Boys generally engage in more risky sexual behaviors than girls, and many cultures are more tolerant of male adolescent sexual activity or may even encourage it. Also, adolescent boys tend to use alcohol and drugs more often than girls, which can lead to sexual risk-taking.
The role of manhood promoted in many societies may discourage young men from showing affection or other emotions while encouraging them to seek control, success and power. Such pressures may prompt boys to act aggressively, leading to injuries, accidents and homicides.1
In Mexico, for example, mortality rates for males and females are about equal until age 14, when male mortality begins to increase. Mortality is twice as high for males as for females among people 15- to 24-years-old. The leading causes of death for young men in Mexico are accidents and homicide.2
Many men feel stress as a result of not being able to live up to the expected norms of manhood. "There are clear patterns of sex differences in substance use and suicide rates, with boys in developing countries generally reporting higher rates of substance use and boys completing suicide at much higher rates than young women," concludes a World Health Organization (WHO) review of research on adolescent boys.3
These risky male behaviors affect women negatively, encouraging some men to have sex only for physical gratification, to have multiple partners and to treat women with little respect or even violence. Boys generally begin sexual relationships at an earlier age, have more partners and are more sexually active before marriage than girls. Also, boys frequently see irresponsible or abusive behavior toward women and girls, often within their own families, which can encourage them to act irresponsibly. As men grow older, these unhealthy behaviors may become more difficult to change.4
What boys need
Encouraging young men to avoid risky sexual behaviors can result in better reproductive health for everyone. In a larger context, helping young men to develop self-esteem and a sense of purpose in life can lead to better treatment of women and less risky behavior. But how can health programs help achieve these goals?
"Many views on adolescent boys have emerged out of a deficit perspective, looking at boys negatively and trying to get them to take more responsibility," says Paul Bloem, who directs a WHO project for adolescent males. "Instead of a negative, deficit-oriented view, we [at WHO] are trying to understand boys the way they are and see what they need for HIV prevention and for their health and development. By having healthy adolescent boys, you influence the health of girls as well."
The best way to reach boys is to go where they are in the community. For example, the Gente Joven program of the Mexican Family Planning Association (Mexfam) initially opened three centers for adolescents. But the program soon began using peer educators, youth councils, media and other techniques in order to reach boys in street gangs, in sports clubs, at work and in school. More than 1,500 peer promoters distribute information to other young men and women.5
"Young men have a lot to contribute and we should spend more time listening to them," says Errol Alexis of the Margaret Sanger Center International. "If they come with an idea and identify a way to achieve something, they are more likely to give their support." Based on his work in training peer educators in Namibia, Zambia and the Caribbean, Alexis believes boys are often willing to support women's rights to contraception. The peer educators worked through soccer clubs, military and police forces, and church groups.
In a low-income area of Rio de Janeiro, a year-long effort by Instituto PROMUNDO identified beneficial behaviors toward women, such as seeking relationships based on equality rather than sexual conquest. While none of the 25 young men in the study (ages 15 to 21) showed all characteristics all the time, several demonstrated some of the behaviors. Such activities as a mentor program and peer groups were used to nurture beneficial behaviors.
In the central India city of Jabalpur, CARE International is working with boys as part of an effort to improve the health care of adolescent girls in urban slums. Early in the project, CARE realized the need to reach boys as well. "They constituted an important influential category in decision-making," says Dr. Y.P. Gupta of CARE, who supervises the Jabalpur project. Boys often need information, counseling and reproductive health services as much as girls. Getting boys involved, however, was more difficult than reaching girls, he says. Very few boys participated initially but eventually were recruited through schools and youth groups. A Youth Health Convention for boys has promoted better reproductive health through posters, slogans and essays, quiz programs and street plays. More than 2,700 boys from slums and another 2,600 boys in schools have participated.
One important need of adolescent boys is basic knowledge of reproductive health issues. In the slums of Lucknow, a city in north India where premarital sex is traditionally taboo, a survey of unmarried boys ages 15 to 21 found that 8 percent were sexually active, but most had little knowledge of sexually transmitted diseases (STDs).6 Another study found that sexually active rural and urban boys in the Indian state of Gujarat know little about STDs or how to use condoms correctly.7
Using media
Communication messages may be more effective if adapted to address male and female concerns, one study concludes.8 In rural India, the Child in Need Institute has developed a kit that tells the story of Shankar, a 13-year-old boy. It uses flip charts and activities to educate adolescent boys about puberty, self-esteem, responsibility, contraception, safer sex, hygiene, STDs and childbirth. Kits with different topics are used with different age groups, but all of them focus on the theme of men being responsible for their sexual behavior.
