ORIGINAL RESEARCH

Men's social representations of being a man and their implications for HIV/AIDS

Priscila da Silva Domingues^I; Antonio Marcos Tosoli Gomes ^II; Denize Cristina de Oliveira^III.

^I Nurse. Specialist in Collective Health in Nursing, Master Student of the Nursing Master's Degree at the State University of Rio de Janeiro. Brazil. E-mail: prydomingues@hotmail.com
^II PhD in Nursing. Professor, State University of Rio de Janeiro. Brazil. E-mail: mtosoli@gmail.com
^III PhD in Public Health. Professor, State University of Rio de Janeiro. Brazil. Email: dcouerj@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2016.8779

ABSTRACT

Objective: to analyze homosexuals' and heterosexuals' social representations of being men, and their implications for HIV infection. Methodology: in this qualitative study, semi-structured interviews were conducted at a testing and counseling center in São Gonçalo, Rio de Janeiro, in 2013. Results: masculinity entails virility; men are regarded as sexually insatiable by nature. The participants pointed to the evaluative dimension of man as an individualistic subject with hedonistic practices. They presented the image of the real man as unbridled sexual activity. Conclusion: men are understood today in ways that can raise new discussions bearing on the social construction of the notion of man, as well as its implications for vulnerability to infection by HIV/AIDS.

Keywords: Men's health; HIV; masculinity; health vulnerability.

INTRODUCTION

The relationship of men with their health has been the subject of discussion in debates and academic circles in recent times, especially in an attempt to reformulate health care for this subject, who little seeks for care services. This attempt also includes the improvement of the health practitioners to better serve this clientele that has been outside this scenario for a long time.

Since health practitioners are used to receiving women, children and elderly people in primary care services, they often do not know how to cope with the presence of men. In light of this, the current policy named National Policy for Comprehensive Care to Men's Health (PNAISH in Portuguese) emerged with the objective of "understanding the male singularity in its diverse sociocultural contexts, enabling an increase in the expectation and quality of life, reducing the morbidity and mortality rates due to preventable diseases and causes"1:3. This policy aims to promote the prevention and control of STDs and human immunodeficiency virus (HIV) infection in the male population in conjunction with the National Program on Sexually Transmitted Diseases/Acquired Immunodeficiency Syndrome (STD/AIDS) (HIV)"^1:32.

During the period from 1980 to June 2011, 608,230 AIDS cases were reported in Brazil. In 2010, 34,218 new cases were reported, with a national incidence rate of 17.9/100,000 inhabitants and a gender ratio of 1.7 new cases in men for each case in women. "In the age group of 13 years or more, 22.0% of the total of 15,026 AIDS cases among men reported in SINAN in the year 2010 involved homosexuals, 7.7% bisexuals, 42.4% heterosexuals, 5.0% injecting drug users (IDU), 0.6% vertical transmission and 22.1% were ignored cases"^2:20.

In light of the above, there is a need to study male identity and its implications for HIV infection. Therefore, the study aimed to analyze the social representations of being a man for homosexuals and heterosexuals and their implications for HIV infection.

THEORETICAL-METHODOLOGICAL FRAMEWORK

The study is based on the Theory of Social Representations that, unlike other forms of knowledge, presumes a specific relation between the subject and the object of knowledge: that is, there is no dichotomy between the subject and the object, even with a projection of the identity of the former on the latter3. The study is based on the Theory of Social Representations that, unlike other forms of knowledge, supposes a specific relation between the subject and the object of knowledge, that is, there is no dichotomy between the subject and the object, including a projection the identity of the first on the second⁴.

This is a qualitative study, whose objective is to understand the representations built on the phenomenon being a man, rebuilt by two social groups. Qualitative research deals with the universe of meanings, reasons, aspirations, beliefs, values and attitudes in the social sciences, seeking to deepen the complexity of human phenomena⁵.

For the accomplishment of the present research, the field work was carried out at the Testing and Counseling Center (CTA in Portuguese) located in the municipality of São Gonçalo-RJ. Ten men were initially interviewed, two of whom identified themselves as homosexuals and eight as heterosexuals. They arrived at the health service by spontaneous demand to perform the HIV test. Men aged 18 to 59 years, randomly selected, were approached to participate in the study based on the following inclusion criteria: not being a patient with mental or neurological problems and accepting to participate freely in the research, after being informed of the study and its respective objectives and after reading the informed consent form and signing it. Subjects who sought the CTA to do another type of test rather than the HIV were excluded from the study.

