(Peter Sternberg is a development worker employed by ICD/CIIR. He has worked with CISAS as a health educator and a researcher for the last four years. Contact details: Peter Sternberg, CISAS, Apartado Postal 3267, Managua, Nicaragua.)

Men's participation in sexual health promotion is seen by many as a promising strategy. (Drennon 1998). However, apart from a very few recent interventions, such as Stepping Stones, an HIV prevention programme based on gender relationships (Welbourn 1995) and Fathers Inc. a Jamaican peer based approach to adolescent men's sexual health (Lize, 1998), health promotion has been slow to take up the challenge.

In 1996, CISAS (Centro de Información y Servicios de Asesoría en Salud), a prominent Nicaraguan non-governmental health promotion organisation, began working with groups of men. This was mainly in response to demands by women from some of the poor communities where it works. The women argued that it is all very well working with women and girls to promote sexual and reproductive health and empowerment, but if you really want things to change, you have to work with men too.

From its inception, in 1983, CISAS has worked from a perspective of community empowerment with particular emphasis on the empowerment of women. However, CISAS has recognised that the health promotion agenda being followed by many organisations is conservative and male-orientated, and in general views women more as vehicles for reproduction or the transmission of illness than as individuals with their own intrinsic value (Wilton 1994). This stance not only ignores women's needs as individuals (Doyal 1991), but also ignores men as a group (Barker 1996). The result is to reiterate women's responsibility for health, especially for reproductive health, while ignoring the possibility that men could, alongside women, play a positive and proactive role in promoting their own health and the health of their families and communities (Wegner et al 1998).

There is a stereotype of men as sexually voracious, careless and irresponsible. Men who conform to this stereotype are unlikely to be much concerned about the possibilities of fathering an unplanned child or of contracting HIV or other sexually transmitted diseases. However, the stereotype is not borne out by reality. For example, citing his own research, carried out in Puerto Rico in the 1950s, the veteran health promoter and family planner, Stycos, stresses that the men he interviewed were far from 'the sex-crazed males anxious to demonstrate their fertility' (Stycos 1996, 2) he had been led to expect. What he found instead was that expectations and norms of male and female behaviour made communication between men and women, especially over matters to do with sex and sexuality, very difficult. Stycos identified this lack of communication between the genders as an important aspect governing sexual behaviour, and concluded that there was a need to work with men in highlighting the benefits to them as individuals of family planning. It is only by the establishment of a men's agenda in reproductive health that things will change. This is a lesson, Stycos says, which has too often been ignored; it is a lesson which CISAS is taking seriously.

CISAS hoped, through this research, to provide men with a body of information which they could use to understand their behaviour, attitudes, and the context of these, in order to:

• develop an awareness of the social and cultural norms defined by machismo, and the way these norms create a certain model of 'acceptable' male sexual behaviour, and a particular set of attitudes. Individual men needed to consider how similar their actual behaviour and attitudes are to the stereotypical model of masculinity with which they are presented, the model that in Nicaragua makes up the machismo system.
• consider the effect of their behaviour on themselves and on other people.

It was hoped that, by helping men to think through these issues, it would be possible to change the power relationships which lead individual men to put themselves and others at risk.

Following the revolution in Nicaragua in 1979, one of the aims of the Sandinista government was to foster more stable and egalitarian families, and to enshrine equal rights for women within the constitution (Lancaster, 1992). In this aim, as in so many others, the Sandinistas failed due to a combination of war, bad planning and economic instability that culminated, in 1990, in their electoral defeat.

The two governments that followed have pursued neo-Liberal monetarist policies, and adopted structural adjustment programmes set up by the World Bank (Vargas, 1998). Over the last ten years, these policies have caused not only rising prices and stagnating wages, but also a rise in unemployment and a rapid expansion of the 'informal economy'. The gap between the haves and the have nots has widened dramatically, today, over 70% of the population live below the poverty line (ibid). Managua, once one of the safest cities in Latin America, has become a battle ground for rival gangs of young men. Violent crime, robbery, prostitution and sexual tourism are on the increase (CENIDH, 1998). The country and the economy have also been afflicted by a series of natural disasters, culminating with Hurricane Mitch in 1998. Some 865.7 thousand people were directly affected by the hurricane, losing their homes, their livelihoods or both (Alforja, 1999).

