Conflicted masculinities: understanding dilemmas and (re)configurations of masculinity among men in long-term relationships with female sex workers, in Kampala, Uganda

Abstract

This ethnographic study explores the experience of men in long-term relationships with sex workers and their construction of masculine identities in Kampala, Uganda. Data were collected in 2019 and comprise in-depth interviews with 13 male partners and two group discussions of women with long-term male partners. Thematic analysis used an intersectional lens to frame reconfigurations of gender and masculinity in the context of relationships with sex workers. All men had been clients of sex workers before progressing to become long-term partners. We discuss the complex ways in which men participated in value systems of respectability and reputation to (re)configure gender relations that made sense of their long-term relationships with sex workers. Men viewed their relationships with women through the normative lens of traditional masculine roles associated with monopoly over a partner’s sexuality, provider and father. However, poverty, HIV, the failure to have exclusive sexual rights over a partner, and the shame associated with sex work intersected and disrupted masculinities. Despite this, men found meaning in these relationships through the woman’s commitment to the relationship, her financial support, her help in accessing HIV services, and the children from the relationship, thereby attaining respectability and avoiding a crisis of masculinity.

Keywords:

• Uganda
• female sex work
• masculinity
• long term relationships

Introduction

Sex workers are often portrayed negatively as immoral, disease carrying agents and criminals; labels that extend to their long-term partners (Brewis and Linstead 2000; Vanwesenbeeck 2001). By dating a sex worker, a man loses the privilege of exclusive sexual access to a woman, which may threaten his masculine identity (Bhattacharjee et al. 2018; Muldoon 2015) both in terms of his reputation and his respectability (Wilson 1969). Reputational masculinities are endorsed by male peer and are associated with practices such as multiple sexual partnering, commanding and aggressive behaviour towards women and in opposition to competing men. Respectable masculinities tend to be endorsed by the whole society because they are associated with practices such as marriage and faithfulness (Siu, Seeley, and Wight 2013). While the clients of female sex workers can be said to be motivated by the desire to fulfil reputational masculinities (Shumka, Strega, and Hallgrimsdottir 2017), long-term partners accept that ‘their’ woman has multiple partners, which taints the men’s reputations (Wyrod 2008).

A man may start a relationship with a sex worker as a client through a casual encounter intended to meet sexual desires, and then develop a long-term relationship (Hammond and van Hooff 2020). Such relationships are challenging for both the woman and the man, as they attempt to define their relationship differently from that of the woman’s encounters with clients (Bhattacharjee et al. 2018; Warr and Pyett 1999; Mbonye et al. 2016). Besides dealing with negative social perceptions, couples in these relationships may be disadvantaged economically, have higher HIV infection rates and have children from previous relationships (Onyango et al. 2019; Warr and Pyett 1999). However, with most research highlighting the plight of female sex workers within relationships, the voice of their long-term partners is missing (Bekker et al. 2015; Huynh et al. 2019) which may be partly due to the challenges of accessing men in relationships with women who practice sex work (Fleming et al. 2015; Schmidt-Sane 2020).

Hegemonic masculinity has been implicated in men’s pursuit of paid sex (Hammond and van Hooff 2020; Shumka, Strega, and Hallgrimsdottir 2017). When clients become lovers they cannot expect to have a monopoly over sex with a woman, something that may be challenging to dominant forms of masculine identity (Huynh et al. 2019; Jewkes et al. 2012). Studies focusing on the long-term partners of female sex workers, particularly on how these relationships shape men’s perceptions of themselves are few, especially within sub-Saharan Africa (Onyango et al. 2019; Schmidt-Sane 2020). In response to this gap, this paper explores the experience of men in long-term relationships with female sex workers in Kampala, Uganda, and the construction of their masculine identities.

Theoretical underpinnings

Gender norms of masculinity and expectations of what it is to ‘be a man’, play a part in determining the characteristics and qualities of men’s behaviour (Connell and Messerschmidt 2005; Wyrod 2008; Hearn 2013; Bassey and Bubu 2019). A man may behave differently depending on whether he is a father, lover, husband, son or worker. These roles interact to influence one another (Misra, Curington, and Green 2021). An intersectional lens offers a useful framework with which to identify the different forms of masculinity that develop in men’s long-term relationships with female sex workers, influenced by several factors acting together rather than independently to shape their experience (Onyango et al. 2019; Syvertsen et al. 2013; Warr and Pyett 1999).

