Volume 15, No. 3, January 2004

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By Maceo Thomas, MPH, Health Educator; Mark A. Boss, PERCY Project Director; and Esther Kaggwa, MSW, Director, National Programs, National Organization of Concerned Black Men

Although human reproduction involves women and men, efforts to improve sexual and reproductive health typically target women only. Moreover, when men are targeted, programs are generally intended, ultimately, to improve the health of young women. Promoting the sexual and reproductive health of young men is essential to enhancing young men's overall health, reducing some of the major health risks they experience, and encouraging behaviors to prevent unintended parenthood and sexually transmitted infections (STIs) , including HIV, in young men.¹

Why Intervene in Men's Health?

Males' health is important because young men matter and because a gender gap exists in health outcomes. In 1920, men and women in the United States had an equal life expectancy,² suggesting that there is no inherent, biological life span difference between men and women. Yet today, as in the past eighty years, men in the United States die sooner than women. Today, men's life expectancy is almost six years less than women's.³ Moreover, men have a higher mortality rate than women for all 15 leading causes of death,⁴ and the disparity is even greater for black men. In the last two decades, suicide rates have increased most rapidly among young black men.⁵ Half of all new HIV infections in men occur among black men.⁶ In 2001, the chlamydia rate among African American males ages 15 to 19 was 12 times higher than that among white males (1,550 and 128 per 100,000, respectively).⁷ Recent data document rising rates of syphilis, gonorrhea, and chlamydia among young men who have sex with men.⁸ These differences are not biological, but more than likely behavioral and reinforced by societal definitions of how men should behave.

The Definition of "Masculinity" Contributes to Health Disparities

The health disparities that affect men may be addressed, in part, by examining and changing attitudes and behavior that cultures define as "manly." In fact, males' sexual health cannot be discussed adequately without exploring concepts of masculinity. Merriam-Webster defines masculinity as "having qualities appropriate to or usually associated with a man." Because cultures differ, definitions of masculinity, or what it means to be a man, will also differ. In every culture, "being a man" comprises both positive and negative attributes. Often, being a man means providing for the family. "He always sees that there is a roof over our heads and food on the table." When discussing what it means to be a man, people rarely use adjectives related to sensitivity. For example, one more frequently hears, "He is solid as a rock" than "He is so caring." Programs designed for boys and young men need to reinforce and support the whole male. Programs must address masculinity, because societal views of masculinity may be directly related to health disparities affecting men, especially men of color.^{9,10,11,12,13,14}

Men of Color Face Additional Challenges That Contribute to Health Disparities

When definitions of manhood include provider and protector, it is important to recognize that some men of color face challenges in meeting these roles due to such barriers as racism, poverty, lack of education, underemployment, and reduced access to services. These barriers may lead men to adopt survival coping strategies that threaten their health. For example, some young black males adopt the "cool pose" as a coping strategy.¹⁵ The cool pose comprises attitudes and behaviors that present a young man as "calm, emotionless, fearless, aloof, and tough." Young men intend this facade to deliver a message of control in the face of adversity and seemingly insurmountable obstacles. The cool pose suggests competence, high self-esteem, control, and inner strength and hides self-doubt, insecurity, and inner turmoil. This pose often manifests itself, as well, in reluctance to show weakness or to communicate emotions, especially the softer emotions. Such a pose may also encourage "tough" behaviors, such as failure to visit doctors and make it difficult to express warmth and caring in intimate relationships or to negotiate peaceful resolution of conflicts. Tough behaviors, encouraged by the cool pose, certainly contribute toward young men's rates of violence, suicide, substance abuse, HIV infection, and unplanned fatherhood.

The PERCY Project Addresses Sexual Health among Young Black Males

In order to reduce health disparities affecting men, especially young men of color, providers must challenge youth's definition of masculinity. Theory-based programs should utilize interactive, participatory, health communication in culturally appropriate interventions for young men of color. In addition, health programs for males should reflect a male-preferred format including gender-specific and developmentally appropriate materials. The Peer Education and Reproductive Counseling for Young Men (PERCY) Project, developed and implemented by the National Organization of Concerned Black Men, Inc., is a model of such a program. The PERCY Project incorporates innovative programming that works to reduce teen pregnancy and STI rates by challenging the views of adolescent and young adult black males on what it means to be a responsible male.

