Competition and [616263]

Article
Competition and
Humiliation: How
Masculine Norms Shape
Men’s Sexual and Violent
Behaviors
Paul J. Fleming1, Clare Barrington2, Suzanne Maman2,
Leonel Lerebours3, Yeycy Donastorg4, and
Maximo O. Brito5
Abstract
We use data collected from in-depth interviews with men ( n¼30) in the Dominican
Republic to explore how men’s concern about being perceived as masculine influ-
ences their interactions with their social networks and how those interactions drive
men’s sexual behaviors and use of violence. Men’s sexual and violent behaviors were
shaped by the need to compete with other men for social status. This sense of
competition also generated fear of humiliation for failing to provide for their families,
satisfy sexual partners, or being openly disrespected. In an effort to avoid humiliation
within a specific social group, men adapted their behaviors to emphasize their
masculinity. Additionally, men who were humiliated recouped their masculinity by
perpetrating physical or emotional violence or finding new sexual partners. These
1Department of Health Behavior and Health Education, University of Michigan School of Public Health,
Ann Arbor, MI, USA
2Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina,
Chapel Hill, NC, USA
3Clinica de Familia La Romana, La Romana, Dominican Republic
4HIV Vaccine Trials Unit, Instituto Dermatolo ´gico y Cirugı ´a de Piel, Santo Domingo, Dominican Republic
5Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
Corresponding Author:
Paul J. Fleming, Department of Health Behavior and Health Education, University of Michigan School of
Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
Email: [anonimizat] and Masculinities
1-19
ăThe Author(s) 2017
Reprints and permission:
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DOI: 10.1177/1097184X17715493
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findings emphasize the need for understanding these social dynamics to better
understand men’s violent and sexual behaviors.
Keywords
masculinities, HIV, AIDS, aggression, gender norms, sexually transmitted infections,
batterer
The social constructivist view of gender posits that gender is not an inherent trait of
an individual but rather is constructed through social interactions (West and Zim-
merman 1987; Connell 1995). This distinction puts the focus on the actions of
individuals, and importantly, the instit utions and social network members that
ascribe meaning to those actions. Additionally, this view sees power inequalities
as central to understanding gender and associated dynamics (Connell 1987; Kimmel
and Messner 2001). In the past two decades, masculinity theorists have focused on
these power inequalities, including those between society’s constructed “hegemonic
masculinity” (i.e., most dominant for m of masculinity in a society’s pattern of
gender relations) and the other types of masculinities (Connell 1995; Hyde et al.
2009; Lusher and Robins 2010). The influence this system of power has on almost
all males in a society is extremely important to their behaviors (West and Zimmer-
man 1987; Courtenay 2000; Butler 1993). As men weigh how to act in a particular
situation, their position in this power structure and their desire to maintain position
or advance will typically play a role in how they behave. In this article, we explore
these theoretical concepts of gender and power within men’s social interactions
using data collected from in-depth interviews with thirty men in the Dominican
Republic (DR). Specifically, we aim to explore how masculine norms influence
men’s social interactions and how those interactions drive men’s sexual behaviors
and use of violence.
Previous Work on Caribbean and Dominican Masculinities
De Moya (2004), a prominent Dominican masculinities scholar, wrote about the
socialization of Dominican males into the prevailing standards of masculine beha-
vior. He posited that masculinity is a “totalitarian” regime that controls the lives of
Dominican boys and young men. De Moya (2004) used participant observation and
interviews with men and women to identify the “rules” associated with being a
“normal” boy in the DR, including “He cannot publicly show fear of anything,”
“He should not sob nor cry, even when hurt,” and “He should show a vivid and
visible erotic interest in all females who come close to him when he is with his
peers” (pp. 73–74). These behavioral ideals are instilled in young Dominican boys
and enforced by others through punishment and shaming during youth and adult-
hood. As De Moya (2004) states, “Dominican males are socialized in a strongly2 Men and Masculinities XX(X)

restrictive and prohibitive environment, which surely cripples their spontaneity,
authenticity, and joy, and produces hypocrisy and neurosis” (p. 73). Thus, these
rules not only stifle men but may also cause a considerable amount of stress, as
they attempt to meet the rigorous standards of manhood. Pleck (1995) refers to the
effects of this stress in his masculine gender role strain paradigm. Those men who do
fit neatly into the masculine ideals may feel stress to maintain that status and those
who do not fit may feel the same stress as well as discrimination and shame related to
not fitting the ideal.