In this study, we also draw on notions of masculine reputation and respect to offer insight into how men in relationships with sex workers navigate dilemmas and reconfigurations of masculinity and gender relations in a situation where a sex partner is shared with other men. Masculine reputation is associated with behaviour associated with sexual prowess, having many children and authority defying behaviour, while respectability, the degree of conformity to society-wide values, is associated with having material possessions, providing for a family, being faithful and having exclusive access to sex with one’s partner (Siu, Seeley, and Wight 2013; Wilson 1969). Men’s experience in long-term relationships with sex workers provide insight into how they participate in value systems of respectability and reputation that make sense both to themselves and for significant others.

Methods

Study setting

We draw on findings from a year-long ethnographic study conducted between January and December 2019 in two of the five divisions of Kampala district in Uganda. The district has a population of about 1.5 million people (UBOS 2017) and unlike the central business district of Kampala city, the two suburban divisions in which data were collected were slums characterized by poor housing and crammed settlements. Many residents are involved in petty trade, doing whatever they can to earn a living. Shops are located along the roads and alleyways beside homes, and homes and open spaces function as workshops for artisans, mainly motor vehicle garages and furniture workshops. Night life is vibrant and busy characterised by entertainment, night clubs, bars, restaurants and lodges. Alcohol and drugs can be accessed by both old and young men and women. At night, women selling sex are a common sight, although some women do so during the day as well. Women work on the streets or sit in bars, or in and around night clubs, guest houses and lodges. Night police patrols sometimes result in arrests for various types of crime, including prostitution, which is illegal in Uganda.

Study participants, sampling and data collection

A total of 13 men participated in interviews, but ethnographic data were collected from a wide range of persons and contexts through observation and conversation. Interviewees were approached through their female partners who were attending a clinic run by the Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit. Known as the Good Health for Women Project (GHWP), the clinic started recruiting female sex workers in 2008 and their male partners in 2011 (Vandepitte et al. 2011; Rutakumwa et al. 2015). Women who identified as having long-term partners were asked if they could invite these partners to participate in a study. Of the 50 men approached, 13 accepted the invitation to meet with the first author who provided additional information regarding the study.

Being an ethnographic study with a sensitive population, rapport building was prioritised for about three months before interviews were conducted. During this time, visits to the 13 men’s homes and workplaces were conducted. Some visits took place during the day, some in the evenings, and others at weekends and during working hours. Conversations and observations informed the development of topic guides for in-depth interviews. Initially interviews were not audio recorded, as we prioritised rapport building and some men were wary of their voices being captured in a recording (Bengry-Howell and Griffin 2012; Rutakumwa et al. 2020). On such occasions, the first author took brief field notes and wrote them up later into full accounts. At a later time follow up, interviews with 9 of the 13 men were conducted and these were audio-recorded. Interviews lasted between thirty minutes and one hour and were conducted in locations chosen by participants, including homes or private spaces in restaurants.

Two FGDs were also conducted with female sex workers who were in long-term relationships with men to triangulate ethnographic and men’s interview data and generate additional insights into relationships with long term partners. A total of 13 women participated in FGDs which were audio-recorded, translated and transcribed from the local Luganda language to English.

Data analysis

Data analysis was an on-going process, with bi-weekly ‘brain storming’ meetings taking place between the authors to discuss the field work, and the memos and summaries written up by the first author. These meetings generated interpretations and ideas that either contributed to the list of potential themes or formed questions that informed further observation and interviews. After fieldwork had been completed, a more structured analysis followed the principles of thematic analysis (Braun and Clarke 2006). Topical coding frames were developed and data were summarised using Excel tables to identify themes and subthemes. Themes from in-depth interviews and FGDs were generated separately but later merged based on similarities and relevance to the study’s aims which were to explore experiences of men in long term relationships with female sex workers and how this influences their construction of masculinity.

Ethical considerations

Ethical approval for this study was received from the School of Medicine, Research and Ethics Committee, Makerere University College of Health Sciences (#REC REF 2017-155) and from the Uganda National Council for Science and Technology (#SS 4849).

Findings

Characteristics of the main sample

The 13 men involved in the study were aged between 26 and 51 years. Most had primary or secondary level education; one was a university graduate. All the men had at least one child; most had children with more than one woman. Ten of the men were in a current relationship with a sex worker. Seven of these men were cohabiting with their partner and described them as wives or “my woman”. All but two reported having concurrent partners, with some regularly paying for sex from other women. Two of the men planned to formalise their relationships with their long-term partner through marriage, while others did not intend to do so. Five men were in salaried employment but still complained that it was too little for all their needs. The other men were in irregular, informal employment, characterised by periods of uncertainty and no income at all. At such times they depended on others, in particular, their partners for a livelihood. Most men resided in rented single room houses in low socio-economic settings. Only two men were staying in houses they owned.

