They're ubiquitous and often subtly menacing. They loiter in groups on street corners, use strong language, look ready to cause trouble-and quite often do.

Males 15 to 24 account for up to half of all men living with HIV.  [Photo ©PAHO/WHO Armando Waak]

Who are young men? In our societies, they are often defined by what they are not: they are no longer boys, they are not yet "real men," often they are not yet employed, most are not yet fathers. They are members of a system in which they do not have any real status.

Boys and young men face unique problems on the path to manhood, but these are often overlooked. In part, this is because of their apparent physical and emotional invulnerability. They often act tough, cool, and resilient. We are less concerned about their problems than those they cause. After all, in the Americas and elsewhere, when a person is harassed in the streets or is the victim of a crime, chances are the perpetrators will be young men.

In many ways, young men seem to be their own worst enemies. They are more likely to inject drugs and most likely to do so using risky methods. They have more sexual partners than any other group, yet they report that they feel less at risk for AIDS. In many countries, young men are most likely to buy sex and also to assault their sexual partners. They are the group most likely to end up in jail, a nurturing environment for further sexual risk, drug abuse and violence.

Of the many dangers young men face, HIV is one of the most serious. Although women are more vulnerable to contracting HIV, it is men who drive the HIV/AIDS epidemic. This is because men tend to have more power in sexual relations, determining, for example, when sex should take place and whether a condom should be used. Moreover, in the Americas and elsewhere, boys are becoming sexually active at an ever-younger age. Four out of 10 Jamaican boys have had sex before the age of 15. One-third of American and Brazilian boys have had intercourse by this age, as have one-quarter of boys from Costa Rica and the Dominican Republic.

Worldwide, young men under the age of 25 currently account for up to 25 percent of all people living with HIV. Older men make up another quarter, while women account for the remaining half. This means that males under 25 account for approximately half of all men infected with HIV. A small proportion of these are infants born with the virus, but the vast majority are boys and men in the narrow age range of 15 to 24. The fact that this age group, spanning only nine years, represents nearly half of all men living with the virus shows that boys and young men are one of the most vulnerable-and dangerous-groups in the epidemic.

This pattern can be changed. Young men are at an age and stage in which their attitudes and behavior are still forming. Many of them are still in school or college, where there are structures well in place that provide life skills education. Most are easily influenced by community and peer leaders and by figures in the media such as music and film stars. And young men do have a will to learn.

In the past, sexual and reproductive health centered around family planning and was generally considered a female domain. Recently, there has been much more effort to include men in reproductive health issues and to offer more male-friendly services. But there is still a great deal of work to be done to raise awareness of the complexities of the construction of masculinity and sexual behavior, and to put this greater awareness into practice.

In Latin America, where there are more services for young men than in many regions, 17 organizations in a 1998 World Health Organization survey reported that services for adolescent males were scarce and underresourced. Government support for these services was difficult to obtain, so that most of their funds came from private international agencies.

In a 1997 U.S. Agency for International Development (USAID) survey of its sexual health programs in developing countries, it was found that only 25 percent of these programs' clients were male, and only 10 percent of USAID funds were allocated to working with men. Yet USAID programs are considered to be relatively progressive in terms of male involvement.

Constructing masculinity

In the social sciences, particularly in anthropology and cultural studies, there has been a growing focus on men and "masculinities." The social components of masculinity-those cultural practices that establish the differences between men and women-can be traced back to antiquity, with origins in laws, forms of governance, distribution of goods and services, daily activities, and even language and ways of thinking. These differences are primarily of power, with men having more than women in almost every social sphere.

But where do young men fit in? Developmental psychology has taught us a little about how boys learn masculine behavior. We know about the biological changes associated with puberty and the functions of hormones around this time. We also know that boys often grow into men who form unequal and harmful relationships with the opposite sex. What happens to make them become this way? What is their side of the story?

In the gender and development literature, there is a shift away from viewing men as merely "the problem," the cause of women's suffering. Instead there is growing recognition that men and boys are social beings who face their own challenges, and who live in a gender system that can also cause them to suffer.

Men face social pressure to conform with dominant ideas about being a man, and failure may lead to discrimination or disadvantage. For young men, the goal of becoming an ideal man can be frustrating and even dangerous. If men are supposed to be powerful, how are young men in situations of poverty and rapid social change supposed to gain power? If young men are supposed to be strong, how can they prove their strength in an urban context where there are few recreational or other legitimate outlets for physical expression? If they are supposed to take their girlfriends out on expensive dates, how can they do this with no money and scarce legal opportunities for getting it? If men are supposed to be able to support a family, how can they do this in a competitive modern economy in which they cannot seem to get a foothold?

To be sure, growing numbers of men are themselves seeking a more gender-equitable world. These men need to be seen as partners in reproductive health programs and development work in general. While organizations around the world are recognizing this, acting on it and in many cases having significant success, they are still in the minority, and overall the change is painfully slow.

Before greater numbers of young men become allies in the fight against HIV, organizations working in this area will have to do more to reach out to them, creating opportunities for them and understanding and meeting their special needs. This implies that those involved in the care and prevention of AIDS must strive to put attitudes of blame aside-and instead take a long, hard look at what it means to be a young man.

Thomas Scalway is the author of Young Men and HIV: Culture, Poverty and Sexual Risk, published last August by UNAIDS and the Panos Institute of London.