While De Moya’s research focuses on a singular dominant ideal masculinity,
other scholars within the DR and the region have identified two distinct ideals that
are often in conflict with each other. This idea was first proposed in the region by
anthropologist Peter Wilson (1969, 1973) and later applied in Jamaica by Whitehead
(1984). Wilson’s (1969) framework posits that men are subject to two intercon-
nected value systems that he calls respectability andreputation . A man’s reputation
is judged by his male peers and depends on his “masculine activities.” The mascu-
line activities include sexua l prowess, athletic compe tition, strength, seducing
women, and fathering children. A man’s respectability, on the other hand, is judged
by the entire society and tends to be based on European middle-class values (stem-
ming from norms diffused during colonization). To be respectable , a Caribbean man
needs to conform to the rules set by the church and government, as well as work
hard, provide for one’s family, and participate positively in the society. Wilson
(1974) notes that “both together make up a single system” and that they are “dual
and contradictory” (p. 118). Other scholars have similarly noted competing gender
norms—such as the casa/calle (house/street) norms in the DR (Kerrigan et al. 2001)
and homosocial/heterosocial social spaces in Mexico (Hirsch 2009). Men are
socially rewarded for being both respectable and reputable and thus must fulfill both
norms, even when they conflict. In terms of health-related risk behaviors, the rep-
utation (and calle /homosocial spaces) is where group dynamics exist that facilitate
and promote sexual risk behaviors and other potentially harmful behaviors such as
violence and alcohol abuse (Hirsch 2009; Kerrigan et al. 2001).
Our team’s previous empirical research with men in the DR has explored several
dimensions of the relationship between men’s social networks and risk-taking beha-
viors. A mixed methods study with male steady partners of female sex workers in La
Romana, DR, found that men’s sexual risk-taking was influenced by their perceptions
of their peers’ risk-taking and the social influence exerted by those peers through social
network interactions (Barrington and Kerrigan 2014; Barrington et al. 2009). We sub-
sequently conducted a qualitative exploration of men’s peer group relationships—
focusing on male peer groups and homosocial spaces—and found that most men lacked
trusted friendships and many avoided friendships due to perceptions that peers would
pressure them to behave in ways they did not want to (Fleming et al. 2014). We also
found that men’s sexual behaviors and willingness to get tested for HIV is, in part,
shaped by concerns of projecting a masculine image of strength to their social
network (Fleming et al. 2015; Fleming, Barrington, Powell, et al. 2016).Fleming et al. 3

These theoretical perspectives and our previous research indicate that men’s
social interactions play a crucial role in influencing men’s behaviors in the DR.
However, we lack a nuanced understanding of how men perceive and describe these
social interactions and the specific mechanisms by which masculine norms influence
men’s sexual and violent behaviors. The aim of this current study is to fill these gaps.
Method
Study Setting and Context
We conducted in-depth interviews with thirty men in two cities in the DR: Santo
Domingo and La Romana. Santo Domingo is the capital and financial center of the
DR and has an estimated population of 2.2 million people (National Council on
Population and Family 2010). La Romana is the third largest city in the DR with a
population of approximately 250,000 (National Council on Population and Family
2010) and is located on the southeastern coast near many popular international
tourist destinations. The surrounding a reas are also home to a large Haitian-
descendent community who live in bateyes and work in sugar production. We
conducted our research as part of a larger study, which aimed to assess the
feasibility of offering voluntary adult male circumcision as an HIV prevention
strategy in the context of primary care settings in the DR (Brito et al. 2009;
Brito et al. 2015; Brito, Luna, and Baile y 2010; Fleming, Barrington, Pearce,
et al. 2016; Brito et al. 2017).
Recruitment and Data Collection
Our sample of thirty men was drawn from men who attended their follow-up visit for
the parent study ( n¼362). The parent study used referrals and community outreach
to find men who were eighteen to forty years old and were willing to undergo a
circumcision. To reach a sample at heightened risk for HIV, female sex workers in
both sites were asked to refer their sexual partners, and in La Romana, one recruiter
was dedicated to recruiting men from nearby bateyes (Haitian-descendent commu-
nities with a high HIV prevalence relative to the national prevalence). Follow-up
visits (six to twelve months after circu mcision) for the parent study occurred
between July 2013 and March 2015. We conducted in-depth interviews with all
available men that came to their follow-up visit in May or June 2014, until all thirty
interviews were conducted and the study team determined that we had reached
saturation of themes. Men were reimbursed for their travel to the clinic (approxi-
mately US$10). Interviews were audio recorded and conducted by the first author in
Spanish using a semistructured interview guide. The interviewer is a white non-
Hispanic male in his thirties with experience conducting qualitative interviews with
men in Latin America on topics of gender and masculinity; he is a fluent nonnative
Spanish speaker. Apart from questions related to men’s experience in the parent
study, the interviews focused on three overarching questions: (a) how does the man4 Men and Masculinities XX(X)

define manhood in the DR?, (b) to what extent does the man want to be perceived as
masculine by important others?, and (c) how do interactions with other men shape
his own behaviors? All study procedures and protocols were approved by the Insti-
tutional review boards at the University of Illinois at Chicago, The University of
North Carolina, Chapel Hill, and the Instituto Dermatolo ´gico Dominicano y Cirugia
de Piel “Dr. Huberto Bogaert Dı ´az” in Santo Domingo, DR.
