reputation. Men’s discourses
on HIV risk invoking Zulu cultural ideals of respectability (hlonipha) intersect in new
ways with Christian gendered ideals emphasising women’s responsibilities to the family
and home. The reality for most women in contemporary South Africa is that they work to
support families and are increasingly unable or unwilling to depend on men to provide
household support (Hunter 2010; Muthwa 1995; Posel and Rudwick 2013; van der Vliet
1991). In the colonial period, single women often sought to maintain a socially respectable
image by joining women’s Christian associations (Gaitskell 1982). In the contemporary
context of HIV, men in our study tended to view church-going women as respectable,
more trustworthy and as presenting a reduced risk of having or transmitting HIV.
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Among our study participants, distrust in relationships was often linked to migration to
cities and to distance between partners. Men whose partners lived in townships suspected
such women of being engaged in behaviours such as drinking and partying, inferring that
women living in the cities were more likely to be sexually promiscuous and open to
temptation. Such views may be an artefact of the colonial and apartheid systems of labour
migration, which drew men out of the household and community to work in the cities and
the mines. Men were inclined to develop relationships with women living close to their
places of work as they sought to recreate the ‘comforts of home’ (White 1990). Men’s
negative views of women in urban areas have been documented since the 1930s, when
African women first started moving to cities seeking a means to support themselves and
their families (Gaitskell 1982; Marks 1988). Such women were viewed with suspicion
since they frequently resided in the city without husbands or fathers and were more likely
to be economically independent of men (see Marks [1988] on colonial officials and Zulu
patriarchs collaborating to ensure the control of African women). In recent research,
young men in townships expressed a preference for rural girls, who they viewed as more
likely prospects given the young men’s lower income status and their desire for less
sexually experienced or materialistic girls (Bhana and Pattman 2011).
Men in this study reported cautioning their female partners against being lured away
by men with money. Men’s fears in this regard were not unfounded. Researchers have
investigated the not uncommon practice that younger women seek out older male partners
who are more likely to have the financial resources to support a woman and a family
(Jewkes and Morrell 2012). Furthermore, younger men, among whom unemployment is
extremely high, are often not considered suitable partners (Bhana and Pattman 2011;
Casale and Posel 2010; Hunter 2007). Hunter (2010) describes women’s critiques of men
in contemporary KwaZulu-Natal, referring to the men in their lives variously as their
‘minister of education’, ‘minister of entertainment’ or ‘minister of transportation’ and so
on. Women, he argues, view men as incapable of supporting them and rationalise having
multiple male partners as a strategic means to meeting their varied economic and social
needs (cf. Bhana and Pattman 2011). As Hunter (2007) has noted, transformations in
masculinity over time have supported new formations of multiple concurrent partnerships
among men too, associating such practices in both men’s and women’s expectations with
normative masculinity.
Study participants used physical separation and distance as a legitimate reason to insist
on condom use invoking issues of trust. Couples have to be cautious in their negotiation of
condom use. As van Campenhoudt (1999) notes, ‘the condom is no longer a simple
protective device that is more or less easy to use, but one’s attitude toward the condom
(whether or not it is used) is a resource through which the partners send each other
messages and structure their relationship’ (186). Montgomery et al. (2008) found that
individuals will only use condoms when ‘this does not threaten the ideals of relationship
trust and security’ (738) (see also Cusick and Rhodes 2000). By insisting on condom use,
couples in our study were indicating to one another that physical distance challenged their
trust in their partner’s fidelity. Those men who were living with their partners were more
likely to trust their partner and to report cessation of condom use.
As noted above, heterosexual relationships have been impacted by significant
reductions in formal marriage rates (Budlender, Chobokoane, and Simelane 2004; Posel
and Rudwick 2013). Unemployment is a major factor contributing to lower marriage rates
(Casale and Posel 2010; Klasen and Woolard 2008). Consequently, many individuals in
coupled relationships are unsure whether the relationship will result in a formal
commitment like marriage (Hunter 2010; Preston-Whyte and Zondi 1989; van der Vliet
Culture, Health & Sexuality 9
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1991). It is not surprising, therefore, that issues regarding trust are central in men’s
discourses regarding their partners.