Below, using pseudonyms, we present men’s narratives about their experiences being in a long term relationship with a female sex worker, and examine the opportunities and challenges this presented to their construction of desired identities and masculinity.

From client to lover and long-term partner

All men had met their partners through sex work as clients. Transitioning from client to lover was complex and varied from man to man. Some men smoothly transitioned from client to lover when after being regular clients they fell in love with the woman. Such men were not concerned about the identity of the women but focused on building a working relationship just like any other couple. John, a 40 year old man, described how he first met his partner:

Well we met on the street and I was linked to her by another woman and we agreed on a fee since she was a sex worker. Later, however, we became lovers and she started complaining about my other lovers…

Because of the nature of women’s work, it was difficult to ensure fidelity within the relationship. However, as a couple some strategies were used to try and establish a semblance of faithfulness. Peter, a 35 year old man, worked in a brothel and had met his partner there. He claimed that years of experience at his workplace had equipped him with the ability to differentiate between a client and a love competitor:

If she is your partner, and you found her doing that work, you will accept that it is her job. But then you might find her with another man who is not a client, then she will have crossed the line… She can say it is a customer (client) but the appearance of a client is different from that of another partner. It is different in that the client is always quick to complete the negotiations [for sex] while another partner will not rush.

Additionally, condom use with clients and non-use with intimate partners signaled differences between close partners and clients. This was captured by women in a discussion group:

For these clients you insist on condoms when they approach you but when you are partners you treat them differently and even go for HIV tests when you start a commitment to be sure.

Similar sentiments were echoed in another group discussion with women:

Remember, with clients you are roughly telling them to be quick since you are preparing for the next client, which is not the case with a lover.

Some men knew how difficult it would be to expect women to insist on condoms. John had regularly bought sex from different women and knew how to negotiate for condomless sex. As a result of his knowledge of his own behaviour, he knew he could not expect his partner to always use them with clients. He seemed resigned to accepting this situation:

But as you know, this money is very tempting and I have also been with these sex workers for [so] long. There is no woman that does not offer condomless sex, there is none. There is nothing to do, I tried to get her out of sex work, but she refused because she could not find an alternative income earner.

Nevertheless, men like 27-year-old Samuel whose partner sold sex in the same brothel that he managed, believed that women could insist on condoms during sexual encounters:

Most of the women are very strict on the issue of condoms and it is very hard to tell them not to use condoms. Because when even the man is putting on the condom and it gets a slight damage, she causes a stir thinking that it is deliberate.

In the setting in which the study was conducted, sex work is not just illegal, it is seen as immoral and responsible for the spread of disease and criminality. Although some men admitted that they could not change the societal perceptions about sex work, they focused on the benefits to themselves as individuals from the relationships. This, however, did not prevent the men from receiving insults from the public:

You know, there are people who gossip and they will say that there comes the husband of so and so [the sex worker]. I don’t like it at all. However, I have no problem as long as she earns some money, and when she buys meat and I eat I don’t have a problem with her job (William 26, homeless with very unstable income)

Keeping the secret of sex work was an important task for both partners to protect the relationship. Women tried their best to do this by hiding the nature of their work and hoped their partners would do the same. As one woman commented during a group discussion: ‘So, let us say you are the partner of a sex worker but have kept it to yourself, how will someone else start revealing those secrets?’

However, not all the men considered sex work to be perceived negatively but realised it was still problematic for some. Samuel commented:

Sex work is no longer a shameful business as it used to be, and it is done by so many women including those that are married. Despite that, many still hide and do not want the members of the society to know that they are sex workers. They will pretend that they are doing something else and disguise like that. In other cases, others try to ensure that they work in places far away from where they stay so that they are not seen by people that they might be related to or are familiar with.

The path from client to lover was more complicated for some men. Donald, a 45 year old man, for example, had only been interested in buying sex. Things changed when his partner became pregnant and new commitments had to be negotiated and agreed upon. Identity formation as a long term partner was grudgingly embraced by men like Donald, who slowly accepted the undesired new situation:

We started off jokingly without any love involved and had sex shortly after meeting and before long as usually happens, condoms were removed and we had condomless sex. That pregnancy came to me as a surprise as I had not planned to have children with her. But I had no choice but to look after her.

