Fixing Men: Sex, Birth Control, and AIDS in Mexico

With an evocative cover photograph of a food stand selling "Cocos a la Viagra," Matthew Gutmann's latest volume aims to bring men and masculinity into the rich but heavily women-focused literature on sexuality and reproductive health. In being and getting "fixed," the Oaxacan men in Gutmann's stories are viewed through their experiences of sex, contraception, vasectomy, desire, and HIV/AIDS. The author makes his way into these intimacies by bonding with fellow laborers in Oaxaca City's Ethnobotanical Garden, interviewing patients and providers at the state AIDS unit, and volunteering at a vasectomy clinic, along the way dispelling stereotypes of machismo, men (not) having sex with men, and Mexican male sexuality being culturally driven.

Gutmann's anthropological insights are often striking, even as the repeated insertion of the self into the narrative can be unsettling to the historian. The issue of HIV/AIDS in Oaxaca is portrayed in all its global complexity, in contrast to the misguided, microcultural lenses employed too commonly by social and health scientists. Here we see the hopeless context of sickness and suffering deriving from the exploitation of migrant workers to the United States and the moral economy of loneliness that drives migrant men to having sex with prostitutes and perhaps other men, either directly or as "milk brothers."

Neoliberal globalization is shown to frame the Mexican government's privatization of and retreat from health services delivery, and its refusal to negotiate lower drug prices with big pharmaceutical companies (which Brazil, Thailand, South Africa, and other countries have done), sharply reducing the number of people who can be treated with life-extending anti-retroviral medicines. Exigencies of the global economy are also driving neglect of social conditions, exacerbating health problems generally (as well as AIDS specifically) and leading many to (pluralistically) self-medicate with unsterilized injections of ethnovitamins and antibiotics. Gutmann argues that in being the site of migration, infection, and sometimes medical care, and in influencing Mexico's refusal to challenge U.S. corporations, the United States acts as a "shadow state" for HIV/AIDS in Mexico. Yet he is sometimes harsh on the Oaxaca-based health workers who engage in conscious discouragement and triage for AIDS treatment, but who are themselves subject to neoliberal pressures.

Gutmann is at his most nuanced when discussing vasectomy, perhaps because his participant observation is total; he himself has had the procedure. The "emotional anesthesia" he offers to allay the concerns of men about to undergo vasectomy, and the practical assistance he provides to the surgeons, leads them all to open up to his probing questions. Sadly, we never hear about the history of vasectomy in Mexico: where are the fathers, mothers, uncles, aunts, and cousins that historians and anthropologists of women's reproductive experience have turned to so effectively?

While an eminently contemporary gaze at men, sex, and reproductive health, Fixing Men does engage with history on several fronts. The book (too) quickly traces the recent history of Mexican health services policy through expansion, decentralization, and contraction. Unfortunately it leaves out Oaxaca's protests against health reforms in the 1980s, which served as an important precursor to more recent municipal and regional protest. Gutmann does better with his fine summary of family planning since the 1970s, the process of "planning men out of family planning" (p. 100). His discussion of medical profiling—the uses of cultural stereotypes to (erroneously) diagnose and treat—also resonates with historical concerns around blaming and its consequences.

A chapter on traditional sexual healing of men offers a discerning analysis of the uselessness of binary and essentialized male/female categories, even as cultural stereotypes retain a powerful hold on popular and medical perceptions of gendered sexual and reproductive health. We hear, too, of the limits to Oaxaca's recognition of medicina tradicional and tidbits of Gutmann's learnings from his predominantly female healer informants. Yet there is surprisingly little discussion of the traditional boticario (and its part in Oaxaca's evolving medical pluralism), which dispenses, variously, contraceptives, remedies for sexual and reproductive ailments, and stimulants, such as the colorful octopus and shrimp-laced "Cocos a la Viagra." For the social and cultural historian, Gutmann's book is a good reminder that reproductive health macro- and micro-histories deserve masculinization.