Many reproductive health programmes are now incorporating a "gender perspective" into their sexual health services. Still focused mainly on serving women, however, these programmes need to widen their focus to include men and couples in order to deal effectively with the gender issues underlying many of the problems they aim to address. 

When envisioning strategies to achieve equality between the sexes, a common error is to conceive of a process in which women gain and men lose. It is undeniable that equality would entail men's loss of control and dominance over women, loss of privileges in the labour market, and loss of leisure time in non-working hours. No wonder there is such widespread hopelessness when contemplating the goal of transformation of male roles! Nevertheless, efforts to involve men in working towards this goal entail gains for both sexes.

Male participation in reproductive health and childrearing is often phrased as a responsibility or duty but it may also be proposed as a right. Stating that men have a right to care for their children, for example, offers an entirely different approach to men. It also leads policy-makers to think differently about enabling conditions that would make it possible for men to make a greater commitment to their children. The current emphasis on responsibility leads towards punitive policies, such as enforcement of child support, directed at men who are "irresponsible." Such strategies are necessary to support abandoned women and their children, but they are often not equitable for low-income fathers, nor are they sufficient to bring about the desired social change. In many developing countries, low-income male heads of households already work 12- to 14-hour days and they do not have time to assume additional responsibilities.

Strategic communications are those that focus on men who are already commited to their families, who are acting "responsibly" according to their traditional role as breadwinner. The men who have not abandoned their families and who are "responsible" heads of households would probably respond more positively to an expansion of their rights rather than to admonitions to be even more responsible. The men most likely to assume such a task and be open to new ideas are surely not those whose actions place them at the end of the spectrum of irresponsible and oppressive masculine behaviour.

The advantage of the rights perspective may be clear regarding the structural changes needed to enable men and women to balance domestic and work responsibilities. It may not be as obvious when it comes to gender roles and sexuality, however. A rights perspective would promote principles of equity and mutual respect in sexual relationships and transform those aspects of traditional roles that undermine these principles. At the individual level, one might say that a person has a "right" to transgress the limits set by these cultural expectations.

Other aspects of the cultural model serve to justify or pardon behaviour that is otherwise seen as socially undesirable. One common expectation regarding male sexuality is that it is instinctive, uncontrollable and aggressive. As a result, men engaging in sexual coercion or harassment may not believe they are doing anything wrong. Or, if they do recognize wrongdoing, they may not see themselves as deviant or criminal.

Studies on sexuality and gender carried out in Lima, Peru, in 1995 revealed that today adolescents more rigidly define the male role than the female role [1]. This study asked adolescent focus groups to name types of boys and girls according to their sexual behaviour. Both groups listed a range of names describing different types of girls/women who take the initiative or are not easily controlled by men. In contrast, no focus group gave a similar diversity of sexual types for boys, although they made a vague differentiation between a "mover" and a "quiet guy". In general, the boys said that one is either a "man" or a "faggot" (homosexual).

"Empowerment" may be defined as "authorizing" or "making able". Empowering men in relation to sexual health thus means enabling or authorizing them to participate in the responsibilities and benefits of good sexual health.

The taunts directed at a man who deviates from the standard role imply that he has taken on the female role, the ultimate humiliation. The labels and names applied to the unfortunate boy or man are all codes for denying him manhood: he is feminized, a girl, a homosexual. This intensely humiliating process of socialization also conditions men to view women and homosexuals as the "despised other", and any identification with them is a threat to their manhood. The fear generated by homophobia may be one reason for the weakness or absence in most countries of a men's movement, similar to the women's movement, to transform traditional ideas about masculinity.

Changing male and female sexual cultural models is a complex, difficult and long-term process. Homophobia and misogyny (hatred of women, especially by men) are the most powerful mechanisms of social repression reinforcing the traditional model of male sexuality. Thus, sexual education programmes, violence prevention programmes and education from the gender perspective all need to focus directly on the themes of gender equality and sexual diversity. If men are not educated to recognize the key role of homophobia and misogyny in their own socialization, repression and oppression, they will not have the intellectual or emotional resources to confront the social pressures that will inevitably besiege them as they begin to abandon traditional male sexual patterns.

For those who have worked for decades to liberate women from men's dominance and power, it may feel absurd and seem counterproductive to talk about empowerment of men. Yet empowerment is not synonymous with power and domination over others. Supporting men as they move beyond traditional definitions of masculinity is a process of personal and collective empowerment.

Bonnie Shepard, Programme Officer, Andean and Southern Cone Region, Ford Foundation, Santiago, Chile; Tel: 56-2-232-5454; Fax: 56-2-204-9385