One result of this instability has been the exponential growth of the Nicaraguan civil society since 1990, in an attempt to fill the gaps left through government inaction and lack of interest. CISAS and other Nicaraguan non-governmental organisations have been in the forefront of championing human rights, and have managed to keep gender power relations more or less on the policy agenda. Nicaraguan NGOs have had some notable successes, including the passing of a law that made intrafamilial violence a crime punishable by imprisonment, and the establishment of several pilot projects of a new police service staffed by officers specially trained to deal with crimes against women and children. Despite these initiatives, police reported, in 1998, that crimes against women and children had increased by 17% from their 1997 levels (INEC, 1999).

Nicaraguan women continue to be under-represented in the public sphere and abused in their private lives (Montenegro, 1997). Only 11% of National Assembly legislators and 25% of the Nicaraguan members of the Central American Parliament are women (CENIDH, 1998). The official 1998 demographic and health survey, ENDESA-98, found that 29% of Nicaraguan women have been physically or sexually abused by their male partners. Of these, over 46% had been abused in the previous twelve months (INEC, 1999). The Nicaraguan media is conservative in its representation of women (Montenegro, 1997), and this has been brought home to many Nicaraguans by its virtual silence on former Sandinista president Daniel Ortega's continuing refusal to recant his senatorial immunity so as to answer charges of sexual abuse brought by his step-daughter in 1998.

Statistics about sexual and reproductive health in Nicaragua reveal that though almost all of the women (over 95%) who took part in the 1998 national demographic survey had heard of modern contraceptive methods, only 60% of women of fertile age were users in 1998 (ibid). Some 15% of women have unsatisfied contraceptive needs (ibid). Though contraception is legally available, Government policy is to emphasise the need for sexual morality and abstinence until marriage (GHCV, 1997). Sex education in schools is taught within a framework of 'family values' which views sex as a necessary evil for perpetuating the species (GHCV, 1997). This may be one of the reasons why, at an average of 3.9 children per woman of fertile age (INEC, 1999), the Nicaraguan fertility rate is one of the highest in Latin America. It may also help to explain why by the age of 19, 46% of Nicaraguan women have been pregnant at some time (statistic from INEC, 1999). In Nicaragua, abortion is illegal except for medical reasons. Even then, abortions can only be legally performed with the permission of three doctors, and the partner or the guardian of the woman. Unsurprisingly, there is a high rate of illegal abortions, many of which are performed under unsafe conditions (Pizarro, 1996).

In 1998, the Ministry of Health recorded an incidence of 153 per 100,000 cases of sexually transmitted infections (STDs). By September 1999, some 476 cases of HIV infection had been reported since 1987 in a population of 4.8 million people. The Ministry of Health recognises that there is substantial under-reporting of STDs including HIV, and the actual figures are probably much higher (MINSA 1999). The organisation PASCA, which coordinates HIV prevention initiatives for Central America, argues that although reported numbers of infections are low, the population is at risk because of its predominantly young profile, high fertility rate, and low or irregular usage of condoms (PASCA, 1997).

Almost without exception, studies about gender and sexuality in Nicaragua highlight one, overarching aspect of the culture: machismo. There is no English word which adequately translates this term. However, machismo could be described as a cult of the male; a heady mixture of paternalism, aggression, systematic subordination of women, fetishism of their bodies, and idolisation of their reproductive and nurturing capacities, coupled to a rejection of homosexuality. The Central American psychologist, Martín Baró (1988), characterises it as a strong tendency towards and valuing of genital activity (that is, penetration); a frequent tendency towards bodily aggression; a carefully cultivated devil-may-care attitude or indifference towards any activity which does not clearly reinforce masculinity; and 'Guadalupismo,' a hypersensitivity towards the idealised notion of women as virgins or mothers.

Machismo is not just present in the behaviour of individual men: it is manifested in political and social institutions and is deeply ingrained in the culture (Monzón 1988). Machismo has been seen as a system of political organisation - 'a political economy of the body' (Lancaster 1992, 236), in which the cult of the male is an important underpinning of the productive and reproductive economy. Machismo gives rise to powerful images which legitimate women's subordination, and establish a value system which is concerned with regulating not so much relationships between men and women, but relationships between men, where women are conceived of as a form of currency.