Data collection included semi-structured interviews that were recorded with an MP3 electronic device and then transcribed and it was performed between October and December 2013. The interviewees were first approached by the CTA professionals themselves. After agreeing to participate in the study, they were taken to a room reserved for them to participate in the interview.

For the treatment of the data, authors used the thematic-categorical content analysis6, which consisted of a process by which the discursive material, after scanning, was systematically transformed and aggregated into smaller units - the recording units (UR). The RUs that had close significance between each other were grouped, giving rise to the units of meaning (themes). Then, these themes were quantified and regrouped to form the categories, ready to be presented and discussed. The operation of the analysis of this study was based on the worksheets prepared by the authors. It should be noted that the RUs referred to in the text were identified according to the respondent's number (R1, R2, R3 ...). The research was approved by the Ethics and Research Committee, CAAE 15570813.4.0000.5282, opinion number 436.075. The researched population was informed about the guarantee of the anonymity of the material obtained in the research (speeches provided during the interview).

RESULTS AND DISCUSSION

Since birth, children are influenced by adults to behave in the social environment. Along with games, the norms are learned according to what each family and society expect from a male and female pattern. Several rules are passed for boys to become men, even though these rules are often unspoken, having the look as the pattern of approval and/or disapproval of behaviors in order to form the way of being of men and women⁷.

Therefore, children, in the relationship with adults and with others are influenced by gender models to live in society. The gender is constituted from how we are socialized, how we behave and act, becoming men and women; it also refers to the way these roles and models are internalized ⁸.

Masculinity is a model that prescribes attitudes, behaviors and emotions to be followed by men and the model still valued by them is that of hegemonic masculinity that, in turn,

[...] is defined as the central model, which implies considering other styles as inadequate or inferior. This opens the way to a more dynamic approach to masculinity: the crucial division between a hegemonic masculinity and several subordinates that serve as counterpoint and paradigm^9:63.

This model is built from the relation of power that a man should have in relation to the other, that the submissive being, which is the woman, and reflects in the results of the present research. To reinforce oneself as a real man, subjects try to distance themselves from everything that concerns the feminine. We can perceive this distance through the narrative of the homosexual participants, in which they point to an affective and emotional distance when referring to the man considered real.

The man who has a car does not want to know anything besides the car; the one that has a motorcycle just wants to know about the motorcycle and forgets the family. (R8)

Men prefer the car rather than the family. (R8)

It is perceived that homosexual respondents reveal their classic representation of men, which is characterized by emotional and affective detachment. They also expose the focus that the "real men" have for socially valuable objects (car/motorcycle), objects that denote virility before others.

By distancing themselves from the female universe, men often fail to express their emotions so as not to be considered as weak, as this feature is supposed to be inherent in the female world. If a man emotes, he can be considered by other men or even by women as a weak being and without the strength to bear his responsibilities⁷.

The discourses of the homosexual interviewees point to the evaluative dimension, characterizing them as individualistic subjects, since material goods appear as if they have more value than the family. Thus, the representation of men is that of the subject who thinks about himself and forgets the collective aspect.

The real man is an individualist. (R8)

In the contemporary social scene, "social life and opaque identities have been replaced in their tragedies by the phobic individualism of a playful and hedonistic consumerism"^{10: 277}. The man, in turn, assumes an individualistic position and seeks to establish himself financially among the others, becoming competitive and attaching more value to material things and to power. Thus, social recognition is an important factor to be affirmed socially as real men. "In the confrontation between men and women in social relations, either in the domestic sphere or in the public sphere, all the advantages, according to the dominant values of the individualistic, competitive and capitalist society, seemed to be belonging men" ^11:48.

As pointed out earlier, the real man is seen as an individualistic individual who does not care about the collective aspect. In the discourse of homosexual subjects, they reveal a practical and negative dimension:

Liars, they lie too much, they are all liars. (R1)

They do not want anything serious with life. (R8)

The homosexual man has the representation of man as a subject with hedonistic practices, an eternal consumer, who seeks pleasure in material things.

