The postings on this topic give important guidance on differences among men, on what shapes the role of men in the epidemic, on what men can do practically, and on issues about strategy.

DIFFERENCES AMONG MEN

Men are differently positioned in relation to the HIV/AIDS pandemic, and we need to recognize these differences when shaping strategy. There are, first, differences in men's sexuality and sexual identity, between men who have sex with women, i.e. men in heterosexual relationships, and men who have sex with men, i.e. men in homosexual relationships. (There are also men who have sexual partners of both genders, and different patterns of sexuality through the life course.) Among men who have sex with men there is significant difference between those who are affiliated with a gay community and those who are not (see Michael Flood's posting).

Men also differ in their cultural background, and in their ethnic or racial identity and situation. Many contributors mention the cultural specificity of their own context, the local patterns and traditions of gender relations. Ruben Reyes Jiron notes the power with which differences in racial situation can affect young people.

Men's response to the pandemic is also shaped by their economic and class situation. Tanya Shahriar notes the nuances of masculine identity, the idea that a wife should never outshine a husband, in middle and upper class Bangladesh. Robert Morrell notes the significance of unemployment and poverty in disrupting family commitments and producing a context for HIV transmission in southern Africa.

There are also differences of generation that need to be attended to. Ruben Reyes Jiron and Michael Flood talk specifically of youth, at the stage of forming sexual relationships. Radhika Chopra mentions the role of children. Puleng Letsie speaks of older men, married and with children of their own.

WHAT SHAPES THE ROLE OF MEN IN THE PANDEMIC

Men's actions in relation to the pandemic are shaped by gender patterns in culture. Where there is an ideology of male supremacy, or male privilege, men may ignore women's interests and safety in sexual encounters, to focus on their own pleasure or prestige (Chuck Goolsby, Puleng Letsie).

The specific customs and ideas current about sexuality are also relevant. Michael Flood shows how asymmetrical ideas of men's and women's sexuality encourage unsafe sex among young Australians. Similarly, Babatunde Ipaye cites evidence of a strong belief in men's sexual initiative among Nigerian youth. The way sexual relationships are constructed may be important. "Throwing out the condom" as a sign of trust in a relationship is humanly understandable - but still dangerous.

The economic and cultural circumstances in which men find themselves are not prominent in medical research on the pandemic, but as Robert Morrell argues, they can be very important. Economic restructuring and disruption may make it impossible for many men to perform traditional masculine social obligations, resulting in cultural disruption, personal desperation, high levels of violence, and rapid spread of HIV. Puleng Letsie points to another tragic circumstance - HIV transmission occurs when men DO carry out traditional obligations, in this case, marrying widowed sisters-in-law who have been infected by their husbands, resulting in whole kinship networks being devastated by AIDS.

WHAT MEN AND BOYS CAN DO

Many of the contributors mention education - the general need for educational action towards gender equality (Muoy Kry Chea), and the specific need for HIV and safe sex education directed towards heterosexual men (Michael Flood, Puleng Letsie). Puleng Letsie notes the difficulty here, that previous campaigns of this kind have not met with a good response. Clearly, new thought is necessary. Ruben Reyes Jiron mentions the effectiveness of testimony in a youth camp, including testimony from an HIV-positive participant. Radhika Chopra makes the imaginative suggestion of integrating health education with the body care and beauty practices in which young people are already interested.

To the extent men control sexuality, they have the capacity to change sexual practices. Tanya Shahriar argues for a more active role of men in reproductive health generally, and for more research and policy support for this. Michael Flood points to the "choreography" of sexual encounters, and the way safer sex can be integrated into sexual arousal and pleasure - a point already familiar in gay communities but not much accepted in heterosexual populations.

Several contributors suggest changes in patterns of care-giving. Puleng Letsie mentions the need for men to care for HIV-infected women. Babatunde Ipaye mentions African traditions of care-giving, and suggests these can be consciously fostered, for instance involving boys in "care clubs". Radhika Chopra argues that we should not ignore the caring capacity of children, both boys and girls - as shown in other issues.

Finally there are larger cultural changes in which men's role may be crucial. Muoy Kry Chean mentions the importance of developing attitudes of respect for women; men and boys can play a role in the education of children in this direction. Robert Morrell points to another cultural change - to revalidate the role of the community, and the concern of elders, in relation to young people's sexuality. This goes against a powerful modern trend towards individualism, but it may be vital in building community responses to HIV/AIDS.

ON STRATEGY FOR CHANGE

The interweaving of sexuality with gender inequality creates patterns that are complex and not easy to change. Some of the strategic problems emerged in our discussion.

Tanya Shahriar notes that when we recognize the importance of addressing men about reproductive health, we may think that a focus on men's actions, and an address to men only, is sufficient. But this is mistaken. Gender relations are involved, and integrated programs involving both women and men are necessary.

Robert Morrell, in the African context, also notes the importance of addressing heterosexual men - but not by constructing them as "a problem" or "the cause" of the pandemic. HIV/AIDS messages need to gain cooperation, and should be designed in the light of the larger issue of building more respectful masculinities.

Both these issues touch on the question of what are men's interests in change, which we will address in the third week of this on-line discussion.