A serious problem with using machismo to explain men's behaviour is that the cultural values which surround machismo are constantly being defined and redefined. This state of flux seems to be an integral part of Nicaraguan society. As the political commentator and sociologist, Oscar Rene Vargas points out: `As a country, Nicaragua is eternally searching for an identity and oscillating, in an ambivalent way, between old and modern, tradition and fashion, native and foreign.' (Vargas 1999, 19; my translation). It is this flip-flop oscillation which belies any attempt to explain Nicaraguan culture or the political and social system in terms of single word concepts like 'machismo', or for that matter 'Neo-Liberal', 'Conservative' and 'Catholic'. Such labels cannot be used, either, to explain or predict men's behaviour. However, helping Nicaraguan men understand themselves and the way that machismo operates in their lives might provide men with reasons to participate in actions aimed at altering the oppressive structures which maintain women's subordination and exploitation.

Our research examined men's knowledge, attitudes and behaviour in three areas fundamental to the social construction of masculinity: sexuality, reproduction and fatherhood. It aimed to provide information which could be used for planning further work with men to help them develop an understanding of their role in the promotion of sexual and reproductive health.

In all, ninety men were recruited for inclusion in the study, from five urban and three rural communities where CISAS was already working with groups of women and children in different parts of Nicaragua. They were aged from 15 to 70. Seventy percent were married and/or living with their partners, and 30% were single. The average number of children fathered by each man was 4.7. Forty percent of participants had been educated to primary level or less, 50% had secondary education, and 10% had tertiary education.

Work began in August, 1997, with a workshop. Thirty eight men from the communities mentioned above who had previously participated in CISAS activities (such as community meetings and discussion groups) were invited to attend by CISAS health educators. During the workshop, participants discussed issues around sexuality, fatherhood and reproduction with CISAS health educators in small groups and in plenaries. Participants also completed a biographical questionnaire which included questions about their values and practical experience of contraception and fatherhood.

Using the results of the questionnaire, a small team of CISAS staff put together a guide for in-depth interviews and focus groups on the same key issues as the initial workshop. Participants for these were men from the CISAS target communities who had not participated in the workshop. Ten men were interviewed, two from each of the five regions of the country where CISAS works, and five focus groups (one in each region) were held with eight men in each group. The men were recruited by CISAS health educators from men who had participated from time to time in CISAS activities such as discussion groups or community meetings.

Many men seem to find it liberating to discuss close relationships and sexuality with other men. After the workshop and after almost every focus group and interview, participants came up to researchers to thank them for having the opportunity to share their opinions with other men about these rather intimate subjects. Many commented that it was the first time in their lives that had the opportunity to talk about these themes.

In qualitative research, not only the content, but the context of what is said is important (Miller and Glasner 1997). In any verbal interaction, speakers make the assumption that what is said will produce a desired reaction in the people they are speaking to (Potter 1997). If the reaction is not the desired one, the speaker will change or correct what he or she says. While some regard this problematic for researchers, since it implies that sociological research is always subject to contextual bias, others argue that it is very useful, since shows how established norms influence the ways in which people behave (May 1993). In our research, participants contradicted themselves, or clarified their comments, when they were afraid that what they had said might cast aspersions on their masculinity, or on the image that they wanted to project as reasonable, rational and caring people. These two inter-related sets of values underlie what was said, and informed the relationships between participants and between participants and facilitators. The comments and opinions which appear below must be seen in this context.

 Some results

An important theme in the discussions about sexuality was the belief that male sexuality is governed by instinct, and that it is something wild which men need to make an effort to control. In all focus groups, men expressed pride in their stereotypical image as sexually voracious conquerors of women and therefore 'real men'. This comment, one of many such, indicates that the first thing every man does on meeting a woman is to evaluate her as a possible sexual conquest. Such an evaluation, according to participants, involves her parametros físicos (physical appearance), and - secondly - her marital status. `Men, because they want to be machos say that "whatever goes into the broiler is meat"... I've had sex with cousins, not with aunts, you understand, you have to respect them a bit more'.

In focus groups, all participants spoke of their sexuality in terms of force and strength, and of female sexuality in terms of beauty and passivity. Participants in two focus groups stated that 'honest' women should not have opinions on what they want in sex: it is up to the man to know how to please them. While many participants pointed out that sexuality had much to do with the way people communicate, none of the participants identified communication as an attribute that they felt they had, or that they desired, with their partners.