All mess, nothing is right. [...] They are all about the mess. (R5)

Violence, hedonistic consumerism, and masculinized phobic individualism express social relations of power that structure and substantiate multiple groups of belonging, constituting a subjectivation that legitimates individuals' behaviors¹⁰. Today's society fosters the self-absorbed, competitive and eternal producer-consumer subject, and ends up adopting a hedonistic and materialistic way of living, in which living means seeking pleasurable and immediate sensations without measuring the means and consequences¹².

In the discourses of heterosexual men, as well as in those of homosexuals, the real man also appears as a subject with hedonistic practices.

For these men of today do not worry at all. They just want to enjoy life; they do not think about tomorrow. (R4)

The guys go out there doing stupid things, they use drugs; they do not have any concerns. (R9)

Heterosexual subjects reveal man's adherence to a new concept of social time, that is, their processes are inserted in a short time, which opens the door to success, hedonism of sensations and recognition for power¹³. That is, the practice of hedonism occurs when one obtains promptly the longed social recognition and the pleasure that is obtained by the conquest.

At the same time, the representation of men towards self-referred heterosexuals encompasses the dimension of social recognition, in which status before society is placed as something to be conquered.

I think man today is very worried about possessing. The real man is concerned about having something. Worried about getting what he wants. I speak for myself; men are very worried and sometimes very anxious. (R2)

The struggle for the achievement of socioeconomic status generates a certain stress on man, which causes concern for the achievement of social recognition. "Work is something associated with being a man and, therefore, failure to achieve progress in this field or loss of employment can generate not only economic, but also identity tensions"^7:40. Man, therefore, has behavioral patterns that approximate those required for a machine, and while being identified as a machine man, they are unable to problematize the way in which they live socially 14. Therefore, man has patterns that lead to impulsivities and, among them, sexual impulsivity. As in the speech exposed by the heterosexual man, besides the machine that has to work socially, there is still the representation of the man being as a sex machine.

[...] likes having many women, hooking up with a woman and hooking up with another. (R4)

[...] the man tends to be a womanizer, a player. He goes out with friends and where do they go? ... A sex machine ... They go to the club, go to the whorehouse, go to the brothel. (R10)

Sex constitutes one of the pillars of the affirmation of the masculine identity, since, for the common sense, the need for sex belongs to the masculine nature and when there is lack of sex in a conjugal affective relation, it is justified that they seek it out of home because of men's need of a physical satisfaction¹⁵. To achieve sex, or even sexual satisfaction, many men also consider the possibility of acting as sex workers. Payment for sex is something historical and cultural in the male universe. The house of prostitution is historically regarded by men as the setting for the first male sexual relations, since especially young men seek these environments in order to learn how to relate sexually ¹⁶. That is, in the male imaginary, this space serves for the learning of sexual techniques.

In the house of prostitution, the female sex worker is seen as an object and the sexual practice as a service to be paid. Men who attend these places have the perception of the other man or the other woman as an object, which serves as an instrument to give pleasure through money. This relationship is made from the acquisition of a product for momentary gratification. For this same author, "the man, the male, is characterized by the need to unburden his own sexual energy; the prostitute is the simple instrument that allows the necessary release" ^17:93.

When money is offered, the bonds of the relationship disappear altogether: the obligation is radically less than with any specific object, for the latter, because of its content, choice and utility, becomes more easily linked to the personality of the supplier. It is due to the instantly aroused desired and instantly extinguished desire that prostitution satisfies only the equivalent to money, which does not create bonds, as it is, in theory, available at any time and is always well-accepted ^{18: 536}.

The relationship that exists between men and sex workers is established due to a valuation that these men attribute to these women that alleviate their anxiety as a consequence of the day-to-day concerns. "It is in their body that man rests and unloads the frustrations and stress of daily toil. By talking to her, he calms down, and asks for her opinion; thus, it is sealed the recognition of her identity"^19:73.

When questioning men about the relationship between the real man and HIV infection, the homosexuals represented man as a sex machine.

They relate [sexually] day by day with several people. (R1)

Male sexual activity is seen as a rite for the constitution of virility. In Brazil, man is represented as a sexually active subject and eager to have sex, unlike the woman, who is seen as passive and whose sexual experience depends on the establishment of the affective bond to occur¹⁶. That is, for common sense, a man does not reject sex. In the social imaginary, man is seen as a sex machine; he has to be ready at all times for sexual activity, as a way to prove his virility.