Data Analysis
Qualitative data analysis was iterative, starting with the completion of the first
interviews and continuing throughout the data collection and writing process (Gibbs
2008a). After each interview, the first author wrote field notes about the interview
and memoed about notable things the participant said or did (Emerson, Fretz, and
Shaw 2011). Interview questions and probes were modified in response to observa-
tions from early interviews.
Audio recordings of interviews were transcribed verbatim in Spanish (McLellan,
MacQueen, and Neidig 2003). After transcription, the first author read through each
transcript while listening to audio to identify key themes and stories and discussed
preliminary findings with coauthors and the study team. For each participant, the
first author wrote a brief summary of each participant using available details from
their life and then wrote analytic summaries of what the participants said related to
key areas of interest (e.g., competition, meanings of manhood, and interactions with
peers; Sandelowski 1995). This process served to contextualize the meanings of
manhood and other key concepts within the life of individual participants.
Subsequent to writing these summaries, we developed a codebook with deductive
codes derived from the interview guides and inductive codes based on themes/ideas
identified in our memos and summaries (Gibbs 2008b). For example, deductive
codes included “meanings of manhood” and “violence” and inductive codes
included “humiliation” and “selling yourself.” We coded the transcripts using the
Atlas.ti software. The code outputs for key themes were used to systematically
assess and deepen our understanding of ideas in the summaries. Using the narratives
and code outputs, we prepared matrices for the analysis of patterns across the study
population and for the comparisons between subgroups (e.g., older men vs. younger
men, married vs. single, La Romana vs. Santo Domingo, and Haitian descendent vs.
non-Haitian descendent; Miles and Huberman 1994). We integrated memo writing
throughout this process to facilitate the interpretation of the data and to provide an
audit trail of the analysis to document our interpretations (Saldan ˜a 2009). After
reviewing all memos, analytic summaries, and matrices, we identified prevalent
narratives and themes that responded to our research question. Findings are
described below using illustrative quotes with pseudonyms; in the Results section,
we operationally define the terms common ,many men ,o rmen often as referring to
more than half of participants and some orfewmen to refer to themes reported by
less than a quarter of participantsFleming et al. 5

Results
We interviewed thirty men, fifteen men in each study site, between the ages of
twenty and forty. Most men were partnered, employed in either the formal (e.g.,
working for a business) or informal labor market (e.g., street merchant), and had at
least secondary education. We first describe how masculine norms emphasizing
competition shaped men’s interactions with their peers and then how this competi-
tion is dependent on social context. Finally, we demonstrate how this competition—
and specifically men’s fear of being humiliated and social pressure to respond to
instances of humiliation—shaped men’s decision-making around sexual and violent
behaviors.
Competition and the Importance of Social Context
Men described that being perceived as masculine was not simply about meeting
certain expectations of manhood, but also that they additionally needed to success-
fully compete against other men. While Hector said he was fulfilling the masculine
role of providing for his family, he add itionally highlighted the importance of
success relative to other men in his social network:
[You have to] always do things well …try to feel equal to them, if he tried to be more
of a man than you, you can’t just stay behind him, you have to show him that you are
equal to him, make him see, for example, that what he can achieve, you can also
achieve.
In addition to being a provider, Hector felt the need to keep up with other men in his
network. Thus, portraying a masculine identity was both about performing certain
behaviors and about performing certain behaviors better than other men. What men
competed about depended on their own personal priorities in a given social context
but typically reflected normative masculine characteristics such as a capacity to earn
money, purchase material goods, attract or satisfy sexual partners, or have multiple
sexual partners. Daniel, a twenty-one-year-old university student, commented that
successfully competing required that men, including himself, could adapt them-
selves to emphasize different masculine characteristics (e.g., providing financially,
aggressive, and sexually potent) depending on their social context because different
social groups placed varying degrees of value on each characteristic. He said a man’s
portrayal of masculinity depended on “ which group he’s going to sell himself
to…there are different ways a man can be perceived, that’s what he ends up
selling.” Many men’s comments highlighted the importance of context; below, we
use the story of Erick—a twenty-year-old street vendor who lived with his wife and
young son—as a case example of how men described varying their behaviors
depending on the expectations of a particular social group.
