Broadly speaking, men are expected to be physically strong, emotionally robust, daring and virile. Some of these expectations translate into attitudes and behaviours that have become unhelpful or frankly lethal with the advent of AIDS. Others, on the contrary, represent valuable potential that can be tapped by AIDS programmes.

Men's traditional role as economic providers -- a major contribution to family welfare and survival -- has traditionally meant that women are the ones expected to look after children and care for sick family members. With millions of women falling ill and dying of AIDS, and millions of children left orphaned, it is urgent for men to be more fully engaged in domestic tasks and the provision of care within the family.

Extra challenges for HIV prevention arise from traditional expectations that men should take risks, have frequent sexual intercourse (often with more than one partner) and exercise authority over women. Among other things, these expectations encourage men to force sex on unwilling partners, to reject condom use and the search for safety as "unmanly", and to view drug-injecting as a risk worth taking. Changing these commonly-held attitudes and behaviours must be part of the effort to curb the AIDS epidemic.

The roots of such behaviour lie in the broader culture and in the home. Boys are encouraged to imitate older boys and men, and discouraged from imitating girls and women. Boys who see fathers and other men being violent toward women, or treating women as sex objects, may end up believing this is "normal" male behaviour. A recent study in Germany, for example, found that young men who were disrespectful in relationships with young women had often witnessed similar relationships in their homes.

During childhood and adolescence, girls are often kept close to their mothers while boys are permitted to spend most of their time outside the home. This gives them more freedom but also greater exposure to other boys and men who may implicitly or explicitly encourage them to see women as sex objects that men have a right to dominate. It may be in this context also that they learn behaviours such as substance use or rejection of condoms. A survey of 15-to-19 year-old boys in the U.S. found that those with traditional views of manhood were more likely to have been involved in violence and delinquency, substance use and unsafe sexual practices than boys with less stereotypical views about what "real men" can and should do.

Is it possible to change the way boys are brought up? Research suggests that when fathers and other male family members offer a positive role, boys develop a more flexible vision of manhood and are more respectful in their relationships with women. But all members of the family have an important role in raising boys. Mothers often reinforce traditional ideas about manhood by showing that they do not expect sons to do household chores or express their emotions. Relatives, teachers and other adults may worry more about the sexual behaviour of girls, leaving boys to learn about sexuality on their own. Boys may be discouraged from talking about their bodies and issues such as puberty and masturbation. This can be the start of lifelong difficulties for men in talking about sex and learning the facts rather than believing the many myths that surround the subject.

Reaching Adolescent Boys Being able to talk about one's problems, including concerns about sexuality, and seeking support are important first steps for boys -- and girls -- to protect themselves against unsafe sexual practices. Yet many boys grow up believing they should not depend on others, worry about their health or seek help when they face problems. One result is that boys often pretend they know a great deal about sex, whereas they are frequently uninformed or misinformed. In India, for example, young men callers to a hotline on sexual health did not believe they were at risk of contracting sexually transmitted infections (STIs) including HIV because they perceived themselves as the "givers" during vaginal and anal intercourse. In surveys in fifteen cities in Latin America and the Caribbean, fewer than a quarter of young men between fifteen and twenty-four years old could identify the female fertile period. Sexual health education for boys and young men calls for trained and sensitive staff who can listen carefully and deal with their sometimes aggressive energy. Apart from information and skills concerning safer sex, boys need opportunities to discuss their concerns related to sexuality, including potency, masturbation or penis size. Health promotion programmes and reproductive health clinics, which boys often see as "female" spaces, need to be re-oriented -- or new ones created -- so that they attract young men. Above all, with support to teachers, schools can become prime locations for education about sexuality, AIDS and life-skills that can help boys avoid endangering themselves and their partners. A 1998-99 World Health Organization survey of seventy-seven governmental and NGO health promotion programmes for adolescent boys turned up a number of creative approaches to attracting boys to health clinics and into discussions about health. Some clinics offer special hours for boys and young men. Some programmes seek to connect boys with adult men who can serve as positive role models, while others hire and train young men to work as peer health promoters. Recognizing boys' many interconnected needs, most of the programmes surveyed work simultaneously in general health promotion, vocational training, counselling, educational support and the prevention of violence and substance use. Some reach out to young men wherever they congregate -- in schools, sports clubs and events, workplaces, bars, taxi stands, military facilities and juvenile justice centres.