LETTERS ON THE VALUE OF THE “MAN UP MONDAY” CAMPAIGN While we are intrigued by the argument put forth by Fleming et al. that public health ought to strive for a “gender transformative” approach to health messaging,1 the authors made a poor choice in selecting the Man Up Monday campaign to illustrate their points. While the authors correctly acknowledge the value of establishing safe spaces for men to constructively explore and question harmful gender norms, they failed to point out that Planned Parenthood was the site of the pilot in Southeastern Virginia; Planned Parenthood is widely recognized for bringing men into a traditionally woman-dominated space for sexually transmitted infections (STI) testing and other services that provide a wealth of opportunities for deeper education on sexual health and intimate partner relationships.2 In that sense, the success of the Man Up Monday campaign in that region exhibits a gender transformative approach in that it encouraged potential uptake of these additional services. As noted by several of our pilot sites, Man Up Monday has also proven effective in reaching women who heeded the campaign’s call to action—many by engaging in STI testing
Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at [email protected].
at those sites alongside their male sexual partners (unpublished raw data from Planned Parenthood of Southeastern Virginia Man Up Monday, 2012 Pilot [e-mail communication]; University of Missouri Student Health Center Man Up Mizzou, 2014 Pilot [e-mail communication]; and Murray State University Health Services Man Up Monday, 2013 Pilot [written communication]). By fostering a couples-based approach to changing sexual behaviors, Man Up Monday reflects best practices3 and directly addresses the authors’ concern that STI prevention efforts promote “respectful, communicative, and responsible sexual relationships.” None of the authors contacted our team for more information about the campaign. We would have been happy to share the processes involved in its development, the various evaluation methods applied, implementation methods deployed, and outcomes we have measured thus far in our pilots. The authors did not empirically test their assertion that the Man Up Monday Campaign is damaging to any of the exposed populations. Therefore, by no acceptable scientific standard are they able to conclude that the Man Up Monday campaign “may be considered unethical” because it “purposefully reinforce(s) hegemonic norms.” We would ask that the authors heed their own advice that “public health has an ethical obligation to carry out a careful assessment of the risks and benefits of existing programs according to the established evidence base,” and suggest that they take the opportunity to conduct a more empirical examination of their framework, based on all available evidence, before denouncing what has otherwise shown promise as an effective campaign to address a critical health behavior in a population that public health has traditionally struggled to reach: men. j Morgan L. Johnson, MPH Rachelle N. Reeder, MPH
About the Authors Morgan L. Johnson is the Director of Programs and Research for The Monday Campaigns, New York, NY.
October 2014, Vol 104, No. 10 | American Journal of Public Health
Rachelle N. Reeder is a Programs and Research Associate for The Monday Campaigns. Correspondence should be sent to Morgan L. Johnson, MPH, The Monday Campaigns, 215 Lexington Ave, Suite 1001, New York, NY 10016 (e-mail: mjohnson@ mondaycampaigns.org). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted May 25, 2014. doi:10.2105/AJPH.2014.302107
Contributors Both authors discussed and helped draft this letter.
References
1. Fleming PJ, Lee JG, Dworkin SL. “Real Men Don’t”: constructions of masculinity and inadvertent harm in public health interventions. Am J Public Health. 2014; 104(6):1029---1035. 2. International Planned Parenthood Federation. (June 2009). The truth about men, boys and sex: Gendertransformative policies and programmes. Available at: http://www.ippf.org/resource/Truth-About-Men-Boysand-Sex-gender-transformative-guide. Accessed May 8, 2014. 3. Burton J, Darles LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of the evidence. AIDS Behav. 2010;14:1---10.