Erick lived in a close-knit community on the outskirts of La Romana and, like
most men, worried about being able to provide for his young family: “I’m not going6 Men and Masculinities XX(X)

to feel content knowing that I have a son, a woman that aren’t eating well, that I can’t
even buy a pair of shoes or nothin’.” While he was sincerely concerned about the
well-being of his family, he also worried about the bad impression his neighbors
would have if he was not adequately providing for his family. He said, “[I worry
that] people are talking, humiliating me, making me feel lesser, ‘Look at him !He
had his family, look now how he’s fallen, they can’t buy anything, they can’t eat
well, and they’re getting too skinny.’” He described how this fear of not being able to
provide for his family—and fear of others gossiping about him—was a constant
worry for him because this fear was related to his social status (e.g., “look now how
he’s fallen”). His neighbors valued the provider masculine role and also devalued the
calle (street) masculinity that emphasized violence and sexuality. When asked how
he could demonstrate his masculinity to his neighbors, Erick responded, “Don’t be
causing trouble in the calle so that no one talks [bad] about you.” He was concerned
that if he got into fights or was known to have extramarital relationships, he would
lose social status among his neighbors. Erick articulated that his neighbors valued
men that were responsible fathers and provided for their families and he tried to
adapt his behaviors accordingly.
While his neighbors were one important social group for Erick, his friends were
also extremely important in his life. He described that he and his group of friends
grew up together and they were like family to him. Despite this familial intimacy
Erick had with his friends, he said that there were situations when he needed to use
violence to demonstrate his masculinity to them:
There are always people that think they are more manly than you, they start getting
fresh [confrontational] and stuff, you [perpetrate violence] so that you aren’t standing
there with your arms crossed, so that you can demonstrate to him that you, too, are a
man …That’s what happens with this type of violence. When you have five or six
friends and you want those friends to respect you, you’ve got to prove that in front of
everyone you are more than them. [You can do that] through violence.
Erick’s friends expected him to use violence for instances when other men were
confrontational and challenged his masculinity. For Erick, the social value of perpe-
trating violence depended on his context: it inhibited his ability to compete for social
status among his neighbors but enabled him to gain social status among his friends.
This contradiction played out in the lives of many men in our study who each
belonged to various social groups (e.g., work colleagues, neighborhood, friends,
church members, etc.) with different behavioral expectations.
Humiliation Is a Key Element of Competition
These conflicting norms and the importance of successfully competing with other
men to gain social status caused men to worry about being humiliated. Men used the
word humiliation to describe instances where their status, value, or respectabilityFleming et al. 7

was called into question; typically, these were direct threats on their manhood. Thus,
it was a tool for competition since instances of humiliation severely restricted a
man’s ability to successfully compete w ith peers. These humiliations were, by
nature, public affairs that typically resulted in their social network members talking
negatively about the man and were related to the normative characteristics of man-
hood discussed above (e.g., sexual prowess, earning money, and competition).
Men referred to examples—often occurring at drinking establishments—where
another man would bump into them, shove them, or say something to humiliate them
in front of their friends or girlfriend/wife. Female partners could also humiliate men
by not showing sufficient deference in public. Benito describes one example of
another man being confrontational when he was with his girlfriend:
I was with my girlfriend buying some sandwiches and three guys passed by my side and
I accidentally ran into one of them. I turned around and said, “Excuse me” and …the
guy got aggressive and he poked me like this in the chest [he gestures a forceful poke]
in front of my girlfriend. That’s humiliating !He did it precisely to humiliate me so that
my girlfriend would see that she was with a coward.
This type of humiliation was considered a challenge to men’s status because it was
emasculating to be disrespected.
Men’s sexual relationships with women were another potential source of losing
respect and feeling humiliated. Most men said that the biggest humiliation would be
if a man’s wife or girlfriend was unsatisfied sexually or was cheating on him with
another man. Edwin, a thirty-nine-year-old man who had been married for twenty-
two years, described why it was important for him to satisfy his wife:
[If] I don’t make my wife satisfied, she’s going to satisfy herself somewhere else, that’s
the problem, you know? I have to try and satisfy her so that she doesn’t leave me for
someone else.
