Once given short shrift as "women's partners," men are now the focus of a growing number of research efforts and programs pertaining to sexual and reproductive health. The contributions in this issue of Perspectives on Sexual and Reproductive Health, based on both research and on-the-ground experience, show that much has already been learned about men's sexual and reproductive health needs and about how to meet them, but that much remains to be done.
•Lawrence B. Finer and colleagues report (see article) that publicly funded family planning programs in the United States, which were designed decades ago to provide care to low-income women, are increasingly adding services for men. Moreover, results of a nationwide survey the authors fielded in 1999 indicate that most agencies running such programs are interested in enlarging their male caseload, and many conduct activities aimed at attracting men. Still, barriers to serving men--funding constraints, men's unawareness of services and their perceptions that clinics serve women only--are not insubstantial.
The survey results point up a variety of questions about how best to meet men's sexual and reproductive health needs within the network of publicly funded family planning clinics. The answers, according to Finer and colleagues, may depend on what services are seen as relevant and how they are provided.
•The experience of one San Francisco program demonstrates that it is feasible to expand services for men within existing programs for women, and that doing so need not diminish women's satisfaction with the care offered. Tina Raine and coauthors describe (see article) how a male-friendly program with an emphasis on peer education and outreach was integrated into a publicly funded program that historically had served few men. In the first year that services for men were available, the clinic's male caseload increased sharply: It nearly tripled among teenagers, who were the target population, and more than doubled among older men. Only a small minority of women were bothered by the presence of male clinic clients, and virtually all women were satisfied with the services they received, just as they had been before the male services were launched. Raine and her group discuss both how the program has modified its strategies on the basis of its initial experiences and how other programs might apply the lessons learned in the San Francisco clinic.
•Other programs for men are well under way, although many have not yet had an opportunity to undergo as rigorous an evaluation as the San Francisco one. Two of these are described in special reports in this issue. Genevieve Sherrow and coauthors outline (see article) valuable lessons learned from four years of experience with the Man2Man program in Philadelphia. The program has focused on providing young men from specific sites in underserved areas with a safe environment for discussing sexual health and the possible consequences of risky behavior. Feedback from program staff and participants seems to indicate that the approach is working; in fact, the authors conclude that the traditional view of young men as emotionally inexpressive may reflect that they have lacked the opportunity to express themselves rather than the desire.
Similarly, as Bruce Armstrong relates (see article), the Young Men's Clinic in New York City is finding that underserved young men are responsive to intensive outreach efforts by programs that are "accessible, affordable, culturally sensitive, rooted in the community and tailored to their needs." Despite the clinic's success--or, in some instances, because of it--the program faces many challenges. Armstrong details these challenges, the clinic's responses and the implications for initiatives throughout the country aimed at improving young men's access to comprehensive sexual and reproductive health services.
•Finally, the authors of two viewpoint articles offer their thoughts on important dimensions of men's sexual and reproductive health needs. K. John McConnell and colleagues (see article) make a strong case that integrating male chlamydia control services into reproductive health programs serving women will have several benefits: It will contribute to lowering reinfection rates among women and reducing costs associated with untreated infections among women. It will also improve men's awareness of chlamydia, thereby helping them recognize their responsibility in prevention efforts.
William Marsiglio argues (see article) that one way to help men protect their own health, their partners' and their children's is to promote their awareness of themselves as sexual beings capable of creating life--or, in his words, of their "sexual and procreative identities." Marsiglio lays out a social psychological framework for conceptualizing men's sexual and procreative identities, and a strategy for helping young men understand them vis-à-vis their life goals and responsibilities.