FLEMING ET AL. RESPOND We appreciate the letter written by Johnson et al. in reference to our article, and we are pleased that they have highlighted many of the excellent aspects of the Man Up Mondays campaign. We wholeheartedly agree that the Man Up Mondays campaign demonstrates many public health best practices and has many strengths. That it has resulted in couples counseling and connects men with Planned Parenthood’s high quality services are of course valuable outcomes. It is precisely because of the strengths of this program that we chose it as an example in our article. We sought to point out that even award-winning programs using public health best practices have the potential to inadvertently harm health by using messaging that reinforces gender stereotypes. While we only highlight one program in our article, we would like to point out that many other public health media campaigns use health promotion
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messaging that reinforces gender norms in ways that are potentially harmful. The argument we make is both theoretical and based on extensive previous research with male populations that we have referenced in our article. Our critique focuses specifically on messaging, like that used within the Man Up Monday campaign, designed to leverage gender norms to elicit positive health-related behavior change in men. We drew upon a framework (Gupta’s classification of messaging in health interventions1) to underscore that messages reinforcing gender stereotypes (e.g., “Man Up”) have the potential to have negative consequences. Our essay is intended to be a critical and theoretical reflection, not an empirical article. Thus, Johnson et al. are correct that we have no empirical evidence from their program to show that the campaign has reified hegemonic masculinity or caused any harms. However, we critically assessed the publicly available media portion of their campaign and supported our argument based on the extensive research that is available on the relationship between media messaging, masculine norms, and behaviors that can be harmful to men’s health. The issue of addressing gender within public health programs is complex and has no simple answers. We believe that a dialogue on the social construction of gender within public health programs is long overdue. We sincerely hope that Johnson et al., and others targeting men with public health interventions, continue their important work improving health promotion for men. We also look forward to continuing this conversation and hearing critical perspectives from Johnson et al. and others on the role of gender and masculinity in media messaging for men. It is only through these dialogues that we can collectively create a body of knowledge that will help improve our long-term approach to men’s health. j
Carolina at Chapel Hill. Joseph G. L. Lee is with the Department of Health Behavior, University of North Carolina at Chapel Hill. Shari L. Dworkin is with the Department of Social and Behavioral Sciences and the Center for AIDS Prevention Studies, University of California, San Francisco. Correspondence should be sent to Paul J. Fleming, MPH, UNC Department of Health Behavior, CB 7440, Chapel Hill, NC 27599 (e-mail: pfl[email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted June 15, 2014. doi:10.2105/AJPH.2014.302128
Contributors All authors contributed to the writing of this letter and approved the final version.
References 1. Gupta GR. Gender, sexuality, and HIV/AIDS: the what, the why and the how. Paper presented at: XIII International AIDS Conference; July 12, 2000; Durban, South Africa. Available at: http://siteresources. worldbank.org/EXTAFRREGTOPGENDER/Resources/ durban_speech.pdf. Accessed June 4, 2014.
Paul J. Fleming, MPH Joseph G. L. Lee, MPH, CPH Shari L. Dworkin, PhD, MS
About the Authors Paul J. Fleming is with the Department of Health Behavior and the Carolina Population Center, University of North
e2 | Letters
American Journal of Public Health | October 2014, Vol 104, No. 10
Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at [email protected].
at those sites alongside their male sexual partners (unpublished raw data from Planned Parenthood of Southeastern Virginia Man Up Monday, 2012 Pilot [e-mail communication]; University of Missouri Student Health Center Man Up Mizzou, 2014 Pilot [e-mail communication]; and Murray State University Health Services Man Up Monday, 2013 Pilot [written communication]). By fostering a couples-based approach to changing sexual behaviors, Man Up Monday reflects best practices3 and directly addresses the authors’ concern that STI prevention efforts promote “respectful, communicative, and responsible sexual relationships.” None of the authors contacted our team for more information about the campaign. We would have been happy to share the processes involved in its development, the various evaluation methods applied, implementation methods deployed, and outcomes we have measured thus far in our pilots. The authors did not empirically test their assertion that the Man Up Monday Campaign is damaging to any of the exposed populations. Therefore, by no acceptable scientific standard are they able to conclude that the Man Up Monday campaign “may be considered unethical” because it “purposefully reinforce(s) hegemonic norms.” We would ask that the authors heed their own advice that “public health has an ethical obligation to carry out a careful assessment of the risks and benefits of existing programs according to the established evidence base,” and suggest that they take the opportunity to conduct a more empirical examination of their framework, based on all available evidence, before denouncing what has otherwise shown promise as an effective campaign to address a critical health behavior in a population that public health has traditionally struggled to reach: men. j Morgan L. Johnson, MPH Rachelle N. Reeder, MPH
About the Authors Morgan L. Johnson is the Director of Programs and Research for The Monday Campaigns, New York, NY.
