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Tanzanian Adolescent Boys’ Transitions Through Puberty: The Importance of Context Marni Sommer, DrPH, MSN, RN, Samuel Likindikoki, MD, M.Med, and S. Kaaya, MD, M.Med, PhD

We explored the masculinity norms shaping transitions through puberty in rural and urban Tanzania and how these norms and their social-ecological context contribute to high-risk health behaviors. We conducted a qualitative case study of adolescent boys in and out of school in 2011 and 2012. Tanzania’s social and economic development is reshaping the transition into young manhood. Adolescent boys are losing traditional mechanisms of pubertal guidance, and new meanings of manhood are arising from globalization. Traditional masculinity norms, including pressures to demonstrate virility and fertility, remain strong. Adolescent boys in modernizing Tanzania receive inadequate guidance on their burgeoning sexuality. Contradictory masculinity norms from family and society are shaping their sexual expectations, with implications for their engagement in unsafe sexual behaviors. (Am J Public Health. 2014;104:2290–2297. doi:10. 2105/AJPH.2014.302178)

Inadequate attention has been paid to adolescent boys’ transitions through puberty in the context of the rapidly changing social norms and contexts of many sub-Saharan African countries, including Tanzania.1,2 Significant attention and resources have focused on adolescent girls aged 15 years and older because of their increased vulnerability to HIV and other sexually transmitted infections, unplanned pregnancy, and gender-based violence. Adolescent boys have their own unique health needs and challenges,3 such as increased risks of injury; engagement in violence; abuse of alcohol, tobacco, and other drugs; and risky sexual behaviors.1,4 Adolescent boys’ and young men’s behaviors may also significantly affect the sexual and reproductive health of adolescent girls and young women. Tanzania, like other sub-Saharan African countries, has undergone significant social upheaval in recent decades. Participation in traditional practices, such as puberty rites and ceremonies, has declined; extended-family structures have changed because of migration to cities and the devastatingly high mortality toll of HIV/AIDS5; and globalization and modernization have brought an influx of new ideas and images. These factors are reshaping the contexts in which adolescent Tanzanian boys transition into young adulthood.6,7 It is

important to understand how such changes influence boys’ growing-up experiences, including the masculinity norms shaping their perceptions of manhood and sexuality, to develop effective interventions that promote healthy transitions into adulthood and reduce unsafe sexual behaviors. In many sub-Saharan African countries, girls reaching puberty experience new controls imposed on their burgeoning sexuality.8,9 One reason is their perceived vulnerability to pregnancy and its implications for their marriageability and for family honor.10 By contrast, postpubescent boys are likely to be encouraged, or even expected, to demonstrate their virility (not necessarily through safe sex practices).11 The expression of any qualities that can be interpreted as feminine may be verbally if not physically suppressed.12 Heteronormativity, at least in public, is often the strongly reinforced and desired sign of manhood, and it frequently encompasses engagement in sexual relations and dominance over girls and women.13 Growing evidence suggests that early adolescence may be an important window of opportunity for health interventions affecting the transition into young manhood.14,15 This is partially because of the increased intensity of gendered norms focused on young people

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during puberty (as compared with younger children) and the perceived possibility of reshaping norms that may play a role in highrisk health behaviors.16 Little is known about the masculinity norms and other contextual influences shaping adolescent boys’ perceptions of becoming a man in a modernizing society such as Tanzania, but these may contribute to risky behaviors that endanger health. We have even less evidence on the perspectives of adolescent boys themselves about the influences shaping their participation in and decision-making about safe or unsafe sexual behaviors. Tanzania is a large East African country with an estimated population of 48 million, of whom almost 65% are younger than 24 years.17 More than 120 ethnic groups reside in the country, and Christianity and Islam are the predominant religions. Overall, 2.0% of adolescents and young men and women (aged 15---24 years) are HIV positive, with the likelihood of infection with HIV increasing with age: among persons aged 23 to 24 years, young women are more than twice as likely as young men to be infected (6.6% vs 2.8%).18,19 The increasing prevalence rates with age emphasize the importance of improving prevention efforts with adolescents. The few prevention initiatives that have included adolescent boys have also relied on limited evidence about young people’s sexual maturation experiences in a changing society. We conducted an in-depth study with adolescent boys in rural and urban Tanzania. We sought to explore, from the perspectives of adolescent boys themselves, their experiences of puberty and their interpretations of manhood in their changing social context. We (1) compared an urban to a rural context, which was important because of expected differences in traditional practices regarding puberty; (2) examined the predominant and alternative local masculinity norms being shaped simultaneously by tradition and modernization; and

