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Latinos' beliefs about masculinity discourage prostate cancer screenings

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L. Brian Stauffer

Lydia Buki, who has appointments in community health and educational psychology, said the current informational materials about prostate cancer are not culturally relevant to Latinos.

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3/15/2011 | Sharita Forrest, Education/Social Work Editor | 217-244-1072; slforres@illinois.edu

CHAMPAIGN, Ill. — One of the tests used in diagnosing prostate cancer is so stigmatized within Latino culture that men may be risking their lives to avoid it, according to a new study by researchers at the University of Illinois. Complex cultural and gender beliefs about manliness and sexuality that discourage Latino men from seeking health care – and stigmatize the digital rectal exam as emasculating – could explain why some men don’t seek care until the cancer has progressed, diminishing their chances for recovery.

While prostate cancer is the most commonly diagnosed form of cancer among Latino men, Latinos are significantly less likely to get screened, to be informed about the disease or to have health insurance than African American or non-Latino white men. Consequently, Latinos are nearly four times as likely to be diagnosed at later stages and are more likely to die from the disease than non-Hispanic whites.

Published in a recent issue of the journal Psychology of Men and Masculinity, the study involved in-depth interviews with and a survey of 10 self-identified Latino men ages 45 years and older who had no history of prostate cancer.

Previous studies suggested that while social and cultural constructions of manliness influence health behaviors of men of various ethnicities, there are unique aspects to the definition of manliness within the Latino community.

“Machismo” and “caballerismo” are used to reference manliness within the Latino culture but have disparate connotations, with machismo being a pejorative term connoting hyper-masculine qualities such as aggression and antisocial behavior that are often attributed to working-class Latino men. Caballerismo, however, represents positive attributes and chivalrous qualities such as emotional connectedness and social responsibility.

The study comprised a diverse sample in terms of social class, nationality, education and income levels; most of the men had lived in their country of origin – Argentina, Colombia, Mexico or Venezuela – into adulthood and had resided in the U.S. from two to 37 years.

Participants’ perceptions of manliness were assessed using the 20-item Machismo Measure developed by Arizona State University researcher G. Miguel Arciniega and his colleagues in 2008, which gauges machismo and caballerismo levels based upon participants’ agreement with belief statements about gendered roles and behaviors.

All the participants indicated that stereotypical notions of machismo in the Latino community preclude engagement in preventive health care and testing – even when a man is symptomatic, according to one participant – because seeking care signifies vulnerability and surrendering control of their health and their person to someone else.

Participants felt particularly threatened by the prospect of a digital rectal exam, which they indicated is so stigmatized as emasculating within Latino culture that some men avoid the exam altogether or conceal that they have had it, confining discussion of it solely to the context of heterosexist and homophobic banter. Described by one participant “as the worst experience that can happen to a Latino man,” anal penetration during a DRE is equated with the passive/traditional female role in sexual intercourse and conflicts with the “aura of authority” that is a core concept of traditional Latino masculinity.

“The DRE can be very traumatic for Latino men,” said Zully Rivera-Ramos, who conducted the study for her master’s thesis and is working on her doctoral degree in counseling psychology in the department of educational psychology in the College of Education at Illinois.

“The rectal area is taboo for men because it challenges their heterosexuality. That intersection with the issue of masculinity and being vulnerable to illness and wanting to be in control of their health and themselves really seems to put them at risk for not screening.”

Participants had to engage in complex psychological negotiations, weighing the importance of maintaining their identities as masculine heterosexual men and how they present themselves to others as men against the potential benefits of undergoing the exam.

“The interesting part is that these negotiations happen subconsciously, so they’re not even aware that they’re going through them,” Rivera-Ramos said. “It’s through talking about their experiences that they were able to hint at it and then, toward the end, be more open about it. It wasn’t something that they were able to explain immediately.”

The topic of prostate cancer screening raises a lot of anxiety for men because they sexualize the anal penetration of the DRE and fear its causing an erection, which can occur during exams, said Lydia Buki, a faculty member with appointments in the department of educational psychology and the department of kinesiology and community health in the College of Applied Health Sciences at Illinois who co-wrote the study.

Seven of the 10 participants had undergone the DRE. However, half (five) of the 10 participants – including several who had access to health care – were unaware that an alternate screening method, a blood test for prostate-specific antigen, is available.

Those who were not screened endorsed traditional machismo beliefs and attitudes, Rivera-Ramos said.

The participants agreed that educational messages targeting Latino men, especially working class Latinos, need to be culturally relevant and directly address men’s fears that the screening equates with a loss of manhood. Buki and Rivera-Ramos said that the current informational materials about prostate cancer are only Spanish translations of the materials available in English and aren’t culturally relevant to Latinos. Informational campaigns also need to empower men to take care of their health, the researchers said.

Buki, who also holds appointments in medicine and Latino/a studies at Illinois, predicts that with the Latino/a population in the U.S. projected to triple by 2050 there will be an explosion in the number of people diagnosed with cancer.

“We can see the train wreck coming, and it would be really prudent to start doing something about it now,” Buki said.

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