For Edwin, if his wife cheated on him, that would be a signal for him and for others
in his social network that he was not satisfying her sexually. A cheating partner was
considered the ultimate form of humiliation because it indicated a failure to fulfill
one of his obligations as a man. Men described that “lasting long” (i.e., length of
time between penetration and ejaculation) was a marker of whether or not a man
could satisfy his wife. Luis, a twenty-one-year-old unemployed man who lives with
his parents, described how conversations with friends about lasting long caused men
to worry about being humiliated during future sexual encounters:
Sometimes you hear so-and-so saying, “no, I did this and that and I lasted a half hour
[having sex], I lasted 20 minutes.” [and you think] “So-and-so lasted a half hour? But I
can’t even last 5.” So you worry and try to figure out what’s going on, what’s the
normal time to last?8 Men and Masculinities XX(X)

Luis’s curiosity about the normal time to last reflects his need to compare himself to
others but also reflects the somewhat mythical nature of men’s sexual performance,
given that it is typically a private behavior not directly observed by others. Antonio,
a thirty-three-year-old married man with two kids, spoke about how this could lead
to humiliation:
Women can start talking, so that worries a man that they’ll say something about him,
that he’s a “good-for-nothing” man, and that you don’t make your woman feel good in
bed. These things can cause a woman to look for other partners, you know? This
[gossip] happens a lot and it worries men …because everyone is going to look at you
as a joke.
Again, even though sexual behaviors are typically private between two partners, this
gossip about sexual performance was common and allowed members of men’s net-
works and their potential sexual partners to assess the man’s sexual capabilities—an
indicator of his masculinity. Antonio’s comments emphasize how central a man’s
sexual performance—and specifically capacity to satisfy one’s partner—is to a
man’s social status and ability to avoid being humiliated.
Responses to Humiliation
Men’s responses to this humiliation shaped their sexual and violent behaviors. While
a few men said they were able to ignore instances of humiliation, most said that a
man must respond or react when humiliated. Benito described that a man needs to
respond in order to ensure that he does not lose status:
The man that lets himself be humiliated by another man loses his value in front of
everyone else. He loses respect, or at least what they understand is respect, in front
of everyone else. So, if a man doesn’t respond to a humiliation, he can lose his
value as a man.
Responding to an instance of humiliation is about saving face, recouping one’s
masculinity, and ensuring that social status is recovered. How men responded to
instances of humiliation were important for their sexual and violent behaviors;
below, we describe three common responses: (1) perpetrating physical violence,
(2) humiliating the other person, and (3) taking actions to prevent it—and their
implications for behaviors.
First, the most commonly described way that men responded to humiliation was
with physical violence. Felipe, a twenty-two-year-old married man, said,
It’s really common for guys to respond with violence, it’s rare that someone humiliates
you and you can stay calm. No, you have to do something to get even because you feel
bad about yourself because of what the other person did.Fleming et al. 9

This physical violence perpetration allowed men to “get even” and recoup their
masculinity. In the case of Benito who was humiliated by a group of guys in front
of his girlfriend (described above), he violently threatened them—“I showed them
my gun”—to scare them off and show them he was not a coward.
Men also commonly reported that perpetrating physical violence against
women was often in response to humiliation from their female partners. Jose said,
“A man becomes violent because a woman says, ‘you’re a good-for-nothing, I
don’t feel good when I’m with you,’ so tha t causes conflict.” While only a few men
seemed to express tolerance for physica l violence against women, men described
perpetration of physical violence against women as a common response from men
in their community to instances of humi liation from women. When physical vio-
lence perpetration was used to respond to humiliation, it represented the easiest,
quickest, and most obvious way for a man to demonstrate his manhood and super-
iority to others.
It is important to note that men’s decision to use or not use physical violence in
response to humiliation depended on the context and the potential consequences.
Felipe—the man who described the importance of violence above—described how
men had to balance different priorities when considering their use of violence in
response to humiliation. He mentioned that he was humiliated by his bosses at work:
“they always look for some way to humiliate me or make me feel smaller than
them …they are like, ‘listen, I’m much better than you, you are nothing,’” Felipe
went on to recount his thought process about how to respond:
You can humiliate me in my job and I won’t do anything because I’ll lose my job, but,
truthfully, I feel humiliated …But, if in the calle [street] you humiliate me, I’ll grab
you and hit you with something.
In this case, Felipe prioritized earning money and providing for his family rather
than demonstrating his capacity for violence and aggression. His workplace social
environment called for different behavioral norms and expectations for men than the
calle environment.
