The role of masculine gender norms in HIV vulnerability among Dominican men enrolled in a circumcision feasibility trial

Background: Masculine norms influence men's sexual behaviors. Though this relationship has been extensively theorized, empirical evidence explaining this relationship is limited. This dissertation aims to understand how masculine norms and concern about demonstrating masculinity contribute to men's HIV vulnerability in the Dominican Republic.;Methods: I conducted three studies using qualitative and quantitative data from a feasibility trial of voluntary medical male circumcision for HIV prevention in two Dominican cities. In the first study, I analyzed survey data collected from men 6--12 months post-circumcision (n=293) to examine the association between Gender Role Conflict/Stress (i.e. concern about demonstrating masculine characteristics) and HIV-related sexual behaviors. In the second study, I analyzed data from in-depth interviews with a sub-sample of men in the trial (n=30) to explore how masculine norms shape men's sexual and violent behaviors. Finally, in study three, I used both data sources to explore the relationships between norms of masculinity, male sexuality, and circumcision.;Results: Men's Gender Role Conflict/Stress was significantly associated with having two or more partners in the past 30 days, inconsistent condom use with non-steady partners, and drinking alcohol at last sex, after controlling for socio-demographic characteristics. In the qualitative interviews, men helped to explain this relationship by showing that masculine norms encouraged them to compete with one another for social status and that demonstrating masculine characteristics within their social networks---such as successful sexual performance or being a provider---was a key way to gain social status. Men were especially concerned about being humiliated because of the implications for losing status, which led to engaging in violence and sexual risk behaviors. Finally, nearly half of men reported feeling more masculine after receiving a circumcision. Their main reason for feeling more masculine was improved sexual performance which allowed them to avoid the humiliation associated with an inability to satisfy sexual partners.;Conclusion: Men demonstrate their masculinity through their sexual behaviors and their concern about demonstrating masculine norms to their social network drives men's HIV-related risk behaviors. HIV prevention efforts should ameliorate the negative effects of competition between men and address men's concern about demonstrating masculine characteristics.