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(3) assessed the globalizing influences shaping adolescent boys’ perceptions of manhood and sexuality, such as mass media, the Internet, and global marketing (e.g., alcohol companies). We hypothesized that influences from globalization and modernization create experiences of adolescence that conflict with traditional expectations of young manhood, particularly in urban contexts. We used an ecological framework of adolescent health20 to assess the multiple levels of influence shaping Tanzanian adolescent boys’ transitions through puberty today, particularly those that affect high-risk behaviors.21 We examined historical and cultural norms related to manhood at the societal level, along with adolescent boys’ interpersonal interactions and individual-level experiences. The conceptual framework guided an exploration of adolescent boys’ emotional and physical experiences among their families and peers, in school and in the larger community, along with the norms shaping their perceptions of manhood. We applied the theory of the social construction of gender to better understand the ways adolescent boys’ gendered experiences within their own identities, and among their peers, families, and communities, shaped their perceptions and experiences of young manhood.22,23

METHODS We conducted our study in rural and urban sites in the Kilimanjaro region of northern Tanzania. The predominant ethnic group is the Chagga (the Pare are a smaller local group), whose members follow a patrilineal system of descent and inheritance and compose the third-largest ethnic group in Tanzania. We chose this region in part because Chagga traditional pubertal practices have declined more in modern times than those of other ethnic groups, and increasing numbers of Chagga young people are pursuing an education and being exposed to globalizing influences. Thus the region provided a useful example of the influences of modernization on young people growing up today in urbanizing Tanzania. We previously conducted research on adolescent girls’ pubertal transitions in this region, which provided useful insights for comparisons of gendered experiences and for identifying sites (schools, youth centers) that

would capture a diversity of adolescent boys’ experiences. The project areas were the urban Moshi District and the rural Rombo District. Moshi is a busy commercial town with a heavy presence of nongovernmental organizations and Western tourists. It has numerous primary and secondary schools, vocational training centers, churches and mosques, and hospitals and clinics. Rombo has a marketplace area, a handful of primary and secondary schools, and 1 large hospital. In Moshi, a peri-urban religious secondary school with both boarding and day students served as the source for in-school participants, and a youth center in urban Moshi was the source for dropouts. In Rombo, we found in-school participants at a government secondary school, and a vocational training center was the source for dropouts. We visited government primary schools in both sites. We used a comparative case study design (rural vs urban).24 We collected data in 2011 and 2012 with multiple methods: ethnographic observation of adolescent boys’ environments (e.g., schools, shops, Internet cafes, sports fields), in-depth interviews with adolescent boys, key informant interviews with adults who interacted in adolescent boys’ daily lives (e.g., parents, teachers, religious leaders), focus groups with primary school teachers, participatory activities with groups of adolescent boys in and out of school (n = 160; 60 in school and 20 out of school at each site), and archival review of relevant documents (e.g., curricula). Qualitative and participatory methods are known to be particularly useful and appropriate in the collection of sensitive data.25,26 Such methods are essential for capturing the numerous social, cultural, and economic influences (household, community, peer groups, school, and mass media) on adolescent boys’ lives as they transition into young adulthood, along with their perceptions of and reactions to such influences.

Study Design and Sampling The principal investigator (M. S.) and a research assistant (a Tanzanian young man, aged 27 years) spent 8 weeks conducting the research (4 weeks per site). We gained entrée to the sites because of our previous in-depth research with adolescent girls in the region. We purposively selected the sample of adolescent

