Working With Young Men In Sexual Health Services Part One

Over the last 14 years I’ve run projects which have aimed to increase access to sexual health services, condoms, information and advice for young men – as well as challenging the problematic values and attitudes they sometimes have.  This manual draws on best practice and research as well as my own personal experiences of effective methods of working with young men in sexual health services.

“Clinics were judged to be ‘woman’s domain’, and were only seen as relevant to men when they had to visit a clinic when they’d caught an STI. They would certainly not seek advice there – like the young women, they felt these clinics were staffed by people who were far too old to understand them. Whilst they would have welcomed free ‘stylish’ condoms (ribbed, flavoured, branded), they had a very poor opinion of the condoms which they had heard could be obtained via clinics.”

Young People’s Perceptions of Contraception and Seeking Contraceptive AdviceA Report on the Key Findings from a Qualitative Research Study Prepared for: Department of Health Prepared by: Counterpoint Research

“[Y]oung men approach most services and agencies with some reluctance… men will use services under certain conditions: when they are desperate; when agencies have a strong positive view of them; and when projects do not stigmatise them. There also appears to be an unfortunate combination of young men thinking that illness, vulnerability and asking for help are inappropriate, and agencies (generally) not having the experience or the inclination to target young men specifically.”

Boys’ and Young Men’s Health: What works? Trefor Lloyd, Working With Men for the Health Development Agency.

Despite improvements in the last decade, young men are still very much minority attenders of sexual health services. The implications for us not working with young men in clinics is clear, with rising rates of infection and still high rates of teenage pregnancy. It is clear that we need to adapt our practice to encourage young men to overcome their barriers around asking for help.

However it is often not recognised how difficult it is to work with young men in sexual health services and many clinicians are frustrated at not having the answers to the following

  • How can we work with young men if they are not coming into the clinic?
  • The only time we see young men is when they are in groups, which we find are intimidating and difficult to work with. How can we deal with this?
  • How can we deal with inappropriate behaviour from the boys?
  • What do young men want from us?

This resource gathers what we know about working with young men around sexual health in clinics and gives a step by step practical guide to offering a service that young men will want to come to in order to prevent sexual ill-health rather than only attending services when they are desperate.

The key to working more effectively with young men and to avoid many of the challenges that we encounter is to make attending such services seem, to young men, as men friendly as possible. To do this, it’s important that we demonstrate that we value them as equally as we do all other clients. However as well as valuing them we also need to be able to challenge them and some of the problematic values and attitudes which come with being a man – this isn’t easy.

Work with young men can be very difficult if we do not value them. These posts have practical ideas, which have come out of years of practice with young men – however without really understanding how masculinities are constructed we may never really value young men or understand the way they behave at all.

Many workers in this field will positively dislike working with young men. I have delivered and participated in training where participants (both men and women) have conceded that they feel very negative about men in general. Staff in sexual health clinics will have worked with many people who have been victims of male oppression; rape victims, victims of homophobic attacks, young mothers left to fend for themselves.

High quality participatory and experiential training is important in this respect. Participants need to feel able to explore their own values and where they come from, without the feeling that they are being blamed, in order to be able to see how young masculinities work. Services that work towards understanding this will be infinitely better equipped to come up with their own strategies for working with young men. Even if we don’t like some young men we can learn how to value them.

Being a man is more than just biology. Men are given messages about ‘how to be men’ from an early age until they die. These messages are very powerful because they come from so many different sources; parents/carers, friends, school, men and women, social class, religion, different ethnic cultures, TV, sport, magazines, films, pornography, magazines …..

They are also very powerful because these messages always end up saying the same thing. This is known as hegemonic masculinities, which basically means that there is a rulebook on how men should behave. They should be

Hard, strong or physical

Not open with emotions, appearing emotionally strong by not revealing emotions.

Troublesome, cheeky or rebellious

Focussed on performance, goals and success. Provider. Not needing any help.

Cool, have the right labels, fit in

Into sport

Straight and not be like women

This rule book on how young men should behave is problematic because it offers a very narrow template on how men should be and what roles they should adopt. If men don’t want to adopt these roles they can be excluded and become subject to bullying or ridicule. Many young men want desperately to be a man but find it difficult due to race, class, disability, sexuality, their body, their economic status – for many only way they can assert their treasured masculinity is by being homophobic or sexist or oppressive in some other respect. Some are more able to pick and choose which aspects of masculinity they value and which they don’t.

The messages that young men receive about being a man contradict with attending a sexual health service. Men are meant to be self-sufficient, know everything about sex and not need any help. Furthermore sexual health services seem, whilst not explicitly excluding young men, to be focussed on the needs of young women.

So when young men do come to clinics they have the usual feelings of vulnerability, fear, embarrassment, stigma which they are reluctant to address but they also have further fears about their masculinity and moreover their perceived masculinity. This can be expressed in the masculinity donut.

This demonstrates the difference between internal and external masculinities. Men need to be able to be in control of when they can present their internal masculinities and will present their external masculinities in public until they feel safe to do otherwise.

So young men attending a sexual health service for the first time will be feeling vulnerable, lost, embarrassed, stigmatised. As attending sexual health services is also seen as unmanly there is also a threat that the young man may not be seen as behaving in a masculine way.

Additionally they will be aware that part of their visit will involve revealing their internal masculinities (for example if they are having a check-up) and they are anxious that they do not reveal this until they are ready. Thus what may happen is that they behave in such a way to assert their masculinity. They will create more dough in order to protect their jam!

In a clinical environment young men’s opportunities to create more dough are limited so we may see more young men in groups, or may chat up other people, or talk about needing extra large condoms or hear sexist or homophobic remarks. This can be a major problem for us even if we understand why it is happening. It can create tremendous barriers and can make work with young men feel unpleasant and undesirable. Sometimes when we are working with young men all we see is dough.

The trick is to make attending sexual health services feel like a masculine thing to do. We can’t do this by reconstructing society to enable young men to re-think their masculinities but we can do it by making our services more masculine (or doughy) places to visit. If we do this then the very act of attending our services will be an acceptable expression of masculinity. Then once we are working with them we can start to effect real change.

Part Two

all images and text © Bish Training 2010