Gender and equity considerations in AMR research: a systematic scoping review.

Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.

Power relations in sexual agreements among male couples in Southern Africa.

Sexual agreements between same-sex practising men facilitate communication about health promotion activities, including HIV prevention. In African contexts, male couples negotiate their sexual agreements in relation to rigid cultural prescriptions about male power and privilege, intense hostility towards same-sex sexualities and persistent heterogendered socio-cultural norms. Yet the impact of such norms on relationship practices and HIV risk among male couples remains inadequately explored. This qualitative study examined the role of gendered power disparities in establishing sexual agreements among male couples in two Southern African contexts. Eighteen male couples completed in-depth interviews focused on relationship practices, including sexual agreements. The research employed critical social theory to analyse power relations and socio-cultural norms shaping male couples' explicit and implicit sexual agreements, with a focus on implications for HIV risk. The findings outline different types of and motivations for sexual agreements among male couples, including qualified non-monogamy with female partners only. The study illustrates how Southern African male-male sexual practices remain embedded in a cultural context favouring the replication of heteronormative sexual behaviours and relationship practices. These heterogendered norms impact negatively on the process of establishing explicit, mutually agreed-upon sexual agreements, and thus place male couples at increased risk for HIV.

'You have to bow right here': heteronormative scripts and intimate partner violence in women's same-sex relationships.

Intimate partner violence is increasingly recognised as occurring not only between heterosexual partners but also in same-sex relationships. Heterogendered relationship norms have been identified as intersecting with other social inequalities to create and sustain power differentials between partners - and fuel violence - yet remain largely unexplored in relation to women's same-sex relationships. Building on existing feminist research we explore the use of gendered scripts in South African lesbian and bisexual women's accounts of relationship norms and practices. We apply a feminist poststructuralist lens to focus-group discussion data to investigate how such scripts are drawn on to either uphold or challenge violent and coercive relationship practices. The findings illustrate the salience of heterogendered norms and demonstrate how violent practices become possible in contexts of deepening socioeconomic impoverishment - such as in post-apartheid South Africa - where race, space, gender and sexuality are tied to attempts at reclaiming respectable personhood. Efforts to dismantle inequitable gendered power relations and attendant violent practices require both macro-interventions aimed at shifting structural constraints on lesbian and bisexual women's agency, as well as micro-processes aimed at scripting equal power relations between partners as desirable.

'We go to the bush to prove that we are also men': traditional circumcision and masculinity in the accounts of men who have sex with men in township communities in South Africa.

In predominantly isiXhosa-speaking township communities in South Africa, men who have sex with men negotiate their identities and sexual practices alongside heteronormative cultural scripts of what it means to be a man. Such idealised notions of masculinity are predicated on the selective appropriation of cultural practices that preserve (heterosexual) male privilege and power. In this paper, we explore the identity work done by men who have sex with men, with particular reference to male circumcision as a cultural practice widely drawn on to inform and regulate normative masculinity. Through a narrative-discursive analysis of the accounts provided by men who have sex with men from township communities, we highlight how participants' dissident sexualities are constructed as compromising their masculine identities. Participating in cultural practices such as traditional circumcision aligns participants to the idealised forms of masculinity that afford men full citizenship in their communities. Study findings suggest that sexual dissidence is less troubling to participants than deviating from gendered markers of hegemonic masculinity, and point to ways in which marginalised men might have an interest in maintaining the dominant gendered order. We conclude with implications for research and programmatic work with gay, bisexual and other men who have sex with men.

Constructions of masculinity among a group of South African men living with HIV/AIDS: reflections on resistance and change.

Male sexuality in Africa is often associated with harmful sexual practices, which, in the context of HIV and AIDS, often positions men as central to the spread of the epidemic. Despite this focus on men's practices, there is a lack of research exploring the subject positions of men living with HIV. This study explores how masculinity is constructed by a group of black South African men who self-identify as heterosexual and are living with HIV. Using discourse analysis, a construction of a normative masculinity is identified as being both idealised and perceived as a burden, in that men continually need to engage in actions that affirm their position as 'real' men. By depicting men as invulnerable and unemotional, this construction limits men from acknowledging health risks or accessing support. A second discourse constructs HIV and AIDS as disrupting normative masculinity, in that it restricts men's agency through illness and the need for care. A final discourse relates to a transformed masculinity, where men living with HIV reconstruct their masculinity, as conforming to normative constructions of male identity is perceived as restrictive and harmful.