The second potential response to humiliation—humiliating the other person—
allowed men to avoid the potential negative consequences of perpetrating physical
violence. Men who used this strategy criticized and/or perpetrated emotional vio-
lence against the person who originally humiliated them which allowed them to
recoup social status by calling into question the social status of the other person. For
example, if a woman gossiped about a man’s sexual performance, the man may
spread negative rumors about her. Benito said that if a man chose not to respond with
violence to women’s insults about his sexual prowess, “he’ll insult her behind her
back to try and humiliate her worse than he was, I mean, he’ll say that she smells bad
down there or something like that.” Th is retaliatory response allowed men to
respond to the humiliation and recoup their masculine status while avoiding the
potential negative consequences of perpetrating physical violence.10 Men and Masculinities XX(X)

The third strategy was preventing or minimizing instances of humiliation, which
also had implications for their behaviors. Men who wanted to prevent humiliation
related to confrontations with other men said they avoided bars or nightclubs, large
groups of friends, and/or drinking alcohol. In contrast, men who wanted to prevent
humiliation related to their sexual performance used several behavioral strategies to
minimize or prevent humiliation. First, some men commented that they might pre-
emptively change their sexual behaviors in order to avoid being teased. Pedro, a
thirty-five-year-old man with a steady job in the tourism industry, spoke of his
decision when he was younger to start having sex with sex workers:
I went out with friends, we paid [to sleep with] women, we were in that environ-
ment …It’s psychological, I felt like if I didn’t do what the others were doing, I wasn’t
normal …If I were to say ‘no’, I worried what they would think of me.
He modified his sexual behaviors as a younger man because he wanted to avoid
feeling humiliated in front of his peers. Second, as an alternative to changing actual
sexual behaviors, some men also exaggerated the truth or deployed lies to safeguard
their sexual reputation. Arturo, a twenty-eight-year-old married man, provides an
e x a m p l eo ft h i s :“ Im a k es o m e t h i n gu pt om a k em y s e l fl o o kg o o dd u r i n gt h a t
moment of conversation [with friends] …I could say, ‘I was with a woman in a
hotel, and Wow !That woman came and came.’ Something like that, a lie.” These lies
allowed these men to avoid losing the increased social status that was associated
with demonstrating sexual prowess. Finally, some other men reported that if they
failed to sexually satisfy a partner, they sought new sexual opportunities to prove
themselves again. Emilio, a twenty-one-y ear-old construction worker, said that
“faced with this type of humiliation, a man will try to grab that same chick that
started to talk crap [about his sexual capabilities] and do it with her again so that she
can see that it was just only that one day …[or] they’ll try to find other women to
prove themselves.” Attempting to have sex with the same sexual partner or find new
partners offers the man an opportunity to satisfy the woman and shift the negative
gossip about him. The existence of multiple behavioral strategies to combat humi-
liation related to sexual prowess emphasizes the salience of this factor in shaping
men’s sexual behaviors.
Discussion
We found that the relationship between masculine norms and men’s sexual and
violent behaviors is primarily explained by male competition and avoiding humilia-
tion in our sample. Men interviewed who successfully navigated how and when to
emphasize certain masculine characteristics or behaviors were able to avoid being
humiliated and losing social status. However, success was ultimately defined by
men’s peers who were aiming to improve their own status and took advantage ofFleming et al. 11

opportunities to humiliate other men. These dynamics emphasize the fragile nature
of being perceived as masculine in the DR.
These findings align with previous research that has emphasized the fragility of
masculinity (i.e., precarious manhood) and that the anxiety it produces is associated
with aggression and sexual risk behaviors (Vandello and Bosson 2012). The concept
of precarious manhood was formalized through the research of Vandello and col-
leagues (2008), but the idea that men are constantly needing to prove their mascu-
linity has been highlighted by other masculinities scholars (Gilmore 1990; Kimmel
and Messner 2001; Pleck 1981). Vandello and colleagues demonstrate through
empirical research with men in the United States when men feel their masculinity
is challenges, they respond with aggression (Vandello and Bosson 2012). Our find-
ings also aligns with research on the culture of honor in southern United States,
which highlights that perceived slights against men must be responded to with
violence to preserve one’s reputation (Nisbett and Cohen 1996; Cohen and Nisbett
1994). Men in our study who were humiliated grasped for relatively quick responses
such as sex with a new partner or perpetrating violence in order to emphasize their
masculinity and recoup their social status. Thus, men’s competition and humiliation
have implications for men’s behaviors, their health outcomes, and the health of their
partners and communities.
Men did not perform a singular coherent configuration of masculine behaviors but
rather adapted to each context and varied their performance of masculinity (Butler
1993; West and Zimmerman 1987). A masculine behavior in one social context
(e.g., restraining oneself from violence perpetration) could be deemed as unmasculine
in another context and thus a man is rarely free from potential humiliation (Fleming,
Andes, and DiClemente 2013; Cohan 2009; Courtenay 2000). For example, some
contexts required men to restrain themselves from violence and other contexts encour-
aged violence perpetration. This variation in masculinities is similar to the theoretical
concepts of casa/calle, homosocial/heterosocial, and reputation/respectability in that it
recognizes that there is not a singular masculine norm (Hirsch 2009; Kerrigan et al.