A major theme described by both men and women was the growing trend of men depending financially on women rather than supporting them as was considered the norm. Such men attracted negative labels such as omusajja baamuwasa which translates as a man ‘being married by a woman’. This was a degrading and stigmatising phrase for men as described in the account of an interview with one of the men:

So, what you now see, women are now doing what the men used to do and they provide for them and the families. Men get ashamed because they are now ‘being married’ instead of them marrying (Peter, 35, lodge manager)

Fatherhood: enactment of a respectful identity

Having children may have started with dispute and paternity doubts in some cases, but once these were resolved, most men embraced the status of a father. This diverted attention away from sex work and brought with it an enhancement of social status. Some men described how being called names that carried deep respect in society such as salongo (a Luganda term for `father of twins’) was a very welcome identity. Sharing children also helped men to appreciate their partners with renewed respect. Donald, who had reluctantly accepted his status as a father, described how this helped him change from referring to his partner as ‘one of those women’ to ‘mother of my children’ when she became the mother of his children. That said, he expressed concern about some of his partner’s behaviour:

… She would go and return the next day at around 10am and never listened to me when I discouraged her from this behaviour. […] I had nothing to do but to continue with her since she was the mother of my children.

Providing for the family, interpreted as ensuring that they had food to eat, shelter and school fees were almost entirely expected of the man. Men who could not provide and relied on their partners felt ashamed and were often ridiculed by others in society. John, aged 40 years, described how he felt belittled when his small financial contribution was deemed insufficient. His current partner had tolerated his infidelities but was sometimes angered by his excuses whenever he was asked to make a financial contribution. They often separated because of these disagreements but would get back together because of the love they shared for one another. John described his experience with sadness:

Recently I went to visit my partner to check on my daughter and took with me some money, the only money I had in my pocket. However, my partner and her grown son ridiculed me and said that it was too little to do much. I felt belittled and left with my money and yet I was only trying to help since I am not working of late due to illness and lack of a motorcycle since the other one was stolen.

Tension arising from the burden of the provider role was evident even in relationships where the men were able to perform the task adequately. Some men seemed torn between the pride of being the sole provider and the lack of support from their working partners. Raymond, a 35-year-old man, described how he managed this dilemma:

She sometimes helps pay school fees but I tend to treat this as a loan to me which I can pay back when I get money because that is the only way I can feel some sort of peace of mind. Otherwise she can quarrel and demean you and reduce your esteem in the home.

Other couples struggled with agreeing who provided for what. Albert, a 43-year-old DJ, publicly prided himself in being the sole provider for his family but privately resented his partner for not contributing more when she had income from sex work:

… for the last 4 days I have been providing money to my wife for transport and food while also providing for home needs. But recently they asked us to provide our child with a T-shirt that costs twenty-five thousand ($7). She refused to pay for it despite not contributing much in the last eight months she has been working.

One of the men, William aged 26 years who depended on the income of his partner, described an arrangement whereby his partner would lock him in the house and go to work as he slept but was expected to be back home at a certain time. When she started staying out longer, he felt disrespected as a man and became annoyed with her:

We had agreed like any other job that she would return at a particular time like 2am or even 1 am. But at times she would return at 6 am and yet I would be locked in and yet I also wanted to go out at around 1am to go have a drink, so I would beat her up.

Some of the women during the group discussions described how when they helped men with financial support, the men reacted by abandoning their provider role. One discussant whose views attracted audible applause from all the other members in the group, stated that in her work as a senga (the paternal aunt in the local culture) she advised girls as they prepared to get married to be cautious with money matters in relationships:

These days, I still advise the girl to have respect for the husband but I also warn her to be cautious about how much she earns because the moment a man knows the entire income of the partner, he becomes less responsible with providing which is a role of a man. So, I tell the girl that if you are earning 200 shillings, keep the 100 secret and declare to him 100 shillings as your contribution to the running of the home.

Staying as a long-term partner

Maintaining a relationship with a woman who was a sex worker was not without its challenges for some men. But men described the strategies and efforts used to ensure the relationship continued. Some men talked about avoiding discussing the women’s work with anyone and ensured sensitive issues were hidden to prevent potential difficulties that might threaten the relationship. Another strategy was to focus on the future with the partner. There were several examples of men who discussed their commitment to the relationship with their partners and spoke about shared dreams and goals. This ensured the partner felt comfortable about their relationship. Jimmy, aged 38 years, had taken the extra step of formalising the relationship. He described how they met and how the relationship developed.