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boys.25 Our sample of out-of-school adolescent boys had dropped out of the formal educational system. At each site, we recruited students through the school administration and out-of-school boys through the administration at a youth center (Moshi) or a vocational training center (Rombo). We aimed to capture a diversity of experiences; our sample had various ethnic identities, economic circumstances, family structures, and academic abilities. At the school sites, we selected a group from 3 grade levels (forms 2, 3, and 4) to capture a further diversity of experiences. We intentionally sampled older adolescent boys (16---19 years) to capture their perspectives on the various influences that shaped their transition to young adulthood. Although the participants in both sites were predominantly Chagga, the urban site also had representatives of other ethnic groups, which provided a more diverse sample. We conducted all group activities in a private location away from school (meeting once per week for 4 weeks), and all participants provided informed consent. In recognition of the sensitivity of pubertal experiences and risk taking, we did not record the group discussions to ensure that participants felt comfortable being open. Instead, we took in-depth notes on verbal responses and nonverbal behaviors. All of the written data collected from adolescent boys were anonymous. Each weekly group session lasted 1.5 hours.27,28 We triangulated our ethnographic observations with select participatory activities in which participants wrote anonymously, brainstormed in groups, or engaged in largegroup discussions. These included (1) puberty stories, (2) puberty questions, (3) good and bad aspects of being a man, and (4) peer pressure stories (Table 1). The use of participatory methods was essential because of the sensitive nature of the topics being explored and the aim of allowing adolescent boys to openly share their lived experiences, perceptions, and questions without fear of punishment or censorship.29 We field-tested the participatory activities (adapted from our previous research with adolescent girls30) prior to the start of data collection. We conducted the activities in English and Swahili, with the Swahili data and findings translated for analysis by the larger research team

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TABLE 1—Ethnographic Observation and Participatory Methods in Study of Adolescent Boys’ Transitions Through Puberty: Tanzania, 2011–2012 Study Component

Method

Ethnography

Observations of public (e.g., schools, markets, Internet cafes, bars) and private (e.g., households) spaces

Puberty stories

Participants asked to write an anonymous puberty story about their first experience of a wet dream or erection

Puberty questions

Participants asked to submit an anonymous list of 3 puberty questions they wanted answered; group discussions generated more questions over

Good and bad of being a man

Participants worked in groups to identify their perceptions on the good and bad characteristics or outcomes of being a man in their local society;

Peer pressure stories

larger group discussion analyzed the lists and identified additional aspects Participants asked to write an anonymous story about an experience in which they did something against their wishes or that they later regretted

course of 4 sessions

(consisting of both English and Swahili speakers).

Data Analysis We used thematic analysis for the multiple sources of data: field notes, narrative notes, transcripts, analytic memos, and participatory verbal and written activities.31---33 M. S. and the research assistant separately coded and analyzed the data, which the entire team then reviewed. Systematic analysis began with multiple readings of the field notes to generate themes and hypotheses, followed by coding of the data collected. We used open coding to identify appropriate categories, themes, and issues that emerged from the data,34 and we used axial coding to build connections within categories. Ongoing analysis through the ethnographic observations and the additional methods in the overarching comparative case study permitted us to integrate local experts’ insights into the final selection of priority themes from the research. The major themes that emerged from the analysis, incorporating the observations and 4 participatory methods, were (1) shame, fear, and worry about body changes; (2) emphasis on virility, power, and fertility; and (3) contradictory masculinity norms across varied social contexts.

RESULTS In the various data collected, we found interesting differences between the rural and urban samples. In both sites, a large number of adolescent boys described feeling shame and confusion over pubertal body changes.

However, rural students were much shyer about expressing their uncertainty. Adolescent boys in both sites described similar masculinity norms influencing their risktaking behaviors.

Shame, Fear, and Worry about Body Changes Both rural and urban adolescent boys expressed fear, confusion, and shame about the insufficiently understood physiological and emotional changes of puberty they were experiencing. Participants submitted a range of questions about puberty, including concerns about perceived abnormal physiological development, confusion about wet dreams, discomfort with erections, and uncertainty about how to manage overwhelming sensations related to new sexual desires. In the urban site, both students and out-of-school adolescent boys predominantly had questions about delayed puberty, such as wanting to know if not having all the signs of puberty or sexual desire during mid- to late adolescence was abnormal or about how to avoid wet dreams. Many participants wanted to know why erections occurred when they saw girls or in the morning without any sexual thoughts. Others wanted basic information, such as the reasons for hardening of the nipples. Urban students asked questions such as, “One day when I slept, I was dreaming of having sex. But I didn’t ejaculate. Then, in the morning, when I urinated, it’s like I urinated the sperm. Why?” Rural adolescent boys had similar questions, expressed anonymously in the questions submitted and in the puberty stories. However, they were much shyer about