2006; Wilson 1969). Connell’s (1995) theorization of multiple masculinities high-
lights that different groups of men (e.g., working-class men and gay men) each have
their own configuration of masculinity. While this concept emphasizes the group-level
variations in masculinity, our findings—and the ideas of casa/calle, homosocial/
heterosocial, and reputation/respectability—indicate that multiple context-specific
masculinities may also be operating within individual men. For example, the man
(Felipe) in our study who chose to back down when being humiliated by his bosses
chose to prioritize his ability to provide for his family rather than prioritize his ability
to demonstrate his strength and propensity to defend himself. Although his deference
to his boss protected his economic livelihood, it also resulted in lower status at work
and feelings of frustration and sadness. Situations like these can cause men anxiety, as
men are actively concerned about their ability to portray a masculine identity.
This anxiety and concern about being able to demonstrate masculine character-
istics is described in Pleck’s masculine gender role strain theory. Pleck postulates12 Men and Masculinities XX(X)

that cultural standards for masculinity exist and that socialization encourages men to
attempt to live up to them. He also highlights that masculine gender norms can be
conflicting and inconsistent, which causes men to worry about their ability to fulfill
norms (Pleck 1995). Pleck describes several ways that this can result in negative
outcomes for men. First, men who are unable to achieve gender role expectations
may suffer from low self-esteem and other psychological consequences (i.e., gender
role discrepancy). In our findings, humiliation results from men being unable to
meet the gender role expectation, and we also found that men reported feeling bad
about themselves in such instances. Pleck also describes that men who have been
able to achieve gender role expectations may result in harmful health behaviors
because the gender socialization process has caused them to fear transgressing
masculine norms (i.e., gender role trauma; Pleck 1995). In our data, we see that
men potentially harm themselves (e.g., adopting violent behaviors or risky sexual
behaviors) in an effort to adhere to masculine norms in a given context. It should be
noted that our data also find support for the fact that men’s concern about being
perceived as masculine also sometimes encouraged them to avoid violence and
adopt other seemingly health-promoting characteristics like working and providing
for one’s family. Overall, the concepts of competition and humiliation are key
factors for understanding how masculine gender role strain works to influence men’s
health behaviors.
The field of study focusing on masculinities and health has largely ignored how
masculine norms—and the dynamics of male competition—can prevent men from
engaging in risky sexual behaviors or violence perpetration. We showed that men
use both violent andnonviolent behaviors as strategies to demonstrate their mascu-
linity. Our data, unfortunately, had no information on whether or not men used
sexually protective behaviors (e.g., abstinence, condoms) as strategies to demon-
strate their masculinity. Future research needs to better understand how competition
between men might be health promoting across a range of behaviors and outcomes.
Ultimately, men need to feel empowered to adopt nonviolent behaviors and not fear
that nonviolence may appear unmasculine or inappropriate to certain members of their
social networks. In some settings, women increasingly have a broader range of accep-
table behaviors and life choices due in part to public health interventions that empow-
ered women and modified their structural environment (Rosenfield 2000; Kim et al.
2007; Grabe 2010). Similarly, more men need to feel that it is acceptable—even to
friends in the calle—to respond to humiliation in healthy or nonviolent ways.
Given the importance of competition, he alth interventions that intervene on
gender (e.g., gender-transformative inter ventions (Dworkin, Treves-Kagan, and
Lippman 2013; Dworkin et al. 2013) should consider not only the harmful
effects of the hierarchy between men and women but also the hierarchy and
competition between men. Health progr amming has spent de cades attempting to
dismantle the hierarchy between men and women due to its detrimental effect on
women’s health (Rosenfield 2000; K im et al. 2007; Grabe 2010). The same
effort needs to be made to reduce statu s hierarchies between groups of menFleming et al. 13

that can encourage competition and hum iliation (Dworkin, Fleming, and Colvin
2015). Often, interventions targetin g masculinities aim to encourage men to
adopt child-rearing tasks or reduce their violence against women (Hatcher
et al. 2014; Van den Berg et al. 2013). But, interventions can also begin to
breakdown hierarchies between men by also asking men to challenge the idea
that nonviolent or sexually impotent me na r ef a i l u r e sa sm e n .E l e m e n t sf r o mt h e
interventions “One Man Can” and interve ntions undertaken by the Family Vio-
lence Prevention Fund utilize some activ ities about competition between men;
however, these efforts should be expan ded and more widespread. Such efforts
w i l lb e g i nt on e u t r a l i z et h ep r e s s u r em e nf e e lt ob e l o n gt oas p e c i f i ct y p eo f
masculinity to avoid being humiliated and losing social status.