The protection of women’s rights in the South African constitution, along with new
laws that ensure women’s legal autonomy, challenge existing gender norms and demand
that men begin to change (Posel 2005; Walker 2005). Female sexuality has been reshaped
by discourses associating women’s freedom to have multiple partners with modernity (van
der Vliet 1991). The high rates of rape and sexual abuse also challenge women’s efforts to
ensure the maintenance of a respectable (read: sexually pure) identity (Posel 2005).
Democracy has also resulted in new demands on men to reconstitute themselves as
‘modern men’ who work alongside women as equals (Shefer et al. 2008; van der Vliet
1991). Posel (2005) notes that ‘[d]emocracy created the space for “men to change” and the
constitution established the legislative and public framework that demands that they do so’
(233). But these changes in gender norms are still very much under contestation and,
consequently, sexual relationships in contemporary KwaZulu-Natal remain complex.
Although both men and women recognise that times have changed and both men and
women can ‘propose’ (initiate) a love relationship and initiate sex, men are still more
likely to negatively label women who initiate sexual relationships (Ndinda et al. 2007).
While we found that men were using moralising discourses and surveillance strategies
to monitor women’s behaviour and assess their relative risk of infection, over the course of
the intervention we found that they increasingly expressed awareness of the need to reduce
their own sexually risky practices and were more likely to report discussing the need for both
partners to test for HIV (see also Hatcher et al. 2014). This is consistent with the quantitative
data from the same project reported by Coates et al. (2014) and the qualitative findings
reported by Maman et al. (2014), which show increased rates of HIV testing over time.
Conclusions
This study draws attention to the moralising discourses men employ in trying to monitor
their partner’s behaviour and to address the risks of HIV infection. The dangers for both
men and women lie in the intersection of moralising cultural discourses with HIV
prevention discourses on behaviour. HIV prevention messaging emphasises self-
regulation of sexual behaviour. Men’s efforts to manage HIV risk by regulating and
monitoring women’s behaviour have the potential to fuel patterns of domestic abuse and
gender-based violence. When men focused exclusively on women’s behaviour, they failed
to consider changes they could make in their own sexual behaviour. Men who recognised
mutual responsibility for managing HIV risk in relationships were more likely to report
considering HIV testing and condom use as a means of reducing their risk of infection.
HIV prevention efforts need to address the dangers of men’s efforts to manage HIV
risk by monitoring and controlling women to address the potential for fuelling gender-
based violence. Prevention efforts need to impress upon men that the only way they can be
sure of their own HIV status is through testing and using condoms, not through subjective
moral judgments of their female partners. As Smith (2007, 1004) argues, ‘it is often
anxieties about morality and reputation that prevent people from protecting themselves’.
Acknowledgements
We thank the communities that partnered with us in conducting this research, and all study
participants for their contributions. We also thank study staff and volunteers for their work and
dedication. In particular, we thank Admire Chirowodza for his contribution in the early phases of
developing this paper. We thank three anonymous reviewers for their thoughtful and helpful
10 D.L. Mindry et al.
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comments that informed revisions to our article. The views expressed are those of the authors and not
necessarily those of sponsoring agencies.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This research was funded by the US National Institute of Mental Health as a cooperative agreement,
through contracts U01MH066687 (Johns Hopkins University – David Celentano, PI);
U01MH066688 (Medical University of South Carolina – Michael Sweat, PI); U01MH066701
(University of California, Los Angeles – Thomas J. Coates, PI); and U01MH066702 (University of
California, San Francisco – Stephen F. Morin, PI). In addition, this work was supported as HPTN
Protocol 043 through contracts U01AI068613/UM1AI068613 (HPTN Network Laboratory – Susan
Eshleman, PI); U01AI068617/UM1AI068617 (SCHARP – Deborah Donnell, PI); and
U01AI068619/UM1AI068619 (HIV Prevention Trials Network – Sten Vermund/Wafaa El-Sadr,
PIs) of the Division of AIDS of the US National Institute of Allergy and Infectious Diseases; and by
the Office of AIDS Research of the US National Institutes of Health.
Notes
1. The term ‘single’ designates individuals who at the time of the interview were not married and
were not in a relationship lasting longer than three months, while ‘coupled’ designates
individuals who were married or in a primary relationship for three months or longer.
