‘With or without your diagnosis, you are still a man’: Understanding Expressions of Masculinity among HIV-Positive, Adolescent Men Who Have Sex with Men in Mexico City Open Access
Bailey, Theresa Sybil (Spring 2019)
Published
Abstract
Studies show that expression of dominant masculine traits and behaviors can increase the risk of contracting HIV, reduce health seeking behaviors and interfere with adherence to HIV treatment. Young gay and bisexual men (YGBM) are at elevated risk for contracting HIV. However, little is known about how YGBM understand and express masculinity. This study explored the relationship between masculinity and experiences with HIV among HIV-positive, YGBM in Mexico City, Mexico. Eighteen semi-structured, in-depth interviews were conducted with horizontally infected, HIV-positive, YGBM, ages 15-19, at two specialized HIV clinics in Mexico City. All participants were asked about masculinity, HIV, sexual behavior, and social norms surrounding gender expression. Data were coded and analyzed thematically.
Participants were socialized from a young age to recognize and express what society typically associated with men and masculinity. They valued and expressed certain aspects, but had to find ways to reconcile their emerging masculine identities with aspects of dominant masculinity they did not agree with or could not emulate. Most participants expressed themselves more societally-masculine, even if it required suppressing outward expressions of their femininity. Men who expressed more societally-feminine characteristics were rejected or devalued more frequently by others, including by other gay and bisexual men. Additionally, most participants preferred to date masculine men and reported limited communication with partners about condom use or HIV.
Consequences for not meeting societal expectations of men were violence, rejection, or judgment from family, friends, and peers. The fear of consequence was a strong motivator for participants to reevaluate their expressions of masculinity, how they navigated HIV disclosure, and the desirability of interacting with others at the clinics. Ultimately, participants felt their HIV diagnosis did not change how they perceived and expressed masculinity.
These narratives can help community-based interventions in Mexico City to better engage YGBM in HIV prevention and treatment. Expanding existing programming to better engage families as support systems, establishing more LGBTQ-friendly clinics, and rolling out LGBTQ friendly sexual education at an early age are just a few ways that potential interventions and future research can build off this study to improve health outcomes among this key population.
Table of Contents
Table of Contents
Chapter 1: Introduction.………………………………………………………………………...1
Background.…………………………………………………………..…………………...1
Problem statement.………………………………………………………………………...3
Purpose statement.………………………………………………………………………...3
Research question and study objectives.…………………………...……………………...3
Significance statement.………………………………………………….………………...4
Definition of key terms.…………………………………………………………………...5
Chapter 2: Literature Review.…………………………………………………………………..8
Conceptualizations of Masculinity and the Subordination of Gay Men.……………….....8
Conceptualization of Masculinity and ‘Machismo’ in Mexico.……….………...12
Masculine Theory in Practice.…………………………………………………...14
Masculine Theory Summarized……...…………………………...……………...19
Masculine Expressions of MSM in Mexico.……………......………….………………...20
MSM and Masculinity Summarized...…………………………………………...23
Uniting the Threads: Masculinity, MSM, and HIV in Mexico…………………………..24
A Unique Reality: MSM and HIV transmission…………………………..……..25
Reconciling Masculinity: HIV risk among MSM………………………………..26
Summary……………………………………………………………..…………………..29
Filling the Gaps…………………………………………………………………..30
Chapter 3: Methods.……………………………………………………….…………………...32
Parent Study……...…………………………………………………..…………………..32
Research team……………………………………………………..……………………..33
Participants……………………………………………….…………..…………………..33
Research design……………………………………………………...…………………..34
In-depth interviews…………………………………………………..…………………..34
Data analysis method………………………………………………...…………………..35
Ethical considerations………………………………………………..…………………..36
Limitations and delimitations………………………………………..…………………..37
Chapter 4: Results.……………………………………………………...……………………... 38
Introduction………………………………………………………………………………38
Participants…………………………………………………………………….....38
Perceptions of masculinity and manhood………………………………………………..40
Sources of lessons………………………………………………………………..44
Emphasizing manhood and perceptions of gay men……………………………..46
Expressions of masculinity and manhood …………………………………………...…..48
Socialization of masculinity and manhood………………………..……………..49
Sexism as a socialization tool………………………………………..…………..52
Being a masculine man…………………………………………………………..55
Dating masculine men and other affirmations of masculinity …………………..57
Consequences of deviation……………………………..………………………………..60
Homophobia as a consequence of non-conformity ………………….…………..60
Reacting to consequences………………………………………………………..62
Tops versus bottoms: Discrimination from within………………………..……..64
Being a man and living with HIV………………………………………………………..66
HIV diagnosis…………………………………………………..………………..67
Disclosure of diagnosis…………………………………………………………..69
Living with HIV…………………………………………………………...……..70
Perceptions of people living with HIV…………………………………………..73
Vision for the future……………………………….……………………………..75
Evolution of masculinity and manhood……………………...…………………………..77
Summary ……………………………………………………………………….………..78
Chapter 5: Discussion.………………………………………………….……………………... 80
Emerging adulthood: a lens for understanding HIV-positive, YGBM……………......…..80
Examining masculinity and manhood ………………………………….………………..82
Familism, fitting-in, and the mastery of code-switching …………………………85
Masculinity and manhood’s influence of experiences with HIV……………….………..88
Masculinity and indications of HIV risk among YGBM…………………………89
Parallels between coming out and HIV disclosure ……………….……………....91
Perceived and experienced barriers: the challenges of living with HIV………......93
Fear as a barrier: risk, access, and support…….………………………..…….…..96
An ever-evolving society and increasing visibility of the ‘abnormal’……………….……96
Implications for public health and recommendations for future research………………...98
Avenues for future research …………………………………………………….102
Conclusion ……………………………………………………………………………...103
References.…………………………………………………………………………..………... 106
Appendices.………………………………………………………………………...………..... 113
I. In-depth interview guide in Spanish………………………………………..……....…113
II. Relevant codes and definitions………………………………………….....………....116
III. Full sociodemographic information for participants (n=18)……………...……..…..119
IV. Framework for understanding double stigma: stigma as origin or working tensions
between social and health interests (Ware et al., 2006)…………….………………...121
V. World map of legal status of transmitting or exposing another to HIV (2012)……….122
VI. Examples of gender identity and sexual identity scales………………………..……123
Reference for Tables and Figures
Table 1. Key Sociodemographic Information…………………………………………………....38
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