The PERCY Project is based on the Strain theory, which proposes that inconsistencies between societal expectations and available opportunities for success cause personal frustration and alienation, driving people to risky behavior.¹⁶ To counter frustration and alienation, interventions need to offer skills and strategies to maximize opportunities for the target population. The Project attempts to counter the negative influences of the "cool pose." Its all male sessions emphasize open communication and the importance of acknowledging personal feelings. Sessions focus on self-esteem, healthy relationships, abstinence, and negotiating the use of protection as well as other subjects that young men seldom discuss. For example, a session may begin with the question "What does it mean to be a man?" followed by, " How does society's view of being a man influence your sexual behavior?" Young men of color need culturally specific programs that:

• Provide gender-specific sexual and reproductive information within a cultural context
• Promote a positive self-concept, including self-esteem, self-efficacy, self-respect, and life skills¹
• Build their skills in communication, negotiation, and refusal¹
• Provide confidential access to clinical care and health services¹
• Build youth-adult partnerships by involving young men in programs' planning, implementation and evaluation.

Upholding traditional notions of masculinity may be said to be killing men. The attitudes and behaviors that young men of color adopt to cope with their culture's definition of masculinity may lead to the serious health disparities they experience. To eliminate these disparities, innovative, culturally sensitive, gender-specific interventions must challenge young men's notions of masculinity. These programs must focus on the health and well-being of these young men, not for the sake of young women, but because young men, in and of themselves, are of great value to society.

References

1. Sonenstein F. Young Men's Sexual and Reproductive Health: Toward a National Strategy. Urban Institute. Washington, DC. 2000.
2. Courtenay WH. College men's health: an overview and a call to action. Journal of American College Health 1998;46:279-290.
3. Centers for Disease Control and Prevention. National Vital Statistics Report 2002;50(6).
4. Siegried M, Jadad AR. The future of men and their health. British Medical Journal 2001;323:1013-1014.
5. National Center for Injury Prevention and Control. Suicide Prevention Fact. Atlanta, GA: CDC, 2003. http://www.cdc.gov/ncipc/factsheets/suifacts.htm.
6. Centers for Disease Control & Prevention. HIV/AIDS Update. Atlanta, GA: CDC, 2003.
7. Division of STD Prevention. Sexually Transmitted Disease Surveillance, 2001. Atlanta, GA: CDC, 2002.
8. Centers for Disease Control & Prevention. Taking Action to Combat Increases in STDs and HIV Risk among Men Who Have Sex with Men. Atlanta, GA: CDC, [2001].
9. Capraro RL. Why college men drink: alcohol, adventure, and the paradox of masculinity. Journal of American College Health 2000;48:307-315.
10. Courtenay WH, Keeling RP. Men Men, gender and health: toward an interdisciplinary approach. Journal of American College Health 2000; 48:243-246.
11. Davies J et al. Identifying male college students' perceived health needs, barriers to seeking help, and recommendations to help men adopt healthy lifestyles. Journal of American College Health, 2000;48:259-276.
12. Eisler RM, Skidmore JR, Ward CH. Masculine gender-role stress: predictor of anger, anxiety, and health-risk behaviors. Journal of Personality Assessment 1988;52:133-141.
13. Hong L. Toward a transformed approach to prevention: breaking a link between masculinity and violence. Journal of American College Health 2000;48:269-279.
14. Weisbuch M. How masculine ought I be? Men's masculinity and aggression. Sex Roles, April 1999.
15. Billson JM, Majors R. Cool Pose: The Dilemmas of Black Manhood in America. New York: Simon & Schuster, 1992.
16. Pleck JH. The gender role strain paradigm: an update. In Levant RF, Pollack WS (Eds.). A New Psychology of Men. New York: Basic Books; 1995.

I hope one day the world will be tolerant towards people of different backgrounds and there will be an end to racism, homophobia, sexism, and bigotry of any kind. I don't believe I can change everyone's mind. But, if I can reach one person and know that his or her life has benefited from my help, then I won't wear this badge of activism in vain.
- Carlos, peer educator and youth activist state organizer