SOCIOCULTURAL FACTORS AFFECTING
SEXUALITY AND GENDER ROLES
Imbalances in power and resources between the North and the South, as well as political conservatism, have parallels in national circumstances and in the imbalances of power between men and women in virtually every society. Conference participants recognized that social norms and values, beliefs, and institutions transmit powerful -- although often confusing and contradictory -- messages about gender and sexuality. Through the process of socialization within the family and beyond it, individuals absorb these messages and learn what is acceptable behavior for females and males. Beliefs that subordinate women in sexual relationships and produce a culture of silence regarding sexuality and RTIs prevent women from protecting themselves or from seeking treatment. Moreover, these same values generally foster discrimination against girls and women in access to education, employment, and political power.
Beliefs that subordinate women and produce a culture of silence regarding sexuality and RTIs prevent women from protecting themselves or from seeking treatment.
Because women are often excluded from decision-making in the public sphere, priorities, policies, and programs are identified through a lens of gender inequality and patriarchy. Male politicians and bureaucrats rarely give priority to women's needs as women define them. "Who interprets everything? It is the men, and they see what is advantageous to themselves' (Dr. Hind Khattab, Egypt). "Women always put children and men first on their agendas" (Dr. Adepeju Olukoya, Nigeria).
SOCIAL MESSAGES AND CONTRADICTIONS
Inequality is rooted in societal norms and values that:
- define certain personal traits as "masculine" or "feminine";
- circumscribe gender roles and determine the balance of power between women and men;
- determine the meanings of sexuality to the community and the individual; and
- control sexual behavior.
Participants recognized diversity within and between countries in family structures, marriage patterns, and other institutions that enforce gender roles and norms of sexual behavior. Nonetheless, many similarities also exist. For example, in many societies, though not all, women are still considered the property of men -- of fathers, husbands, brothers. In India and northern Nigeria, for example, near-universal early marriage is intended to ensure the "purity" of this "property." Paradoxically, such child marriages, which are usually to older, sexually experienced men, put girls and young women at greatly increased risk of STDs and of problem pregnancies. In most societies, where unmarried girls and married women are supposed to be, respectively, chaste and strictly monogamous, they are nonetheless at risk of being infected by men, who are allowed, even encouraged, to have multiple sexual partners. At the same time, these women are widely denied necessary information and services. "I am most worried about girls and housewives. At least [now that there are some special projects,] prostitutes know how to protect themselves" (Dr. Debrework Zewdie, Ethiopia).
Participants described important variations in social behaviors allowed for women (e.g., in Guyana, women of African heritage have freedom of movement, while those of Indian heritage do not); in approved sexual behaviors (e.g., in some societies, women must demonstrate their fertility before marriage); in the meanings of sexuality in social and personal life (e.g., some societies recognize women's right to experience sexual pleasure, while others require them not to demand or express pleasure); and in the prevalence and types of RTIs.
Religious iconography and texts almost always include messages about sexuality that differ from those implied in "social texts" such as the law or the mass media and, indeed, from the way that people typically live their lives. Such contradictions often include a mother-whore dichotomy. In the Philippines, it is not uncommon to see "a religious icon next to a poster of a nearly nude woman" (Alexandrina Marcelo, Philippines). In Chile, despite religious proscriptions, women use contraception, and despite the church and the law, they resort to abortion. "The people don't care for the church" (Dr. Paulina Troncoso, Chile); "the leaders don't care for the people" (Amparo Claro, Chile). "While ancient Indian texts celebrate and enshrine female fecundity, popular proverbs and practices identify female sexuality as potentially dangerous" (Radhika Ramasubban, India). Most societies frown on prostitution and may even outlaw it, but as long as men pay and women have no other, comparable source of income, prostitution flourishes. Extramarital sex for women is also almost universally condemned. But there are contradictions. In Cameroun, for example, if a couple has not been able to conceive, a husband may encourage his wife to have sex with another man and get pregnant so that he can claim the baby as his. "In Cameroun, the man is always fertile" (Dr. Rosa Befidi-Mengue, Cameroun).
In most societies, where unmarried girls and married women are supposed to be, respectively, chaste and strictly monogamous, they are nonetheless at risk of being infected by men, who are allowed, even encouraged, to have multiple sexual partners.
