AIDS and masculinity in the African city

Book review symposium

Robert Wyrod

— Reviewed by Lesley Doyal, Linda Musariri

27 Apr 2018

Robert Wyrod, AIDS and Masculinity in the African City: Privilege, Inequality and Modern Manhood, Berkeley: University of California Press, 2016. Paperback 312 pp., $27.26. ISBN: 9780520286689.

Reviewed by Lesley Doyal

This excellent book provides one of the few detailed studies of the changing nature of (hetero)masculinities in a specific social context. Using a variety of anthropological techniques, Wyrod explores the impact of the HIV/AIDS epidemic in a deprived community in Kampala. This provides the basis for a sensitive and nuanced analysis that traces the changing nature of gender relations within which AIDS has been embedded.

As the author himself describes it, the study is focussed on whether or not what he calls ‘masculine sexual privilege’ has been undermined by the development of the AIDS epidemic in the context of wider social and economic changes in the nature of Ugandan society. In order to carry out this analysis, he focusses on three aspects of men’s lives: work, sexuality, and authority. As Wyrod points out, gender practices and ideals in each of these intersecting arenas are not static but are continually being redefined. Thus, the study provides a valuable example of the mutability of ‘masculinity’ and the ways this plays out between men (and women) in a particular setting.

To carry out this analysis, Wyrod deployed the classical anthropological approach of participant observation. The longest part of the study lasted a year and was carried out in 2004. This was followed by two shorter periods in 2009 and 2015. It was possible to work a longitudinal element into the analysis by keeping in contact with key individuals, some of whom were also followed up with via Skype or email between fieldwork sessions. Such an approach is of course all too often impossible due to financial and time constraints on the researcher. However, Wyrod makes especially good use of this opportunity by including narratives of those men who are introduced earlier in the book. This in turn provides the foundation for clear and nuanced understandings of the variety of ways that many men’s lives were reconfigured over time. Of particular significance was the fact that so few of the men were able to achieve the goals they had articulated earlier.

These findings reflect the quality of Wyrod’s use of ethnographic methods. Too often ethnographic researchers focus mainly on observation and interviewing or ‘hanging out’ in relatively unstructured time rather than on participation itself. This reflects the serious challenges they often face in becoming actively involved in the community concerned. In this case, however, Wyrod was able to optimise his data collection and analysis through three strategically chosen activities: apprenticing in a carpenter’s workshop where he spent two days a week, volunteering one day a week in a government health clinic, and becoming an honorary member of the Bwaise Positive Men’s Union, which undertook a wide variety of community activities.

Through this structured involvement in the lives of local men, he was able to develop a wide range of personal relationships as well as undertake some 160 formal interviews with men who reflected the diversity of inhabitants in the community. Importantly, he also spent time both before and during fieldwork learning the most common of the local languages, Luganda. As a result, he needed little help in the translation of transcripts or interpretation during interviews or focus groups, taking him one step nearer to the ‘meaning’ of what was being communicated.

Given this exemplary use of ethnographic methods, Wyrod was able to provide extensive and illuminating verbatim accounts from the men involved, with the personalities and circumstances of some of the key characters (and their significant others) becoming familiar to the reader over time. These personal details were woven with considerable dexterity into descriptions of the social and economic context of their lives, providing a valuable synthesis of both the macro and micro dimensions of their changing sense of themselves, as well as the transformations of social and economic circumstances. An important advantage of this creative and integrated approach is that it makes clear not only the commonality of challenges posed by the pandemic to all the men but also the diversity of their responses.

One of the most important themes to emerge from this analysis is the fact that, despite the changes in the shape of Ugandan society in general and of masculinity in particular, there is little evidence of greater gender equality over the period. In an interesting historical account, Wyrod points out that during the early period of the AIDS epidemic, legislative change focussed on promoting the rights of women as well as their greater entry into the labour market. This combination of trends has been noted in many other parts of Africa, leading to the assumption that men are inevitably losing out in the context of status and power. It is certainly clear both from the Uganda experience and from other studies that major challenges are posed by loss of capacity among many men to support their families and the inevitable question marks placed over the potential dangers they represent in sexual encounters. However, the overall conclusion drawn from Wyrod’s analysis is that despite these developments masculine privilege appears to be sustained in complex but clearly identifiable ways, especially in the sphere of sexuality.

One thread in the analysis involves an exploration of changes in the situation of women as part of the gender dyad. Most important is an examination of the impact of the promotion of women’s rights as government policy during the early part of the twenty-first century. This was widely praised internationally and seen as a factor contributing to the decline of HIV infection in Uganda when the epidemic was increasing so rapidly in other parts of Africa. However, closer examination of the situation in Bwaise reveals that the effects of this strategy were much more complicated than was usually assumed. Indeed, Wyrod’s exposition of in-depth conversations with couples is especially valuable in revealing the limitations of legislative strategies in changing gender relations in intimate areas of life.