Focus group participants were asked about the qualities of the ideal female partner. The consensus opinion was that she has a beautiful body, but more importantly she is a cook and household manager, who is willing and able to serve her man faithfully and be a good mother to his children. The ideal male was seen as a worker who makes enough money to support his wife and children: his role is to provide financially for his family's needs. He does not drink, take drugs or womanise. Despite this, 26% of the men who attended the workshop reported having more than one partner 'at the moment'. In discussions in the focus groups, it became evident that it is not just seen as a man's right to have more than one partner, but also as an important expression of his sexuality. This is clear from the comments of these two focus group participants: `From the moment I meet a woman that I fancy, I'm thinking that I'll do something with her, I'm going to get to know her and have an adventure, I can't stop it, it's part of me' and `We're unfaithful by nature, I guess men are just born bad'.

In comparison, the infidelity of a woman is considered to be a different thing altogether: women, unlike men, are not by nature unfaithful. Unfaithful women are therefore `bad' women. This is a good example of the double morality which is a salient feature of Nicaraguan machismo. However, not only is the infidelity of a woman a reflection of her wickedness but also, at the same time, of the failure of a man, since unfaithful women were associated with male partners who do not please them sexually.

Men showed varying degrees of homophobia. To many in the study, homosexuality is 'against nature' and against 'God's will'. Homosexuality was regarded as an illness with a direct physical cause, such as a 'brain tumour' or a 'small penis'. Some believed that it could be caught, as though it was a sexually-transmitted disease. Others saw homosexuality as a result of the loss of values in society. During the discussions on this topic in the workshop, several men pointed out that society's views condemning homosexuality had a direct impact on the way that they relate to other men. There are certain things that men cannot do without being singled out as cochones (a derogatory term for homosexual men). These were not, as might be expected, tasks seen as women's work: they were, instead, about the ways in which men relate to men. For example, a man cannot comment on the beauty of another man. One man commented: `I don't want to say in public or in private, "this guy is handsome, beautiful, pretty", because they'll mark me down as a queer'.

Discussions about lesbianism highlighted the fact that the men's sexuality is centred on the penis and penetration, since many could not conceive of a sexual relationship without penetration. The participants of two groups took this to extraordinary lengths, believing with unshakeable confidence that lesbians have penises (albeit somewhat smaller ones than men: '2 to 3 inches'). Focus group participants spent much time trying to ascribe a direct cause to lesbianism. Most felt it was due to the failure of men to please women sexually, but this was generally seen as the 'fault' of the woman: she was the kind of woman that men cannot please.

During small group work in the workshops, and in interviews, men expressed the opinion that within a marriage or a stable relationship, it is a man's right to decide when a woman should have children. This was never said directly, but it was implicit in many of the comments about contraception. Participants felt this was because they were the ones who would be expected to provide for the children. 87% of workshop participants, and the consensus opinion of every focus group, was in favour of contraception. It was clear from focus group and interview information that the main reason for why participants were in favour of contraception was because it prevented them from having to take economic responsibility for unwanted children. As one man pointed out: `For me, family planning is important. I wouldn't want to have anymore because of my condition. I'm poor and wouldn't like any more children'.

Despite this, using contraception is still seen as a sin, as could be seen clearly in comments from the 13% of workshop participants who expressed opinions against it: 'It's a sin. You see, only God knows what a child's destiny is, you're human, you can't. If God wants a child, he makes one, it is a sin to prevent it.' . Many participants referred to it as sinful even while justifying its use, as in this comment by a workshop participant: `It's a sin but, for me, it's more sinful to bring a mountain of children into the world and not know what to do with them; having them crying of hunger and not being able to feed them. That's a bigger sin'.

Statistics about the number of men in Nicaragua who abandon their pregnant partners are not available, but the percentage of female-headed households is very high, at 31% of all households (INEC, 1999). Almost exclusively, financial problems were seen by men in the study as the reason for abandoning partners and children. However, many did say they felt strongly that it was 'unmanly' to reject or run away from the responsibility. One said: "As a man, you have to take the responsibility, whether it's your wife or your lover or whatever, you can't reject it. Even if you have two women, you have to hide it from the woman you live with. Denying the responsibility wouldn't be manly."

Despite these views, The consensus opinion from interviews and focus groups was that using contraception is not men's responsibility. Focus group participants' knowledge of how the different methods worked was poor, even amongst men with higher levels of education. Most discussions centred on the condom, vasectomy and female sterilisation, probably because these were seen to be the most controversial methods.

