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Class 3
Needs across lifespan
380.720 – Masculinity, Sexual Behavior & Health, 2012 Qtr 2
Discussion questions
General questions
•  AAP Male adolescent SRH clinical report
•  AAP Circumcision technical report & recommendation
•  Frey Preconception health & care
•  Laumann Sexual problems
•  IOM LGBT Report
•  Kann YRBS & risk behavior among gay/bi youth
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Discussion questions
•  Healthy People 2020 Objectives
•  What do you see as reasons focus on men’s SRH
has been lacking?
Males have multiple SRH needs
National Survey of Adolescent Males Wave 4, 2008-10
- Mean age=37 years (range 35-39 years)
Examined 5 SRH need categories
- In need of family planning
- In need of preconception health
- Have STI risk
- Report sexual problem
- Have fertility concern
%
40
30
16
13
7
Have 1 SRH need
Have 2 or more SRH needs
50 (1 in 2 men)
26 (1 in 4 men)
Marcell et al. In process. 2012.
Multiple SRH needs cont.
Among men with 1 need, majority are in need of
•  Family planning OR
•  Preconception health
Among men with 2 needs, majority are in need of
•  Family planning AND
•  STI risk reduction
Among men with 3 or more needs, majority are in
need of
•  Family planning,
•  Preconception health, AND
•  STI risk reduction
Marcell et al. In process. 2012.
2
Discussion questions
•  White Paper
–  General questions?
–  Any feedback given discussion to date?
–  Anything missing?
What are the goals of male
sexual & reproductive health (SRH)?
Prevent
1.  Unintended pregnancy
2.  STIs, including HIV (& control)
3.  Reproductive health cancers
Promote
4. Sexual health & development
5. Reproductive life plan &
preconception health
6. Healthy relationships
Reduce
7. Sexual problems, infertility
Increase
8. Lifespan/survival/quality of life
9. Access to care/satisfied w/ care
Child
Teen
+
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Adult
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+
+
+
+
+
+ +
+
+
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+
Approaches to Work with Men
Gender neutral
Gender aware
Gender sensitive
•
Take into account gender-specific ways a male may
experience health problems & illness differently than a female
& has capability to effectively communicate with a young man
Gender transformative
•
Work to change societal gender relations (& male culture)
such as helping a young man redefine need to be sexually
promiscuous to prove his manhood & promoting healthy
sexuality
Rao Gupta G. Gender, Sexuality and HIV/AIDS: The What, the WHY
and the How. SIECUS Report 2001;29(5).
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How should we prioritize needs?
1. Loss of Disability Adjusted Life Years (DALYs)
- Globally, 5.5% of DALYs that adult men lose each year are attributable
HIV/AIDS (WHO, 2004).
- Apart from HIV/AIDS, syphilis is the STI that causes the most global
DALY loss among adult men (WHO, 2004).
- Men under age 50 are rarely affected by reproductive health cancers.
Testicular cancer, which comprises 1.1% of cancers in men, is the most
common cancer affecting young adult men (Garner et al., 2005).
How should we prioritize needs?
2. Disparities in health outcomes
- Adult HIV prevalence ranges from 37.5% in Botswana to less than
0.1% in dozens of countries (WHO, 2004).
- In the US, blacks make up 13% of the population but 39% of those
with AIDS (Stine, 2009).
- Adult incidence of gonorrhea, syphilis, chlamydia, and trichomonas is
2.2% in east Asia and the Pacific, while it is 25.7% in sub-Saharan
Africa (Glasier et al., 2006).
- In Senegal, HIV prevalence is 55 times higher among men who have
sex with men (22%) than among men in the general population (0.4%)
(CRDH, 2005; UNAIDS, 2006).
How should we prioritize needs?
3. Gaps in access to and use of services
- Unmet need for STI screening among men in the US: In 2001, half of
sexually active men in the US between ages 20 and 44 had received no
sexual health care and, of those who did, half received only a testicular
exam (Kalmuss & Austrian, 2009).
- Due to the stigmatization of homosexuality, men who have sex with
men may not disclose to their providers and thus may not receive
appropriate sexual health care (Ryan & Futterman, 1997).
- While unmet need for contraception among men is lower than among
women, it is still extremely high in many developing countries: 42% in
Bangladesh, 36% in Zambia (Becker, 1999).
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How should we prioritize needs?
4. Relevance to the Millennium Development Goals
a) HIV/AIDS:
- Prevention and treatment for adult men serves Goal 6
directly
b) Family Planning:
- Increasing access and use among men serves Goals 4 and
5 through birth spacing and limiting
- Indirect effects on Goals 1, 2, 3, and 7 as well
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