SOCIALIZATION INTO THE CULTURE OF SILENCE
A woman descries a headache [or weakness] to her doctor, somehow hoping he will ask questions that will allow her to talk about [discharge or other symptoms of infection]. - Dr. Rani Bang, India
Definitions of gender roles, male and female sexuality, power relationships, and the meanings of RTIs are transmitted, maintained, and reproduced by the family and by society. Women themselves -- as mothers, aunts, or mothers-in-law -- are often the key agents of socialization into inequitable gender roles and sexual relationships, enforcing patriarchal norms and perpetuating a remorseless cycle of gender inequality.
Intimate, personal encounters mirror the public imbalance between male and female decision makers. Subordination of women in sexual relations jeopardizes women's self-esteem and hampers their ability to protect themselves from unwanted or unsafe sex, from poor medical practice, and from endogenous infection. Such social values have resulted in a nearly unbreakable culture of silence about sexual matters, in double standards for male and female sexuality, in misinformation, and in a lack of health information services. Females and males of all ages end up ignorant, confused, anxious, or uncertain about sexuality, and at increased risk of infection.
The falsehood that women are the source of infection is enshrined in the many languages that call STDs "the woman's disease" or '"female problems."
The falsehood that women are the source of infection is enshrined in the many languages that call STDs "the woman's disease" or '"female problems." Generally the opposite is true: women are biologically at higher risk of acquiring most STDs in a single sexual encounter with an infected partner than men are. For social as well as biological reasons, women are at much higher risk than men of acquiring iatrogenic and endogenous infections of the reproductive tract.
For both sexes, the risk of infection is increased by the numbers of partners and certain types of sexual behavior of each partner, but male sexual behavior is especially critical as a determinant of female risk. For men, having multiple sexual partners, and sometimes even genital discharge, is a sign of sexual prowess or manhood. Males generally are sexually initiated at an earlier age (often with prostitutes) and have more partners than females. For women, multiple partners are frowned on, and discharges or other evidence of infection are shameful and humiliating. An infected woman may be vulnerable to physical abuse, abandonment, or worse. "Woe betide a woman if a man knows she has anything wrong with her genitals" (Dr. Adepeju Olukoya, Nigeria).
Most women cannot talk to their partners about RTIs --"A woman cannot admit she has a health problem; men don't like disabled women" (Dr. Hind Khattab, Egypt) -- nor can they discuss other aspects of sex, especially their partners' behavior. They cannot talk to health professionals because of their own inhibitions, or because health professionals do not have the time, interest, or knowledge of RTIs. Also, many believe that symptoms of infection -- pain and discharge -- are simply a "woman's lot" in life, not something for which she should seek health care. It is thus not surprising that few women are able or willing to attend clinics for the treatment of STDs.
We [health care providers] have to change. RTIs are more common than we think, for all women, not just commercial sex workers. Most clients that we see are not sex workers. Veronica Baez-Pollier, Chile
Participants described other beliefs and practices that increase women's risk of infection. In Cameroun, for example, as in some other countries, women "clean" the inside of their vaginas frequently to remove even normal discharge. This practice increases the risk of infection, makes the vaginal wall dry, and thus makes intercourse painful for women. Similarly, women use traditional remedies or appeal to local healers for help, not realizing that many remedies are toxic and that certain interventions make matters worse.
PERCEPTIONS OF SEXUALITY
Although participants talked mostly of heterosexual relationships, they recognized that other forms of sexual expression, including homosexuality, bisexuality, and celibacy, are important, and that individuals and their partners may engage in more than one type of sexuality. Sexuality can be a positive experience of mutual love and enjoyment, physical pleasure, emotional support, and wanted pregnancy. It can be a source of self-confidence and esteem for women as well as for men. Too often, however, sexual relations are not positive experiences for women.
The social meanings attached to sexuality and gender, to masculinity and femininity, directly affect a person's experience of sexuality.
The social meanings attached to sexuality and gender, to masculinity and femininity, directly affect a person's experience of sexuality. This in turn can fundamentally affect the individual's identity, sense of self-worth, and ability to act on her own behalf, or even in her own defense. In sexual relationships with women, men use and reinforce the power socially vested in them: "Sex has been used as an instrument of domination by men in a way that [exceeds the power of] even bullets" (Madhu Kishwar, India).
