Men at Risk: Masculinity, Heterosexuality, and HIV Prevention by Shari L. Dworkin (review)

If I had closed my eyes and tried to conjure up a truly excellent report on the state of affairs regarding straight men and HIV/AIDS in 2016, it would look very much like Shari L. Dworkin’s indispensable Men at Risk. Today, thirty-five years into the global epidemic, sex between men and women is acknowledged as the leading mode of HIV transmission worldwide (in the United States, it is the number-one source of new infections for women and the second for men). Dworkin’s book reviews recent domestic and global intervention and research programs, offering tough but fair critiques of individual research projects, outdated and unhelpful concepts and terms, and distinct program genres (women’s empowerment, micro-financing, gender transformation), and proposes ways to make them more effective in the fight against HIV/AIDS. Men at Risk also notes that, influenced in part by growing global attention to women’s health, intervention programming for the heterosexual epidemic is dominated by concern for women, and diverse research, action, and intervention agendas have been mobilized on their behalf.

No such luck for heterosexually active men, who are typically essentialized in women’s programming as callow, irresponsible, violent, sly, uninterested in women’s rights, resistant to women’s equality, and in short undeserving of intervention. Cast as banner carriers for “hegemonic masculinity” or as mere transit routes for HIV’s infection of women, straight men remain the still forgotten population in HIV/AIDS discourses (p. 13). But if, “within the global epidemic,” Dworkin asks, “half of those infected are women, who is the other half?” She answers her own question: “The other half is men” (p. 2). While it seems obvious that “heterosexual relationship dynamics” means that both women and men need to be taken into account, this has not historically been the case. “That fact is the focus of this book” (p. 6).

Who are these men, why are they absent from HIV/AIDS research and intervention programs, what are the consequences of that absence, and what do these men need? Men at Risk is the first full-length in-depth study to address these questions, interrogate the policies and practices of global interventions, and propose models and approaches informed by a sophisticated knowledge of efforts to date and promising approaches in the future. Based on years of research, much of it in South Africa and in collaboration with other experienced researchers, the book dissects a number of conventional assumptions and suggests more fruitful concepts. The dichotomy that rigidly contrasts vulnerable women with invulnerable men, for example, is not useful. Nor is the notion that sexual difference, gender inequality, and male-dominated sexuality (the “sex-gender-sexuality triad”) are the drivers of women’s powerlessness and vulnerability to violence, HIV/AIDS, and other ills. Crucially, such an essentialist vision discourages engagement with other factors that shape identity, behavior, belief, and human relations. For men in South African communities, these include such structural inequalities among men as “racism, unemployment, heterosexism, oppressive policing practices, the prison system, migratory systems, processes of globalization, war, conflict, and more” (p. 7).

Dworkin argues that intersectionality provides a more accurate and intelligent model for intervention and, in contrast to ubiquitous invocations of this term, demonstrates what the concept actually looks like in practice. This is strikingly illustrated in Dworkin’s review of “gender-transformative” prevention and intervention programs, in particular the “One Man Can” (OMC) workshops for heterosexually active men run by the South African organization Sonke Gender Justice. Since 2006, this rights-based organization has held twenty thousand workshops annually that engage men in “critical discussions of how social inequality operates and how these social processes shape health outcomes” (p. 136). As Dworkin found through in-depth interviews with some sixty men who had completed the workshop, many men come to better understand how masculinity, patriarchal authority, and subordination of women can be...