Messages which CISAS and other organisations had publicised about condom use had clearly been received by men in the study. Several proudly, and without prompting, repeated the slogans from the publicity during the workshop. However, while men in the study knew that condoms could prevent HIV infection and unwanted pregnancy, there was general agreement that very few men use them. Different reasons were cited for this, including illiteracy, the fact that the woman was known to be an 'honest woman', and the fact that sex with condoms does not feel the same. Despite this, some 68% of workshop participants reported that they themselves had used condoms within the last six months. In focus groups and interviews, it became clear that men felt that the only women they needed to use condoms with were those whom they judged to be 'suspicious': women in bars, and women whose pasts they do not know. One interviewee summed up the majority opinion: 'when you see a very suspicious woman you might use it, but, sometimes when you meet a woman, maybe who's engaged, but lets you do it, there's no need to use a preservative (condom). You know, they just don't feel the same, it's like attaching a hose or something, you just don't feel right.'

Vasectomy was said to affect the character of the man, making him like a woman. This view expressed a fear which many seemed to feel, that losing their ability to engender children would affect their manhood. Having said this, not all men were against vasectomy; a few said that they would have the operation, because it was a safe and sure method of contraception which would prevent them from having to take economic responsibility for more children. Only one man admitted that he had actually had the operation.

Female sterilisation, more than any other contraceptive method, made men suspect that their partners wanted to have sex with other men. In the questionnaire, participants' responses to questions about female sterilisation reveal widespread fear of women's infidelity. 29% of respondents to the questionnaire agreed with the statement: 'After women have the operation, they look for other men to have sex with'. In discussions, even men who said that they were not against female sterilisation first alluded to, and then dismissed, the infidelity myth: 'if she wants to get sterilised it's because she's crazy, she wants to cheat on her husband, she wants to have one man and then another'.

Over 92% of the men in the workshop regarded abortion as a sin. In the focus groups, women who have abortions were termed `murderers'. In the groups and interviews, the men were asked why they thought abortions happened. Medical reasons were cited, but there was also an understanding that many abortions take place for social reasons, which include relationship and economic problems. In focus groups, the consensus opinion was that abortions were the fault of irresponsible women, highlighting the fact that most men do not see contraception as their responsibility. A woman has an unwanted pregnancy because she, not her partner, is irresponsible.

The situation is slightly different for young, unmarried women. Men do not expect them to be responsible or to be able to resist seduction. Unwanted pregnancies in unmarried young women were seen as resulting from loss of parental control, and especially by fathers. However, even for young women, men saw the solution as having the child and giving it away.

All men in the study who had children talked of feeling mature after the birth of their first children. It was as if fatherhood provides a man with an entrance into 'real' adulthood. For most, these feelings went hand in hand with the realisation that they were now responsible for the upbringing of a child. One man explained that, after the birth of a child, men feel a mixture of joy and worry over how they would be able to cope financially with the extra burden: 'In the moment (when your child is just born) you feel great, but then, well, you know, you start thinking, you're broke and it's also worrying.'

According to participants in four focus groups, providing economically for children is a father's principal role. The other main paternal responsibility mentioned is teaching children how to behave. Men felt that this is done through teaching children important values, including the value of work, honesty, responsibility, and respect for one's elders. These two responsibilities, as a provider and disciplinarian, were the only two mentioned. It is a sad fact that only one man spoke of 'giving love' as a paternal responsibility. On the other hand, it was very obvious that the majority of men in the study value the love of their children, and the time that they spend with them. In the questionnaire, over 95% marked that playing with their children was important to them. In groups and interviews, many men talked with pride of the affection that their children had for them.

The majority of the men in the study reported that they involved themselves 'from time to time' in practical child-care. Activities mentioned included feeding, bathing, dressing, and even washing and ironing clothes. However, day-to-day child-care was seen as a help and support for mothers rather than as part of a father's role.

The men were asked about the content of the last conversation that they had had with their children. Almost all the men said that they had been giving advice. Only one man reported a discussion about a topic which did not have to do with control or discipline. It would seem from this that fathers either lack skills to communicate with their children in other ways, or do not see the importance of this. Many said they find it particularly difficult to communicate with their daughters, and that they are often stricter with them than with their sons. The reason cited for this was that fathers need to be extra vigilant with their daughters, to prevent them from becoming pregnant. Relationships between fathers and their daughters were seen generally as being more difficult. One possible reason for this which emerged from the study is that daughters are regarded as being less valuable than sons. A daughter is not valueless, but it appears that her value is in her ability to serve her family, and not in her as a human being. As one man said: `When I realised that God had given me a girl, I said to myself, 'at least I have a cook to make me tortillas'.