October 2014, Vol 104, No. 10 | American Journal of Public Health
Rachelle N. Reeder is a Programs and Research Associate for The Monday Campaigns. Correspondence should be sent to Morgan L. Johnson, MPH, The Monday Campaigns, 215 Lexington Ave, Suite 1001, New York, NY 10016 (e-mail: mjohnson@ mondaycampaigns.org). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted May 25, 2014. doi:10.2105/AJPH.2014.302107
Contributors Both authors discussed and helped draft this letter.
References
1. Fleming PJ, Lee JG, Dworkin SL. “Real Men Don’t”: constructions of masculinity and inadvertent harm in public health interventions. Am J Public Health. 2014; 104(6):1029---1035. 2. International Planned Parenthood Federation. (June 2009). The truth about men, boys and sex: Gendertransformative policies and programmes. Available at: http://www.ippf.org/resource/Truth-About-Men-Boysand-Sex-gender-transformative-guide. Accessed May 8, 2014. 3. Burton J, Darles LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of the evidence. AIDS Behav. 2010;14:1---10.
FLEMING ET AL. RESPOND We appreciate the letter written by Johnson et al. in reference to our article, and we are pleased that they have highlighted many of the excellent aspects of the Man Up Mondays campaign. We wholeheartedly agree that the Man Up Mondays campaign demonstrates many public health best practices and has many strengths. That it has resulted in couples counseling and connects men with Planned Parenthood’s high quality services are of course valuable outcomes. It is precisely because of the strengths of this program that we chose it as an example in our article. We sought to point out that even award-winning programs using public health best practices have the potential to inadvertently harm health by using messaging that reinforces gender stereotypes. While we only highlight one program in our article, we would like to point out that many other public health media campaigns use health promotion
Letters | e1
LETTERS
messaging that reinforces gender norms in ways that are potentially harmful. The argument we make is both theoretical and based on extensive previous research with male populations that we have referenced in our article. Our critique focuses specifically on messaging, like that used within the Man Up Monday campaign, designed to leverage gender norms to elicit positive health-related behavior change in men. We drew upon a framework (Gupta’s classification of messaging in health interventions1) to underscore that messages reinforcing gender stereotypes (e.g., “Man Up”) have the potential to have negative consequences. Our essay is intended to be a critical and theoretical reflection, not an empirical article. Thus, Johnson et al. are correct that we have no empirical evidence from their program to show that the campaign has reified hegemonic masculinity or caused any harms. However, we critically assessed the publicly available media portion of their campaign and supported our argument based on the extensive research that is available on the relationship between media messaging, masculine norms, and behaviors that can be harmful to men’s health. The issue of addressing gender within public health programs is complex and has no simple answers. We believe that a dialogue on the social construction of gender within public health programs is long overdue. We sincerely hope that Johnson et al., and others targeting men with public health interventions, continue their important work improving health promotion for men. We also look forward to continuing this conversation and hearing critical perspectives from Johnson et al. and others on the role of gender and masculinity in media messaging for men. It is only through these dialogues that we can collectively create a body of knowledge that will help improve our long-term approach to men’s health. j
Carolina at Chapel Hill. Joseph G. L. Lee is with the Department of Health Behavior, University of North Carolina at Chapel Hill. Shari L. Dworkin is with the Department of Social and Behavioral Sciences and the Center for AIDS Prevention Studies, University of California, San Francisco. Correspondence should be sent to Paul J. Fleming, MPH, UNC Department of Health Behavior, CB 7440, Chapel Hill, NC 27599 (e-mail: pfl[email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted June 15, 2014. doi:10.2105/AJPH.2014.302128
Contributors All authors contributed to the writing of this letter and approved the final version.
References 1. Gupta GR. Gender, sexuality, and HIV/AIDS: the what, the why and the how. Paper presented at: XIII International AIDS Conference; July 12, 2000; Durban, South Africa. Available at: http://siteresources. worldbank.org/EXTAFRREGTOPGENDER/Resources/ durban_speech.pdf. Accessed June 4, 2014.
Paul J. Fleming, MPH Joseph G. L. Lee, MPH, CPH Shari L. Dworkin, PhD, MS
About the Authors Paul J. Fleming is with the Department of Health Behavior and the Carolina Population Center, University of North
e2 | Letters
American Journal of Public Health | October 2014, Vol 104, No. 10