Finally, future research needs to acknowledge that masculinities are specific to
social contexts. Most current research on masculinities and health utilizes measures
to characterize the type of masculinity that a man endorses or adheres to (Shattuck
et al. 2013; Santana et al. 2006; Noar and Morokoff 2002). For example, research
within the field of HIV relies on men’s normative beliefs about sexuality (e.g.,
should men have multiple concurrent partners?; Pulerwitz and Barker 2008; Archer
2010). But this assessment ignores that masculinity—and its corresponding beliefs
and behaviors—is context dependent and that multiple masculinities can and do
coexist within the same man. Measures of gender ideology may need to employ
vignettes or other innovative measurement techniques to assess context-specific
attitudes (Finch 1987). Additionally, measuring constructs like gender role conflict
may be more useful than measuring adherence to norms, since it gives a better idea
about men’s internalization of gender norms and how concerned they are to adhere
to those norms (O’Neil, Helms, and Gable 1986; Gottert 2014).
Limitations
Our study findings and conclusions should be considered with some limitations.
First, our participants were voluntarily enrolled in a study of male circumcision.
The sample of men who opted to receive a circumcision may differ substantially
from a more general population of men. Second, our sample is small and primarily
consists of low-income and low-education men. Thus, we are unable to tease apart
differences between subgroups. The issues described in our article are likely to be
different for Dominican men with higher education, higher income, or other factors.
Third, this study is exploratory and theorizes—and provides empirical evidence
for—the mechanisms by which masculine norms, competition, and humiliation
contribute to sexual and violent behaviors. While our data describe these mechan-
isms, future research is needed to establish any causal relationship. Finally, the data
were generated through conversations by participants with the interviewer and the
interviewer’s identity and characteristics likely influenced the types of responses we
received; though we don’t consider this a limitation, our data should be interpreted in
light of this fact.14 Men and Masculinities XX(X)

Conclusions
Health researchers and interventionists have made great strides in acknowledging,
considering, and incorporating norms of masculinity into contemporary studies and
health promotion efforts with men. Cont inuing this forward progress in men’s
health—and the health of their partner and families—requires incorporating social
dynamics, such as competing gender norms, into interventions that address male
competition and empower men to overcome these negative social influences.
Acknowledgments
We would like to thank Martha Perez, Miriam Nova, Riqui Rosario, and Nicolas
Gonza ´lez for their assistance in recruitment and data collection.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This project was supported by the
National Center for Advancing Translational Sciences, National Institutes of Health,
through Grant UL1TR000050. We are grateful to the Carolina Population Center for
training support (T32 HD007168) and for general support (R24 HD050924). Flem-
ing was supported by the University of North Carolina (UNC) STD/HIV training
grant (T32AI007001) and subsequently by an NIDA Training Grant (T32
DA023356). Fieldwork was generously supported by the Explorations in Global
Health Award from the UNC Institute for Global Health and Infectious Disease,
UNC Carolina Population Center’s Research Residency Award, the Mellon Disser-
tation Fellowship from UNC’s Institute for the Study of the Americas, and the Koch
Travel Award from the Gillings School of Global Public Health at UNC.
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Author Biographies
Paul J. Fleming , PhD, MPH, is an assistant professor in health behavior and health education
at the University of Michigan School of Public Health where he focuses his research on the
role of masculinity in men’s health-related behaviors.
Clare Barrington , PhD, MPH, is professor of health behavior in the Gillings School of
Global Public Health in the University of North Carolina at Chapel Hill. Her research has
focused on social and structural influences on health and health behaviors, with a focus on
HIV-related behaviors.
Suzanne Maman , PhD, MPH, is an associate professor of health behavior in the Gillings
School of Global Public Health in the University of North Carolina at Chapel Hill. Her
primary areas of research inquiry include HIV prevention and prevention of men’s perpetra-
tion of gender-based violence.
Leonel Lerebours , MD, was the research director of the Clinica la Familia in La Romana,
Dominican Republic at the time of this study. In that role, he coordinated sociobehavioral and
epidemiological research with the patient population to improve health outcomes.
Yeycy Donastorg , MD, MA, is a physician and social demographer and has been conducting
HIV-related research for over two decades. Since 2002, Dr. Donastorg has been the principal
investigator of the National Institutes of Health HIV Vaccine Trials Network Unit in Santo
Domingo, Dominican Republic, which has conducted numerous sociobehavioral research studies.
Maximo O. Brito , MD, MPH, is an associate professor and the vice chair for urban global health
in the Department of Medicine. His scholarly work focuses on HIV prevention in Caribbean men.Fleming et al. 19