'شما خودتان نیستید': مردسالاری اکتشافی در میان مردان آفریقایی دگرجنسگرا مبتلا به ایدز در لندن

It is now clear that gender is an essential factor shaping the narratives of men as well as women. However, there have been few studies of the daily lives or sexual activities of heterosexual men. Hence, strategies developed to prevent the spread of the HIV virus are rarely based on detailed knowledge of the men whose behaviours they are intended to change; this is especially evident in the developing world where the epidemic is most severe. Nor do we know very much about those men who have already been diagnosed as HIV positive. Around 13 million men are now living with HIV of whom around 96% are in low or middle income countries. Migrants from developing countries also make up the majority of positive people in a number of developed countries. In the UK, for example, heterosexual activity is now responsible for about half of all new HIV diagnoses with the majority of those involved being of African origin. But almost nothing is known about the ways in which different constructions of masculinity affect their experiences of illness. This study used qualitative methods to explore the experiences of a sample of black African men who defined themselves as heterosexual and were receiving treatment for HIV and/or AIDS in London. It explored their feelings, their needs, their hopes and their desires as they negotiated their lives in the diaspora.

The last few years have witnessed a growing recognition that gender shapes the narratives of men just as it does those of women. Much has been written about the social and cultural construction of masculinity (Connell, 1995, Segal, 1990 and Whitehead, 2002). But there are still few detailed studies of the daily lives of heterosexual men. Instead, they are sketched in as shadowy background figures against which women's lives are painted in much greater detail. This is especially true in the context of their sex lives. The emergence of the HIV epidemic has brought the diversity of sexual identities and sexual practices into the open for the first time. However, most researchers working in this area have concentrated either on women or on gay/bisexual men. The sexual activities of those men who identify as heterosexual have been much less visible especially if they live in developing countries where the pandemic is most severe (Bowleg, 2004). It is the ‘feminisation’ of the epidemic which has understandably drawn greater attention to the activities of women in heterosexual relationships, and to the implications this has for their vulnerability to HIV. This is especially true in Africa where heterosexual men appear in the literature mainly as the dominant partners in sexual relationships where their desires pose risks that women are often unable to avoid (Barker and Ricardo, 2005 and Baylies and Bujra, 2000). Thus they are usually represented as conforming to the stereotype of what has been called the ‘hegemonic’ model of masculinity (Connell, 1995). But few empirical studies have explored the sexual subjectivities of heterosexual men and their related activities across a range of African (or other) settings (Silberschmidt, 2005). Gay and/or bisexual men on the other hand have received a great deal of attention in the HIV literature. This reflects in part the history of the epidemic itself with the virus first identified among gay men in the United States while sex between men is now the major mode of HIV transmission in Latin America. It also reflects the high levels of politicisation within gay/bisexual communities themselves. The emergence of new paradigms, particularly ‘queer theory’ and deconstructionist approaches to gender studies, have also contributed to this interest in sexual identities and practices among those who define themselves as gay/bisexual. But again it has generated little direct interest in the sexual lives (or the health) of heterosexual men (Campbell, 2004, Kaler, 2004, Robertson, 2007 and Sorrell and Raffaelli, 2005). Paradoxically, one of the main assumptions behind HIV policies in many parts of the world is that heterosexual practices play a major role in the spread of the virus. However, few preventive strategies are based on detailed or context-specific knowledge of those men whose behaviour they are intended to change. Again, this is especially true in parts of the world such as sub-Saharan Africa where the epidemic is at its most severe. Even less is known about those men who have already been diagnosed as positive (Schlitz & Sandfort, 2000). Current estimates suggest that worldwide some 13 million men are HIV positive, of whom around 96% live in low or middle income countries. Most of these are assumed to be behaviourally heterosexual (Doyal, Paparini, & Anderson, 2008). Similar patterns are evident in some developed countries with large migrant populations. In the UK, for example, heterosex now accounts for more than half the new HIV diagnoses with a majority of these being between people of African origin (UK Collaborative Group for HIV and STI Surveillance, 2007). Yet we know almost nothing about how these positive men live with HIV or die with AIDS and this constitutes a significant obstacle to the development of appropriate treatment and care policies. The study presented here represents one of the first attempts to fill this knowledge gap. It describes the experiences of a sample of black African migrants from a number of different countries who were receiving health care for HIV in London. It examines aspects of work and parenthood as well as access to heath care and other sources of support. The study differs from most existing research in that it was not focussed on the men's roles as the partners of women. Rather, it was directly concerned with their own experiences of illness and how this was linked to their sense of themselves as men. It explored their subjectivities, their needs, their hopes and their desires as they negotiated their lives in a diasporic context. The men in the study were all migrants living outside their ‘home’ communities. Their physical and psychological health was already compromised to varying degrees and they were living with a diagnosis that would inevitably affect the rest of their lives. Not surprisingly, these realities had major impacts not only on their own perceptions of themselves as ‘men’ but also on the perceptions of the people around them. Hence, the study highlighted the fluidity of different masculinities and the ways in which they are shaped by changes in cultural and material circumstances and in bodily changes.

As we have seen, the men in this study faced serious challenges in their lives. They had moved around the world, either to escape threats in their home countries or to better their lives and those of their families. At the same time, they had to negotiate the realities of a serious condition that could threaten their survival. One of the most important challenges faced by the participants was how to combine living with HIV with their own ideas about ‘manliness’ but also with those held in the wider community. Men frequently used the metaphor of ‘weakness’ to describe their predicament yet they felt that they were required by others to appear strong at all times. These feelings of physical weakness sometimes seemed to represent a more socially acceptable way of expressing what others might describe as depression (Emslie, Ridge, Ziebland, & Hunt, 2006). Indeed, a recent study carried out amongst people living with HIV in London found black African men to be the group having the highest levels of suicidal ideation (Sherr et al., 2008). The main theme in most of these accounts was loss of potential. Most men did not have the jobs or the money they had planned to acquire. Many were unable to enjoy the sexual relationships that they saw as a mark of manhood and were without the wives or long-term partners or the children necessary to give their lives meaning. This raised fundamental questions about their sense of themselves as gendered beings. For many, their original sense of how to be an ‘African man’ was no longer sustainable and new ways of being seemed to be emerging. The narratives of the study participants represent the experiences of a particular group in a diasporic setting where health care is easily available. But there are also similarities between those who have migrated and those who have stayed ‘at home’. Global restructuring in patterns of employment, migration and poverty have combined with a growing emphasis on women's rights to cause major shifts in gender relations in many parts of the developing world. And in Southern Africa in particular there is now an ongoing debate about what has been called a ‘crisis in masculinity’ (Dolan, 2002 and Reid and Walker, 2005). This has highlighted the unsustainability of more traditional models of ‘maleness’. On the one hand, lack of money prevents many men from paying for marriage and setting up as heads of households. At the same time, recent studies have suggested that the increase in HIV is also beginning to make an impact on patterns of male behaviour. Findings from KwaZulu Natal, for instance, have indicated that many are so shaken by the huge numbers of AIDS-related deaths that they are beginning to question the traditional concept of ‘isoka’ masculinity in which status is derived mainly from numbers of sexual partners (Hunter, 2005). This environment of contradiction and change may offer opportunities to tackle the HIV pandemic while also promoting gender equality (Barker and Ricardo, 2005 and Peacock and Botha, 2006; Sideris, 2006). It is widely acknowledged that the active involvement of men will be central to controlling HIV and that this in turn will require the reshaping of diverse masculinities across a range of settings. However, this will not be possible without a much more textured understanding of the lives of heterosexual men in different parts of the world. This study represents just one contribution to this important research agenda.