... but are they also the elephant in the room?

1. Men might be from Mars ... ... but are they alsothe elephant in the room?

2. Considering outcomes from poor male engagement with sexual health Dr David T Evans RN BA(Hons) MPhil EdD Senior lecturer in sexual health

3. It’s a man’s world ...

5. “The trouble with men is... threefold” 1) males are frequently treated stereotypically, as though ‘all men are the same’, with same needs, attitudes, behaviours and practices Poster: Greg King, CISH 2011 Evans, D. T. (2004). "The trouble with men is ... Raising the profile of men's sexual health." Nursing in Practice Journal 2004(17): 36-38.

6. “The trouble with men is...” • many men fail to • make full use of the • various self-help and • health promotion • initiatives, which could maximise their health and well-being, and prevent the development of disease Poster: Loraine Stapley, CISH 2010 Evans, D. T. and L. Stapley (2010). "Sexual health issues in men - part 1." Practice Nurse (17 September 2010): 30-34.

7. “The trouble with men is...” 3) many men leave health problems until they are too late; consequently, the treatment is either radical or unsuccessful Poster: EleonoraAssenova, CISH 2010 Roberts, C. and D. T. Evans (2007). Chapter: Male Health. Nurse Practitioner Manual of Clinical Skills. S. Cross and M. Rimmer. Edinburgh & London, Elsevier Publications: 253-270.

8. What do we mean by “the elephant in the room”? It’s like searching for the “invisibilised”, something we all know is there but not speaking about or addressing effectively ... the “presence of an absence” (Jean Paul Satre) an apophasis [’apofasiV], “absent presence”(SlavojŽižek) Serrant-Green conceptualises the result as “screaming silences” ... the “whole [sic] at the centre of discourse” (Lee et al. 2008).

9. Outcomes of poor male engagement with sexual health Covert Interpersonal Cultural Institutional Internalised Overt Poor outcomes of male engagement with sexual health

10. Outcomes of poor male engagement with sexual health

12. Genders, sexualities and well-being

13. 49% of gay and bisexual men have experienced at least one incident of domestic abuse from a family member or partner since the age of 16. p. 25

14. Unprotectedsexand infections

15. Unprotectedsex and infections Poster: Steve Malone, CISH 2012

16. Unprotectedsex and infections www.avert.org May 2013Accessed on 16.04.13

17. Unprotected sex and “family planning” Poster: Angela Wake, CISH 2010 Poster: Vicky Papworth, CISH 2009

18. “An escalation of the of the medicalization of life has taken place, through the pathologization of normality and the removal of the divide between preventative and clinical medicine.” Skolbekken (2008)

19. What might Foucault have to say on the pathologisation of normality? Non-medical ‘problems’ become seen as illnesses, disorders, pathologies and deviancies, which need to be prevented and / or treated. • Non-medical ‘problems’ characterisethe discursive shift in the west’s post-Enlightenment emphasis onto the scientiasexualisas opposed to the ars erotica(Foucault 1984, History of Sexuality volume 1) • The result is an increase in all forms of surveillance and governmentality(Pryce 2001), especially around “policing desire” (Watney 1993) and the construction / reconstruction of the notions of deviance and the “pathologisation of normality” (Skolbekkken 2008).

20. If it’s not on, IT’snot on! Ambition: Prioritise prevention

21. Ambition: Prioritise prevention • Build a sexual health culture that prioritises prevention and supports behaviour change • Ensure that people are motivated to practise safer sex, including using contraception and condoms • Increase availability and uptake of testing to reduce transmission • Increase awareness of sexual health among local healthcare professionals and relevant non-health practitioners, particularly those working with vulnerable groups. p 22

22. Gender stereotypical (poor) ‘coping’ mechanisms ... What they call “letting off steam”

23. Victims of patriarchal hegemony and the potential effects on being a male Masculine identities Victim & cycle of abuse Homeless boys & men CSW Transpeople ‘Savile’ effect Asylum & Torture MRSA Regret

24. Crisis in masculinities or ‘manhood’? “Women have borne the symbolic burden of man’s imperfections, his grounding in nature. Menstrual blood is the stain, the birthmark of original sin, the filth that transcendental religion must wash from man.” (Paglia 1990: 11)

25. “Woman is the primeval fabricator, the real First Mover. She turns a gob of refuse [semen] into a spreading web of sentient being, floating on the snakey umbilical by which she leashes every man”. (Paglia 1990: 12)

26. But this is no battle of the sexes! So many of the indices such as mortality and morbidity figures compare male against female, when it would be more appropriate to focus instead on ‘preventable’ versus ‘inevitable’, and very few poor statistics for men would actually then come out inevitable. Evans, D. T. (2004). “The trouble with men is ... Raising the profile of men's sexual health.” Nursing in Practice Journal 2004(17): 36-38.

27. But this is no battle of the sexes! The needs of boys and young men are different to that of girls and this should be acknowledged. It is important that issues such as relationships, consent, contraception and infections are considered from a young man’s perspective. p. 15 All young people’s sexual-health needs – whatever their sexuality – are comprehensively met. p. 17

28. The Equality Act 2010and the gender equality duty from 2006 • The new duties require a significant change in policy and practice and what has been described as ‘gender mainstreaming’. • This means fully integrating an awareness of male and female health needs strategically and operationally throughout an organisation. • It means moving beyond the assumption that ‘gender’ is limited to occasional awareness campaigns on sex-specific issues.

29. The Equality Act 2010and the gender equality duty from 2006 • The Equality Act requires health organisations to develop and deliver effective work to improve men’s health on a wide-ranging and systematic basis. • While some organisations have a good track record in this area, for many it represents a new area of activity that will require significant support.

30. Programmes & courses BSc(Hons) “top up” degree in sexual health ie 120 credits @ level 6 on top of DipHE PGCert & Masters in sexual health Courses: as outlined in the current CPD prospectus

31. Baroness Gould of Potternewton Honorary doctorate in sexual health (2011) Beatrice Kungwengwe General Practice Awards 2011 “runner up” General Practice Awards 2012 “nominee” Sue Myers General Practice Awards 2011 “runner up” Kay Elmy UK Sexual Health Awards 2012 – winner Prof Kathryn Abel, Dr David Evans & Dr Roxane Agnew-Davies UK Sexual Health Awards 2012 – “finalists” Dr Kathy French First edited book on sexual health Colin Roberts FRCN Former honorary lecturer Well over 2,000 on Sexual Health Skills

32. Thank you! Dr David T Evans Senior lecturer in sexual health D.T.Evans@greenwich.ac.uk 020 8331 8069 @David_T_Evans