In many studies, machismo and the ideas on which it is based tend to act as an explanation (and, occasionally, an excuse) for men's behaviour. However, using machismo as an explanation or excuse assumes that the concept shapes men's conduct. In fact, perhaps its main effect is to present Nicaraguan society with a stereotypical model of men and women's behaviour which individuals may or may not adhere to. The results of this research should not be seen as a picture of a single, objective Nicaraguan machismo operating in interpersonal relationships, but as a snapshot of complicated, endlessly changing relationships between participants, their partners and their children, and between participants and researchers.

If the research has little predictive value for men's behaviour in the context of their relationships, because it cannot depict the context, or explain, the behaviour of individual men in their relationships with women and children, why spend good money in a poor country to do it?

It is necessary, as well as morally defensible, to use development methods which are based on a commitment to empowerment and active participation. Norms of masculinity are so artificial, and so inhuman, that they need to be policed to maintain them (Formaini 1990). Institutions which do this policing include the church, the government, the media, the medical profession, and - most effectively - the family (Schifter and Madrigal, 1996). Together, these institutions put into place a system of discipline which affects the social behaviour of individual men and women under a male hegemony (Connell, 1995). As feminists have contended, empowered individuals can not only challenge male hegemony and norms of gender relations, but play a significant role in reformulating these relations, which would result in true emancipation (Holland and Ramazanoglu, 1994).

Participatory methods based on a commitment to empowerment have rarely been applied to work which focuses on men as gendered beings. Much has been written on the need to focus on women's participation through use of women-only groups, as well as facilitating their full involvement in mixed groups, but the suggestion that a powerful group such as men may require specific attention is new and challenging.

Agencies which are reluctant to work with men on issues concerning sexual and reproductive health (Stycos 1996) may justify this by saying that men have little or no interest in the theme. However, CISAS's experience is that men are very interested, once they can be persuaded to take part. One reason for men's unwillingness to be recruited as participants for such projects as ours may be their perception that health promotion is women's work. Possibly, development agencies themselves have had a major influence in this perception, since few efforts have been made to involve men in proactive community development programmes. Many men, and some development agencies, continue to view men's participation as unnecessary, and even counter-productive (Drennon, 1998).

For some women, the proposition that there might be a sexual health promotion agenda for men is seen as threatening. As Marge Berer (1996) points out, many are suspicious of the aims of health planners to increase men's participation in reproductive and sexual health, viewing this as part of a campaign which aims to win back power which men are losing by a focus on men's rights. It is possible that these fears are well grounded, as they are founded on the bitter experience of the sixties sexual revolution which, for all its rhetoric of sexual freedom, did little to change the subordinate role that women play in most sexual relations with men (Hawkes, 1996). This is supported by some evidence that men's involvement in family planning has actually increased men's control over the fertility of women, rather than resulted in women having more choice (Cornwall 1998). There is also danger that efforts to get men to participate will take funds away from projects which target women and children, and will ultimately result in the restatement of a male dominated and orientated agenda (Berer, 1996; Helzner, 1996).

These warnings should not go unheeded. The setting and application of a men's agenda for sexual health promotion should not result in the curtailment of services for women because funds are being reallocated towards men (AVSC INTERNATIONAL, 1997), nor should it give men the keys to more subtle forms of domination and exploitation. Ultimately, as feminists have long realised, men's participation in the reformation of gender relationships is a two-edged sword. Kimmel and Mesner (1995) point out that by making the processes of the patriarchy visible to men, there is a risk that they will learn new ways of maintaining or even increasing its power, rather than reforming the norms upon which it is based. The job of ensuring that this does not occur lies fairly, if not squarely, in the hands of professional health promoters working with men.

AVSC INTERNATIONAL (1998), Men as Partners initiative: Summary report of literature review and case studies, AVSC International, New York

Barker, G. (1996) The misunderstood Gender: Male involvement in the family and in reproductive and sexual health in Latin America and the Carribean, John D and Catherine T Macarthur Foundation, Chicago

Baró M. I.. (1988) Acción e Ideología. Pscología Social de Centroamérica, San Salvador, University of Central America, (UCA), El Salvador

Berer, M. (1996) 'Men,' Reproductive Health Matters, 7, May, pp 7 - 10.

CENIDH (1998) Derechos Humanos en Nicaragua, Managua, Centro Nicaragüense de Derechos Humanos.

