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Fixing Men

University of California Press

Contents

List of Illustrations......................................................................ixAcknowledgments............................................................................xi1. Taming Men's Natural Desires in Oaxaca..................................................12. The Missing Gamete: Eight Common Mistakes about Men's Sexuality.........................283. New Labyrinths of Solitude: Lonesome Men and AIDS.......................................474. Frisky and Risky Men: AIDS Care in Oaxaca...............................................715. Planning Men Out of Family Planning.....................................................1006. Scoring Men: Vasectomies and the Totemic Illusion of Male Sexuality.....................1307. Traditional Sexual Healing of Men.......................................................1658. From Boardrooms to Bedrooms.............................................................196Notes......................................................................................213Bibliography...............................................................................231Index......................................................................................255

Chapter One

"Well, you know, they did it to me a few years ago...." That is how I began my interviews with men who wanted vasectomies in Oaxaca, conducted during their operations. It seemed to break the ice and get the men talking. They told me why they decided to get sterilized, about discussions they had had with their wives before the procedure, and, invariably, about anxieties as to what would happen with their postoperative sexual desire and performance. Sometimes a man would get jumpy and I would excuse myself. The last thing the poor guy needed was to be interviewed, I assumed. But the doctors and the men themselves would insist, "No, stick around!" I became the anthropologist-as-emotional-anesthesiologist.

Vasectomies were not common in the mountainous provincial capital of Oaxaca, in southern Mexico. But I was not looking for common men-whatever that term might mean. I wanted to know why men who got sterilized decided to do so. The answer turned out to be deceptively straightforward. For many, if not all, of the men I spoke with in Oaxaca, the most common explanation for getting vasectomies was that their wives had already suffered enough-taking birth control for years, getting pregnant, giving birth-and now it was their turn. When I asked these same men why they had long relied on their wives to use contraceptives in the past, and why they had not used a male form of birth control, the men responded with a simple incredulous question: "Like what? The condom?" In Oaxaca, as elsewhere in the world, most artificial, modern forms of contraception-and all the most reliable ones-are for women. The men asked me if I thought they had much of a choice about what form of birth control to use. I responded honestly that the choices available to the men of Oaxaca were part of a larger picture that involved, among others, the international pharmaceutical industry that develops and manufactures birth control devices and medications. Unless a modern contraceptive is made and marketed by these companies, it will not be available in Oaxaca or anywhere else in the contemporary world.

International pharmaceuticals were also involved in the lives of other men I spent time with in Oaxaca, those who traveled to the United States as migrant workers, became infected with HIV while living there in new labyrinths of solitude, and returned home, whereupon they infected wives and girlfriends. When I lived in Oaxaca on and off in the period 2001-05, fewer than two hundred men and women received the life-saving antiretrovirals manufactured by the multinational drug companies and sold to the state-run clinic in Oaxaca. Unlike some countries in the world, in Mexico the government health sector paid the pharmaceutical companies top prices for AIDS medications. As a result, thousands of men and women in Oaxaca who were HIV+ or had AIDS were inevitably going to face premature deaths, many without ever knowing what disease was killing them. I spent time with these dying patients, and I attended the Wednesday-morning meetings with the medical personnel where decisions were made about exactly which men and women would be given the drugs and who was doomed to an early demise.

In Oaxaca, doctors said the migrant men had become infected with HIV after having sex with other men in the United States. When I asked one doctor how he knew this and why he was so sure, he told me, "That's what Mexican men do: they have sex with other men." When I asked him if he had sex with men, he looked startled. When I asked if his father or brother or son or uncle or neighbor had sex with other men, he began to get annoyed. It turned out that a lot of what passed for knowledge in this realm was based on common sense and cultural folk wisdom. The notion of "men's natural sexual desires" was blamed for a host of health problems like AIDS in Oaxaca. And if these generalizations were not necessarily accurate for all men-"That's just the way men are!"-then at least they were true for men who grew up in Mexico. Mexican culture and Mexican male culture were considered the culprits in many a Mexican medical schema.

Surprisingly to me, the medical people who seemed least taken with dichotomous views of men's sexuality and women's sexuality as entirely and naturally distinct were the men and women who called themselves traditional indigenous midwives and healers. From these mdicos tradicionales I also heard of techniques that women can employ to keep their men from straying, and I learned why men go on sexual diets after their wives give birth. In distant rural communities along the coast and in the mountains of the state I often discovered a far more expansive and self-conscious understanding of what culture means for the diagnosis and healing of illness than I heard in the various biomedical clinics in Oaxaca City where I spent time.

My arrival in Oaxaca coincided with efforts launched from Mexico City-and the implementation of an earlier 1993 report by the World Bank-ordering that health care throughout the country be further privatized and decentralized. These stringent measures further exacerbated an already inadequate situation in providing care to those most in need, which in Oaxaca nearly always means the nearly two million indigenous people, most of whom live in poverty and some in extreme poverty. The conditions of poverty and miserable health care are the same as those that propel so many people to try their luck as migrant workers in the United States. Seen in this context of scarcity and suffering, issues of impotence, infertility, and infidelity among men might seem inconsequential. I can only affirm that none of the men and women with whom I spent time in Oaxaca from 2001 to 2005 belittled my questions about sex, birth control, and AIDS.

MEN AND WOMEN TAKING POLITICS PERSONALLY

Many studies on reproduction to date have focused on women. This...