I observed her movements since she was working in a saloon next to where we used to relax. I would see her pass by near […] and could see that she was pretty. So, one time I approached her and we talked and decided to start a relationship. We even organised the traditional introduction ceremony and [have] lived together since then. She keeps demanding a wedding like all women.

Interestingly, some women in the discussion groups described how they used more acceptable jobs to disguise their own involvement in sex work and avoid unwanted questions as a strategy or maintaining peace in the relationship:

If he asks where I am, I will say that am at the saloon. Even if you have taken on a sexual client, he will not suspect you that you have cheated on him and [that way] I will not disrespect him, and he will not complain.

Other men discussed their efforts to ignore the nature of their partners’ sex work. For example, Patrick, a 37 year old man, repeatedly said ‘what she does is none of my business’ in response to questions about his partner’s work.

Men also described occasions when their partners gave support that demonstrated their commitment to the relationship, which was a key ingredient to keeping it going. John who had been imprisoned for not providing night security for his employer’s motorcycle that been stolen, described the support he received from his partner. When he had not been able to provide for her, she had still ‘stood’ by him and welcomed him back to her house after the jail term. She showed great patience with him, and this greatly strengthened their relationship and his love for her as a wife.

Anyway, I loved her because she was with me when I needed someone to stand by me the most and that was the time I was in jail. I consider her very special because she is the only woman I have ever taken to be introduced to my parents in the village and they blessed her. My father also liked her.

Perhaps the most noteworthy evidence of support and commitment was seen when men tested positive for HIV and their partners were HIV negative. Men spoke about how their female partners remained in the relationship, provided the support they needed and continued playing the role of a wife and lover. John, a 40-year-old man living with HIV, said:

[…] I came to Kampala and met my partner. We went and tested again as a couple. I was found HIV positive and she was negative. She surprised me because she decided to remain with me despite our discordant results.

All the men in the study who were living with HIV and had started ART attributed their decision to test and treat to support from their partners. Many of these partners had been part of an intervention project providing HIV prevention and care and some had themselves been on HIV treatment for a while. They played a key role in challenging men’s reluctance to access HIV services and guided them to begin treatment.

I must thank her for convincing me to start on ART treatment because had I not met her I doubt the other women with whom I was engaging would have helped me. I was also afraid and just pretending to be strong. You know we men, it has to first put you down before you react (John, 40 year old man living with HIV).

Many men in this study had a history of high risk sexual behaviour and several suspected they had HIV infection even before they got involved with sex workers. Men who later tested for HIV and started ART admitted that they had for a long time procrastinated over the decision to test and had to rely on the encouragement, cajoling and pressure from their partners to do so. During conversation, Raymond aged 35 years described how his partner had tested and started treatment and improved:

Yes, she knew that she had tested positive… She told me that ‘we are already infected and they have told me to breastfeed this child for the first 6 months and even a year’. She told me that she thought I was going to chase her away and quarrel. So after about one year and a half she told me that now that she was taking ART and I was not [and] that I will become weak and die. Then I asked that how can I be assisted, because I fear[ed] going to the health facility. She told me that never worry, I will get you someone to help you.

Similarly, Sula, aged 39 years, suspected he had been infected with HIV for a while after the death of his former partner, the mother of two of his children. One of the children was living with HIV and this presented Sula with a constant reminder. He decided to leave the children with his mother in the village when he had moved to Kampala. When Sula met his current partner, he never told her about his suspicions about his HIV status and history. During her pregnancy, both she and Sula tested for HIV at one of her antenatal visits. His results confirmed that he was HIV positive while she was negative. To his surprise however, she opted to stay with him and support him in dealing with his status:

I appreciate [the fact] that my wife accepted me as someone positive and she felt some pity on me, otherwise she could have gone. But she also saw the situation with my child and also felt bad and so this helped a lot with my stability.

Discussion

Men’s accounts of long-term relationships with female sex workers highlight a complex process of disruption, continuation, pause and reconfiguration in their sense of masculinity. Concepts of reputation and respect are useful in exploring how these processes shaped men’s masculinities (Siu, Seeley, and Wight 2013). In the context in which this study took place, sex work was stigmatised and needed to be kept secret by both men and their partners. This need for silence existed in tension with the everyday ways of being a man, whereby ‘real’ men proudly discuss their sexual exploits and/or marriage relationship in public (Walters and Valenzuela 2019). Yet, the need for secrecy suggests that men and their women had to learn new ways of being and doing gender (Mojola 2014; West and Zimmerman 1987). Men’s failure to have exclusive ‘rights’ over their partners sexually, because it is through sex work that the family earned a living, highlights how sex work disrupts the historical (unequal) gendered norms of male sexual control (Morrell et al. 2013), and undermines the reputations to be gained through this ideal (Siu, Seeley, and Wight 2013). As a compromise, when clients became lovers some women devised strategies to ensure that the sex they provided through sex work was not as intimate as that with a long-term partner, by demarcating boundaries between them (Syvertsen et al. 2013; Warr and Pyett 1999).