Connell R (1995) Masculinities, Polity Press/Blackwell, Oxford

Cornwall, A. (1998) Beyond Reproduction: changing perspectives on gender and health, Bridge, (7) [Internet]. Available from: http://www.ids.ac.uk/ids/research/bridge. [Accessed: 31^st January, 1999]

Doyal, L. (1991) 'Promoting Women's Health'. In: Badura B., and Kickbusch I., (eds), Health Promotion Research, Copenhagen: WHO

Drennon, M. (1998) Reproductive Health: New Perspectives on Men's Participation, Population Reports, Johns Hopkins University School of Public Health, Population Information Program, October.

Formaini, C. (1990) Men: the darker continent, Heinemann, London

GHCV, (1997) Responsibilidad Masculina en Salud Sexual y Reproductiva, Managua, Grupo de Hombres Contra la Violencia, RSMLAC, Si Mujer.

Hawkes, G. (1996) A sociology of sex and sexuality, Open University: Buckingham

Helzner, J. (1996) 'Men's involvement in family planning', Reproductive Health Matters 7: 146 - 154, May.

Holland, J., and Ramazanoglu C. (1994) Coming to conclusions: power and interpretation: researching young women's sexuality. In: Maynard M. and Purvis, J. Researching Women's Lives from a Feminist Perspective, London, Taylor and Walker.

INEC (1999) ENDESA - 98 (Encuesta Nicaragüense de Demografía y Salud - 1998), Managua, Instituto Nacional de Estadistícas y Censos (INEC).

Kimmel, M., and Mesner, M. (1995), 'Introduction'. In: Kimmel M., and Mesner M., (eds), Men's Lives (3^rd Ed) Needham Heights, Mass., Allyn and Bacon.

Lancaster, R. (1992) Life is hard: machismo, danger, and the intimacy of power in Nicaragua, Berkeley, CA, University of California.

Lize, S., (1998) Masculinity and men's health needs: a Jamaican perspective, Bridge, (7) [Internet]. Available from: http://www.ids.ac.uk/ids/research/bridge. [Accessed: 31^st January, 1999]

May, T. (1993) Social Research: issues, methods and process, Buckingham, Open University Press.

Miller J., and Glasner, B. (1997) The 'Inside' and the 'Outside': Finding Realities in Interviews. In: Silverman, D., (ed) Qualitative Research: Theory, Method and Practice, Sage, London

MINSA (1999) Plan Estratégico Nacional de Lucha Contra ETS/VIH/SIDA: Nicaragua 2000 - 2004, Ministry of Health of the Republic of Nicaragua, Managua

Montenegro, S. (1997) La revolución simbólica pendiente: mujeres, medios de comunicación y política, CINCO, Managua

PASCA (1997) Resumen de País - la Situación del VIH/SIDA en Nicaragua, Proyecto Acción SIDA de Centro América (PASCA), Managua

Pizarro, A. (1996) A Tu Salud, SI Mujer, Managua

Potter, J. (1997) Discourse Analysis as a Way of Analysing Naturally Occurring Talk. In: Silverman, D., (ed) Qualitative Research: Theory, Method and Practice, Sage, London

Schifter, J and Madrigal, J. (1996) Las Gavetas Sexuales del Costarricense y el Riesgo de Infeccion con el VIH, Editorial IMEDIEX, San Jose, Costa Rica.

Stycos, M. (1996) Men, Couples and Family Planning: a retrospective look, Working Paper No. 96 - 12, Cornell University Population and Development Program, Cornell University

Vargas, O-R. (1998) Pobreza en Nicaragua: un abismo que se agranda, Managua, Centro de Estudios de la Realidad Nacional (CEREN)

 Vargas, O-R. (1999) El Síndrome de Pedrarias, Managua, Centro de Estudios de la Realidad Nacional (CEREN)

Wegner, M, Landry E, Wilkinson D., and Tzanis J. (1998) 'Men as Partners in reproductive health: From Issues to Action', International Family Planning Perspective 24:1 38 - 42.

Welbourn, A. (1995) Stepping Stones: A training package on HIV/AIDS, communication and relationship skills, ActionAid, London

Wilton, T. (1994) 'Feminism and the Erotics of Health Promotion'. In: Doyal L., Naidoo, J and Wilton T., (eds) Women and AIDS: Setting a Feminist Agenda, Taylor and Francis, London