Chapter 5 uses case studies of a number of couples to explore how notions of ‘women’s rights’ are (re)negotiated within sexual relationships. Central to this analysis is the recognition that both women and men are ambivalent about the significance of this concept against the background of the continuation of both culturally and biologically essentialist notions of masculinity. These apparent contradictions are handled differently among couples, but the overall effect is an accentuation of male dominance especially in those intimate settings where state policies cannot reach. Of course, Wyrod does not claim that greater gender equality cannot be achieved, but he highlights the complexity of strategies involved, as well as the importance of linking these to the struggle for improved living and working conditions and antipoverty policies.

One of the major advantages of this account is that it locates the experience of an AIDS epidemic in the broader context of a complex and deprived community. It does not focus only on those already infected, but explores the implications of the disease for the diversity of people attempting to survive in challenging surroundings. Not surprisingly, this makes a significant contribution from both theoretical and policy perspectives. First, it provides a unique contribution to the current literature on the fluidity of (hetero)masculinities, especially as they relate to HIV/AIDS. Of particular value here are the verbatim quotes that highlight the heterogeneity of individual lives even when they are played out in what are ostensibly the same setting. And finally, Wyrod provides an important critique of the current shift towards biomedical approaches to HIV prevention. As the analysis shows, this can only be limited in its effectiveness unless it is clearly shaped within a detailed understanding of gender relations in general and masculinities in particular within a specific context. Thus, the book has a great deal to offer and I recommend it highly.

About the author

Lesley Doyal is Emeritus Professor of Health and Social Care at the School for Policy Studies and has completed six years as a Visiting Professor at the University of Cape Town. She has published widely in the field of international health with a particular focus on gender. In recent years she has worked in HIV and AIDS using political economy, ethnographic, and intersectional perspectives. Her latest book, Living with HIV and Dying with AIDS (Routledge, 2013) is acclaimed as the first attempt to provide a global and interdisciplinary approach to life with HIV. She has consulted for numerous organizations, including the WHO, UNDAW, and Global Forum for Health Research. 

Reviewed by Linda Musariri

Deviating from dominant narratives on AIDS in Africa, which for the most part have focused on how gender and sexuality contribute to the AIDS epidemic, Robert Wyrod presents an ethnographic portrait of how the disease has altered gender relations and specifically the performance of masculinity. He skillfully explores how the AIDS epidemic and chronic poverty have undermined the hegemonic masculinity of men as decision makers and providers in Bwaise, a densely populated and impoverished slum community in Kampala. He introduces us to the term ‘masculine sexual privilege’, which becomes central to his narrative throughout the six chapters. The term refers to ‘both men’s authority to dictate the terms of sex and a man’s right to multiple sexual partners if he so chooses’ (pp. 8–9). Drawing on his interactions with a total of 116 residents, including nineteen cohabiting couples, Wyrod expertly shows how this privilege is available to all men in their heterogeneity (p. 37). This narrative is based on empirical data obtained from immersive fieldwork involving ‘unstructured time spent observing and talking to women and men’ as well as participating in their day-to day-activities in public places, at work, and in their homes over a one-year period in 2004, followed by short visits in 2009 and 2015.

In the introduction, Wyrod comments on how the tide of the HIV response is shifting towards biomedicalization at the expense of community-based social interventions. Revealing throughout the book that AIDS is as much a social disease as it is medical, he concludes by providing an update on the new Kawempe Hospital being built to replace the Bwaise community clinic, as an example of this shift.

Uganda recorded some of the highest levels of HIV prevalence in Africa in the early 1980s. By the late 1980s and early 1990s, Uganda became the first country in Africa to receive global recognition for effectively reducing HIV infection and prevalence rates. Much of its success is attributed to a strong political commitment and a vibrant women’s rights movement, which in turn have led to a behavioral shift among Ugandans. While this is a widely held assertion, Wyrod reveals that the causes of this change are not as linear as are often assumed. Inspired by Uganda’s success story, Wyrod sets out to investigate how the AIDS pandemic influenced the performance of masculinity, including male sexual privilege, in the context of HIV-prevention messaging that focused on monogamy and abstinence. His study shows that neither AIDS nor the women’s rights movement managed to entirely challenge male sexual privilege, except for in a few contexts such as serodiscordant relationships (couples in which only one partner is HIV positive). That is to say, most men in Bwaise acted as if AIDS did not exist, in that they still had concurrent partners despite being relatively knowledgeable about the risks associated with the much-feared disease.