Having children and receiving financial support from a sex worker helped men find meaning in their relationships thereby avoiding the shamed masculine identity associated with being the husband of a sex worker. In many parts of sub-Saharan Africa, parenthood is so important a part of personhood that it is difficult to gain respect as a full man or woman without having offspring (Whyte 2014). Having a child with someone changes the relationship with that person and it also transforms and expands other ties. Participants in this study described how the birth of a child from their relationship with a sex worker brought strong connection with their partner, a finding corroborated by research in Tanzania (Haram 2004). For most men, children introduced a time perspective into relations with their partner and their wider social relationships as well. Men began to imagine the future through their children, particularly if they were living with HIV (Whyte 2014).

In addition to concepts of masculine respect and reputation an intersectional framework is valuable for appreciating the multiple factors that work together to shape men’s masculine identities (Misra, Curington, and Green 2021). Men viewed their long term relationship with a sex worker through the normative lens of traditional masculine roles – provider, protector and father – but their limited incomes and inability to provide consistently undermined such ideals, as has been reported elsewhere (Silberschmidt 2001). The tension in relationships sometimes resulted in violence, as have been found in South Africa for example (Jewkes et al. 2012). From an intersectional lens, poverty, coupled with alcohol abuse, and stigma, intersected with sex work to undermine financially disadvantaged men’s esteem as responsible husbands and lovers. Their partners took up the role of provider (Beckham et al. 2015) but in doing so, were careful not to upstage the men, instead preferring to remain loyal wives and mothers (Mojola 2014). An intersectionality framework is particularly useful for unpacking the complex, context specific and relational factors influencing men in relationships with sex workers encountered in our study (O’Neill and Campbell 2010). Therefore rather than looking only at how the relationship between men and their female sex work partners shaped their identity, we remained cognisant of the fact that other factors together act to shape the masculinities of these men (Taylor 2010).

While our findings illustrate something of men’s dilemma in dealing with changes in gender relations with their long-term sexual partner, study participants avoided crises of masculinity by subscribing to the value systems of both reputation (continuing to have other sexual encounters) and respectability (being a good and caring partner) within these relationships. Their female partners earned an income through their work to support the family and, for many men, their partners already had links to HIV care. These enabled them to connect to much needed HIV services, through which they regained health, saw a possible future through their children and, in the process, a new form of respectability and meaning in life (Siu, Wight, and Seeley 2014). Women’s involvement in providing and linking men to HIV services was reciprocated by men’s commitment to the relationship which in turn seemed to strengthen the bond between partners (Mojola 2014).

Limitations

Like all research, this study has its limitations. In particular, the sample was selected from willing men contacted by their partners. All knew their partner was or had been a sex worker. There may be other men that are unaware of their partners’ engagement in sex work or who may not want to be identified as the partners of sex workers. Their experiences and negotiations of masculinity may not be the same. However, the use of an ethnographic approach demonstrates that although men who identify as long-term intimate partners of sex workers may appear hard to find and reach, research that involves engaging in the context and the reality of men’s lives, can offer a productive means of access to members of this population (Fleming et al. 2015; Schmidt-Sane 2020).

Conclusion

Long term intimate relationships with female sex workers present men with opportunities to improve their lives by gaining stability and affection while disrupting traditional gender relations and masculinities. Such opportunities may work to increase access to HIV care and support (UNAIDS. 2017, 2019). Crucially, connecting men living with HIV to services provides a means of restoring their dignity and reclaiming aspects of masculinity such as being a partner and often as a father, even if structural challenges such as access to income remain a significant concern.

Acknowledgements

We thank the Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, particularly the staff of the Good Health for Women Project and the Child Health and Development Centre, Makerere University, for their support. We are indebted to participants who gave up their time to tell us their stories.

Disclosure statement

No conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported through the DELTAS Africa Initiative grant #DEL-15-011 to THRiVE-2. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from a Wellcome Trust grant (# 107742/Z/15/Z) and the UK government. The views expressed here are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government.