Advertisements in Zambia, developed with a 35-person youth advisory group, include different messages designed to reach boys and girls. "The messages for girls emphasize abstinence more and helping girls negotiate condom use," says Elizabeth Serlemitsos, coordinator of the project. "For boys, the emphasis is that safer behavior -- abstinence or using condoms -- makes you cooler or more desirable."
In one advertisement, a boy sees a pretty girl and says "with her I could even go live," referring to sex without a condom. His friends try to talk him out of it. Later, he has an STD, and the message says: "Guess who didn't use a condom?" The nationwide project, called Helping Each Other Act Responsibly Together (HEART), uses posters and broadcast advertising to encourage unmarried youth to abstain from sex or to use a condom.
Integrating reproductive health with other services may offer a way to reach adolescent boys. In a survey of health programs working with boys, managers reported vocational education as the primary need for boys, followed by counseling, places for boys to discuss their reproductive health concerns, and reproductive and sexual health services. The report recommended more research on "ways to expand integrated health and health promotion for adolescent boys that include the full range of their expressed needs."9
A study of 23 U.S. programs that involved young men in preventing teenage pregnancy summarized practical advice and philosophies of practitioners. Be knowledgeable about the community and find out what the participants know and are interested in learning, the study says. Using male staff was essential; offering employment training or recreation helped pave the way for providing reproductive counseling; and a playful, entertaining and nonthreatening approach to pregnancy prevention worked best. "Preaching responsibility can turn males off," the report says. "Instead, these programs try to change males' attitudes towards themselves, their relationships with women, and their futures."10
"Men are individuals with their own sexual and reproductive health needs," says Freya Sonenstein of the U.S.-based Urban Institute, which recently reviewed programs working with young men in the United States. "If we can empower men in this area, it will lead to greater gender equality." The review concluded that a comprehensive reproductive health strategy for young men should convey necessary information, foster skills development, provide access to clinical health care as appropriate, and promote self-esteem.11
-- William R. Finger
References
- O'Neil J, Good G, Holmes S. Fifteen years of theory and research on men's gender role conflict: new paradigms of empirical research. In Levant R, Pollack W, eds. A New Psychology of Men. (New York: Basic Books, 1995)164-206.
- Keizer B. Masculinity as a risk factor. Presentation at Coloquio Latinoamericano sobre Varones, Sexualidad y Reproducción, Zacatecas, Mexico, November 17-18, 1995.
- Barker G. What about Boys? A Literature Review on the Health and Development of Adolescent Boys. Geneva: World Health Organization, 2000.
- Brown AD, Jejeebhoy SJ, Shah I, et al. Sexual relations among youth in developing countries: evidence from WHO case studies. Unpublished paper. World Health Organization, 2000; McCauley AP, Salter C. Meeting the needs of young adults. Popul Rep 1995;J(41):17.
- Márques M. Gente Joven/young people: a dialogue on sexuality with adolescents in Mexico. Quality/Calidad/Qualite 1993;(5):7.
- Awasthi S, Pande VK. Sexual behavior patterns and knowledge of sexually transmitted diseases in adolescent boys in urban slums of Lucknow, North India. Indian Pediatr 1998;35(11):1105-09.
- Sharma V, Sharma A. Adolescent boys in Gujarat, India: their sexual behavior and their knowledge of acquired immunodeficiency syndrome and other sexually transmitted diseases. J Devel Behav Pediatr 1997;18(6):399-404.
- Social Marketing in Adolescent Sexual Health: Results of Operations Research Projects in Botswana, Cameroon, Guinea and South Africa. Washington: Population Reference Bureau, 2000.
- World Health Organization Department of Child and Adolescent Health and Development. Working with adolescent boys: survey of programme experiences. Unpublished paper. World Health Organization, 2000.
- Sonenstein FL, Stewart K, Lindberg LD, et al. Involving Males in Preventing Teen Pregnancy: A Guide for Program Planners. Washington: The Urban Institute, 1997.
- Sonenstein F. Enhancing young men's reproductive health. Unpublished paper. The Urban Institute, 2000.
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