Drawing from existing research, Wyrod shows that the practices of polygyny and extramarital relationships, just like monogamy, were an accepted part of manhood in precolonial times and had gone largely unchallenged, leading to their entrenchment in social life over time. Several men from both the lower and upper classes in this study found it difficult to navigate the normative notions of masculinity, of having multiple sexual partners, and of the health campaigns that emphasize faithfulness and abstinence. Thus most men preferred ‘zero grazing’, or reducing their number of sexual partners, to monogamy. Used in a Ugandan HIV-prevention campaign, this phrase was borrowed from the Ugandan ‘practice of tying a cow to a peg limiting its grazing to a small circle or zero’ (p. 23). Interestingly, despite variance in socioeconomic status, men in this study still took advantage of their sexual privilege, whether to improve or maintain their social status (among those who could afford to have many wives or girlfriends), to escape (for those who failed to live up to the hegemonic economic provider ideal or found themselves in troubled relationships), or just for pleasure (p. 179).

Chapter 3 gives a compelling description of the interconnectedness of gender inequality and poverty in the context of AIDS. Male status was tied to wealth and political power in ancient Uganda and continues to be today (p. 48), as evidenced by men striving to live up to their role as providers and to achieve economic security. This provider role has been compromised and reshaped over time, not only due to AIDS but also as women’s sphere of authority has increasingly extended outside the kitchen and into the labor market. Wyrod discusses the work of Ahikire (2003) and Tamile (1999) who argue that in modern Uganda, riding the women’s rights tide, many women have managed to assert themselves to generate their own income, which has undermined men’s role as decision makers in domestic life and as providers.

Chapter 4 looks at the role of women’s rights in shaping masculinity. Wyrod provides a brief overview of how political leadership has shaped masculinity from the time of Obote’s (1966–1971, 1980–1985) and Amin’s (1971–1979) misogynist regimes to Museveni’s (1986–present) pro-feminist government, which has seen women assume leadership roles in politics and participate significantly in economic activities. He comments on how the institutionalization of women’s rights has relatively contributed to the reduction in HIV-prevalence levels in the country, as it allowed women to have a greater say in their intimate relationships. This is exemplified in the story of Edwina, who after being partly influenced by the ideas of women’s rights, refused to have sex with her HIV-positive husband (p. 125).

Wyrod is cautious to avoid the assumption that women were without any power or authority prior to Museveni or the feminist movement. Rather, Museveni’s leadership is seen to amplify the voice of feminists and to strengthen the women’s rights movement to provide a platform for women to assert themselves. Wyrod further problematizes the causal inference between women’s empowerment/rights and women’s autonomy in sexual matters. We see some women in this study using women’s rights rhetoric to claim their place in the labor market but not in their sexual relations, where men are still seen to dominate. This emerges in the story of Madina, who demands of her husband permission to work in town, which she exchanges for her permission that he get a second wife (p. 149).

Wyrod also touches on the concept of ‘responsibilization’, as evidenced by AIDS support groups such as Bwaise’s Positive Men Union, whose aim is to encourage positive living among HIV-positive men. He shows us that living openly may come with tradeoffs; men may lose their social standing by not conforming to the hegemonic masculine ideal, particularly when what biomedicine considers the actions of a responsible citizen undermines some aspects of ideal manhood.

In this book, Wyrod joins his voice with several anthropologists who, while welcoming the advances of biomedical interventions in addressing AIDS, are concerned that these will displace sociological approaches that focus on behavioral factors. They argue that the social aspects of living with HIV and AIDS over the lifespan cannot be overemphasized, from transmission, testing, and treatment seeking to the life lived with HIV/AIDS. Wyrod skillfully manages to illustrate this point. A more nuanced exploration of the interaction and complementarity of biomedicine and the social aspects of the disease would have been welcome.

I appreciate how Wyrod interweaves prominent theories within the study of masculinity (related to hegemony, the crisis of masculinity, and modern manhood) with everyday lives of Bwaise men, making both more comprehensible to a wide audience, including nonacademic readers. This ethnography makes valuable contributions to existing theoretical, programmatic, ethnographic, and political discussions around masculinity in Africa and the AIDS epidemic.

About the author

Linda Musariri is a PhD candidate at the University of Amsterdam. She is part of the ERC-funded project ‘Becoming Men: Masculinities in Urban Africa’, an anthropological study that examines the reconfiguration of masculinities in urban Africa over the last thirty years. Her current research focuses on masculinity and violence in South Africa. She is funded by the National Research Foundation of South Africa and the Amsterdam Institute of Social Science Research.