In the discourse of homosexuals, the real man is considered as a subject with practice of greed. This practice of greed is related to the image of unbridled sexual practice of men.

The man is not satisfied with one thing; he wants more, even if he has to pay for it, he wants it. (R2)

The practice of greed has a channel of communication with the representation of man as a sex machine, in which he is not satisfied with what he has, he always wants more, and he has a compulsive sexuality. And to fulfill his desire, this subject is also capable of paying for sex work.

Male sexuality affirms itself in the sense of having virility attested by several women¹⁶. Common sense points to male sexuality as unbridled, that is, the more a man acts sexually or is willing to act sexually, the more his masculinity is attested.

In the speech of homosexuals in which they characterized the real man, they did not stand as if they were part of this category. The image that homosexuals have of the real man is of a heterosexual subject, who does not belong to their group and is part of the other group. For homosexuals, the real man is not part of their group of belonging. "Heterosexuality - understood as orientation or preference - is also often highlighted by some authors as a structuring axis for male sexuality, becoming almost an exclusive belonging of this sexuality" ^15:149 .

When heterosexual men were questioned about the link between man and HIV infection, there is also the image of man as a sex machine.

[...] I listen, I see in the conversations between married men who have extramarital affairs and often in these relationships with partners over time. (R2)

They are more exposed, more relapse, do things they should not do. (R10)

There is, therefore, for man, a communication between the sexual initiative that these subjects have, often seen as unbridled, and the imaginary one has of the polygamous man. Being a man is defined as opposed to being a woman. In order to define themselves, men use terms such as crude, strong, aggressive, having sexual initiative, staying more out of home and liking to cheat ⁷ .

In the narratives presented by heterosexual men, they point out that real man is characterized as subject with practices that lead to anxiety. Anxiety is triggered from the day-to-day chores, from work, from the maintenance of the home, from the family, that is, from the role assumed by man in the society that represents him as a provider.

Due to concern, anxiety, the pursuit [of sex with other women] to relieve oneself. (R2)

Being a man is associated with being the owner of a man's honor, which is based on two pillars: the responsibility of being a father/husband and having a respected woman. The feeling of paternity consolidates the function of provider, giving rise to the feeling of responsibility, from the relational code of honor that is made due to the paternity ¹³. Sex serves as a practice for discharging and relieving tensions. "In sexual intercourse, man relieves himself, but if it is too much, he empties himself of his energy, becoming weak" ^20:435. Sexual intercourse can also become somewhat sickened, translated by insatiability, in which, as presented in earlier discourses, man does not get satisfied with what he has. The discourses of heterosexual subjects point to a representation of the loss of the secularized practice of the real man. That is, they see the real man as a non-religious person who does not make up the family structure or who does not assume his role in the family.

The head of the family is getting lost; whoever is in the Church is getting lost. (R5)

Marriage is considered indissoluble, monogamous and linked to reproduction. The male moral order of responsibility is founded on the relationship with work and virility, through the economic maintenance of the family and the protective attitude towards its members. But the family dynamics in the new model is marked by the phenomenon of individualism, characteristic of the great Brazilian urban centers. In other words, what is observed today is that the institution of marriage already brings with it the embryo of dissolution. From the informal and uncommitted connection to the divorce, increasingly observed, the family structure has been breaking down over the years.¹². The role of man in the family is being lost due to the phenomenon of individualism.

In the face of these discourses, it can be seen that the social representation of men about being a man presents them with characteristics linked to hegemonic masculinity with an unbridled sexuality. The anxiety triggered by daily stress and social responsibilities from the daily tasks, the work, the maintenance of the home, the family, that is, from the role assumed by man in the society that represents him as a provider, makes them vulnerable to HIV infection because, in the search to discharge this anxiety, these subjects flee from the environment that generates stress and go to other places to take refuge. Sex emerges as a practice to alleviate these tensions, being common that these men search for another partner or an unknown person in order to satisfy their needs.

CONCLUSION

Authors highlight the existence of vulnerability to infection linked to social and behavioral aspects. Men, when influenced by a model of hegemonic masculinity, may endanger both their health and that of others. However, the understanding of man today can bring new discussions regarding the social construction thereof, as well as its implications in face of vulnerabilities to HIV/AIDS infection, in order to deconstruct myths and taboos that permeate the cultural issue of what it is to be masculine, in order to understand this subject within the health services and to address healthy social and sexual male practices.

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