As one father who had sexually abused his five-year-old daughter replied when confronted, "If I plant the mango seed, I have the right to the fruit."
In the context of silence and misinformation about RTIs, young people in many societies are pressured by their peers, the media, and other sources to experience sex early. Parents and religious institutions often refuse to provide facts about sexuality, insisting that young people "just say no." Boys may encourage each other to have heterosexual experiences early and press girls to accommodate them. "Of the 30 to 40 percent of sexually active teens in Mexico City, most had sex with other youngsters, not prostitutes" (Gabriela Rodriguez, Mexico). Girls and women frequently confront a profoundly painful dilemma. They are under pressure to have sex, but, unlike their male partners, they are likely to face severe social, physical, and personal consequences if they do. In many areas, girls and young women are also increasingly subjected to advances from older men who -- promising presents or financial support -- seek virgins in order to avoid HIV infection or to "cure" their own STDs.
Sex is generally a private act, recognized as such by the state. Thus, the stronger partner, usually the man, can, with impunity, subject the weaker partner to abuse. Public demonstrations of male power take the form of sexual harassment of girls and women, or rape. For the most part, states either do not intervene or they side with the abuser; thus, many cases of incest or child abuse and of marital and acquaintance rape go unpunished. Victims are often too intimidated to take action, and the perpetrator may see nothing wrong in his behavior. As one father who had sexually abused his five-year-old daughter replied when confronted, "If I plant the mango seed, I have the right to the fruit" (as recalled by Dr. Rani Bang, India).
Participants pointed out that the double standard of sexual behavior perpetuates and justifies the demand for commercial sex. "To be a good woman [and wife] is to tolerate the husband's sexual behavior" (Dr. Kritaya Archanavitkul, Thailand), even if it includes extramarital relations or visits to prostitutes. The commercialization of women's sexuality and the sex act, reflected in international and national commercial sex industries, pornography, advertising, and the media, projects women as sexual objects all men are entitled to. These images affect women's views of themselves, as well as men's expectations. Although in most countries it is widely accepted for men to patronize commercial sex workers, the prostitute is treated as an outcast, as are the unwed pregnant teenager and the married woman who has an affair. A man's encounters with commercial sex workers or other female or male partners increases the risk of STDs for himself and all his partners. Nevertheless, it is prostitutes who are most frequently blamed for the spread of STDs, including AIDS. "Commercial sex workers are not [the only] transmitters, and should not be made to feel that burden. Scientifically, we do not know that prostitutes are [the major] transmitters of STDs or HIV" (Dr. Debrework Zewdie, Ethiopia).
The sanctity of the privacy of the sexual act, the dominant role and prerogatives allowed to men, and the devaluation of female sexual expression and mutually enjoyable sexuality all serve the interests of individual men and of social institutions in maintaining power asymmetry. Women collude in this pattern of domination for reasons that are not always clear , but that seem to relate to their need for love, security, and the protection of children. "We're paying with our lives our emotions, our bodies. How much more do we have to pay?" (Elaine Hewitt, Barbados).
Participants concluded that interventions that are often suggested to control RTIs -- for example providing women with income information health education and services -- will be effective only if the imbalances in gender power relations are directly addressed.
Acknowledging and confronting the deep-seated power imbalances that women face globally nationally and personally are great challenges. Strong alliances need to be built to undertake these difficult tasks.
- Providing women with economic resources will not solve the RTI problem if women are still expected to be "available" for sex; have partners who refuse to use condoms; are subjected to violence; or are denied contraceptives, safe abortion, and medical care.
- Education will not be effective unless factual information is accompanied by messages regarding socialization sexuality; and gender power relations that encourage equity, caring, and respect in male-female relationships.
- Even if messages are improved they can be effective only if they are backed up by efforts to require men to act more responsibly and by health services designed to meet girls' and women's multiple needs and accommodate their constraints.
- Services can be effective only if women have the means and power to use them.
Participants concluded that interventions often suggested to control RTIs will be effective only if the imbalances in gender power relations are directly addressed.
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