Dissertations & Theses (Open Access)

Date of Award


Degree Name

Doctor of Public Health (DrPH)


Paul Rowan

Second Advisor

Michael Ross

Third Advisor

Beatrice Selwyn


Namibia has a generalized HIV epidemic, with 13% of adults being infected. Its East Caprivi Region has the highest prenatal HIV prevalence in the country, 21%, among girls and women aged 15-24 years. In recent years, researchers have pointed to men who express their masculinity through high-risk sex as driving the epidemic in East Caprivi. This exploratory study examined the role that men and their masculinity concepts played in transmission, how those concepts were evolving over time, what was influencing the change, and in which directions. Employing grounded theory methods and guided by Robert Connell's theoretical framework on masculinities, the study employed in-depth interviews with community leaders and focus group discussions with men 18-24 years of age to elicit characterizations of dominant masculinities in East Caprivi, their developmental contexts, motivations, support systems, and their rewards. A preliminary theory was generated suggesting that socio-cultural, and economic changes introduced into Caprivi following Namibian Independence in 1990, interacted with older, hegemonic masculinity concepts to stimulate new, adaptive ways of performing manhood, accompanied by higher-risk behavior. Through special exercises with focus groups, multiple alternate, culturally-acceptable models of masculinity at lower risk for HIV were also elicited. After applying the Diffusion of Innovations criteria, one was selected as most likely to be adopted by young men in Caprivi. Across focus groups, young men selected a fairly austere, rather than moderate-risk masculinity as their preferred model. The alternates and the forces of transformation may each present opportunities to gendered intervention programs to insert themselves into the adaptive process, providing young men the support and guidance that they need in order to achieve the hallmarks of manhood that they ultimately want – respect and broad recognition – with lower risk for HIV.