2. Fictional names have been assigned to participants to distinguish quotations.
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Re
´sume
´
Diverses interventions pour la pre
´vention du VIH ont eu pour conse
´quence une augmentation du
recours au de
´pistage du VIH. Ne
´anmoins, sensibiliser les hommes a
`leur propre risque pour le VIH,
au de
´pistage et a
`la possibilite
´de recevoir un traitement reste une difficulte
´. Dans cette e
´tude, nous
examinons les points de vue des hommes sur la gestion du risque lie
´au VIH dans les zones rurales du
Kwazulu-Natal, en Afrique du Sud. Des entretiens qualitatifs ont e
´te
´conduits a
`quatre reprises
pendant plus de trois ans parmi une cohorte compose
´e de 126 hommes et femmes en de
´but d’e
´tude.
Ces travaux re
´ve
`lent que c’est principalement en surveillant les comportements de leurs partenaires
que les hommes ge
`rent le risque lie
´au VIH dans leurs relations sexuelles. Les hommes se sont dits
pre
´occupe
´s par la respectabilite
´fe
´minine en invoquant le hlonipha – notion de respect ancre
´e dans
les ide
´aux culturels zoulous et les ide
´aux chre
´tiens – en ce qui concerne les femmes demeurant pre
`s
du foyer. A
`l’e
`re post-apartheid, ces pre
´occupations sont la conse
´quence d’angoisses concernant les
modifications des normes de genre, les taux e
´leve
´s d’infection a
`VIH et le risque majeur de
contracter le VIH dans la re
´gion. Les discours de la pre
´vention du VIH focalise
´s sur les
comportements recoupent les efforts que font les hommes pour affirmer leur masculinite
´en
surveillant et en contro
ˆlant les comportements des femmes. L’impact potentiellement ne
´gatif de
cette situation doit e
ˆtre aborde
´. La pre
´vention doit se concentrer sur la vulne
´rabilite
´des hommes a
`
l’infection par le VIH, relativement a
`leurs propres comportements et aux contextes dans lesquels ils
vivent.
Resumen
Varias intervenciones realizadas en el a
´mbito de la salud han tenido como resultado la elevacio
´nde
la tasa de aplicacio
´n de pruebas de vih. A pesar de ello, continu
´a siendo difı
´cil que los hombres
reconozcan que corren el riesgo de infectarse con el vih, ası
´como alentarlos a aplicarse las pruebas
pertinentes y a someterse a tratamientos en este sentido. En el presente estudio, las autoras examinan
las opiniones expresadas por los hombres en torno a co
´mo enfrentan el riesgo del vih en la regio
´n
rural de KwaZulu-Natal de Suda
´frica. Durante cuatro intervalos de tiempo espaciados a lo largo de
tres an
˜os, se aplicaron entrevistas cualitativas a una cohorte inicial de 126 hombres y mujeres,
encontra
´ndose que la forma en que los hombres enfrentan el riesgo de contraer el vih en sus
relaciones sexuales es a trave
´s del ejercicio de vigilancia sobre el comportamiento de su pareja. En
Culture, Health & Sexuality 13
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este sentido, los hombres manifestaron su preocupacio
´n por la respetabilidad de las mujeres,
invocando discursos relacionados con el hlonipha, concepto arraigado en los ideales zulu
´es y
cristianos, que alude a la creencia de que las mujeres no deben alejarse de su casa. Por otra parte, en
esta era post apartheid, tales opiniones se vieron matizadas con expresiones de ansiedad vinculadas a
las cambiantes normas de ge
´nero, a la elevada tasa de infeccio
´n y al riesgo de contraer la misma
encontradas en la regio
´n. Los discursos en torno a la prevencio
´n del vih basados en el
comportamiento encontraron eco en la actitud mostrada por los hombres a la hora de afirmar su
masculinidad, logra
´ndolo mediante el ejercicio de vigilancia y control del comportamiento de la
mujer. Ello lleva a concluir que deben ser atendidos los posibles impactos negativos de dicha actitud
y que las acciones de prevencio
´n deben centrarse en la vulnerabilidad de los hombres a infectarse con
el vih debido a su propio comportamiento y a los contextos en que viven.
14 D.L. Mindry et al.
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