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expressing their concerns and curiosity in open group discussion. Many adolescent boys expressed concerns about their own virility or how their behaviors might be harming their future virility. Urban students and rural out-of-school participants verbalized these fears most frequently. Discussions among the urban students included concerns that abstinence (which they explained as stemming from religious beliefs, parental control, or shyness around girls) might cause psychological damage in a maturing boy. In the rural site, comparisons to other adolescent boys dominated participants’ concerns, with out-ofschool boys sharing fears that an adolescent boy having insufficient sexual desire might have permanent problems in society. In light of the meanings of manhood that participants shared (in the good and bad things about being a man activity), stressing the importance of virility (and fertility) in the Tanzanian conception of manhood, such concerns are not surprising. Adolescent boys in both sites (although more so in the urban site) shared a range of concerns about the dangers, permissibility, and effects of masturbation. The setting for urban students was a religious Christian secondary school whose teachings condemned masturbation. This may have contributed to the urban students’ worries about this activity. As an urban student asked, indicating a belief that masturbation should be curbed or controlled, “In what ways can a boy avoid doing masturbation when he is addicted like a cigarette smoker?” By contrast, other urban participants submitted questions that relayed their sexual curiosity, such as wanting to know whether

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using lotions and soaps for better masturbatory experiences could have harmful effects. Group discussion further elicited that sometimes participants encountered peers engaging in masturbation in the school bathrooms, but that they refrained from interrupting in the belief that it was best to let each person take care of his needs. In the rural site, adolescent boys were shyer, as demonstrated by the fact that they only inquired about masturbation through the anonymous data collection methods. Of some concern, a rural participant wrote in a story that it was important for adolescent boys to find girlfriends, because otherwise they might engage in “bad things like rape or masturbation.” His categorization of sexual violence with masturbation suggested significant social or cultural prohibitions against masturbation. By contrast, another rural participant asked whether it was true that masturbation was “one of the safe sex [approaches].” In light of the general taboo we observed regarding open discussion of masturbation, it is unclear where the participant had acquired this insight. This suggests the possibility of tolerance among adolescent boys themselves (and possibly the larger society) for discussing masturbation in the context of sexuality education as a way to avoid infection with HIV or unwanted pregnancy in sexual partners.35 The high prevalence of HIV and unwanted pregnancies among adolescents in Tanzania makes this a significant finding. However, we observed strong religious and political influences in the larger society that might hinder the inclusion of such messaging in national HIV and safe sex campaigns or sexuality education in schools. The predominant experience of puberty as described by participants in both sites was that it was not customary for adolescent boys to seek guidance—either from an older man in the family or from someone in the community. Nor was unsolicited guidance common. Adolescent boys who sought information asked peers, and a small number learned from magazines or biology class. A rural participant wrote, I dreamed I had sex with a woman, and when I woke up . . . I found all the bed sheets wet. It was a very embarrassing thing. But, as a man, I just stayed quiet as a man.

An urban participant expressed similar feelings:

The first day that I found myself ejaculating, I saw myself as a sick person. I thought it was a disease called syphilis . . . because of the stories I heard from my friends. I decided to keep quiet.

Some of our participants explained the lack of intergenerational guidance as a result of a decline in local puberty traditions. Many described hearing how previous generations of adolescent boys, or those from ethnic groups other than the Chagga, had received information and social guidance from their elders upon reaching puberty. A small literature on Chagga traditions suggests that a century ago pubertal rites, including male (and female) circumcision and seclusion (to learn to become a man) were common.36 However, the combination of colonial and missionary influences on the region, which both suppressed local traditions and enforced formal education, long ago stifled most memories and experiences of traditional puberty guidance for adolescent boys in our study sites.37

Virility, Power, and Fertility In both the rural and urban sites, we found that 3 primary aspects of manhood were conveyed to adolescent boys regarding their sexuality: a focus on sexual skill and sexual relations, the demonstration of power over women, and the importance of reproduction as part of being a real man. For example, urban students described how being able to impregnate a woman and to seduce a woman were good things about being a man in society. The out-of-school participants, particularly the street boys in urban Moshi, additionally emphasized the need to have a family. The latter may indicate that adolescent boys who are no longer in the formal school system are more likely than their in-school peers to identify with some aspects of masculinity, such as creating a family. Rural students described similar highly regarded characteristics of manhood, such as being able to seduce a woman, but their concept of being a man also included the ability to “handle a woman,” and to “do anything to a woman.” These responses highlighted a strong pressure on adolescent boys to reproduce and to demonstrate sexual prowess. Our findings on virility agree with research conducted in other sub-Saharan African countries; however, our participants’ emphasis on fertility as a fundamental part of manhood has infrequently been

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reported.38,39 Ethnographic observation, including informal conversations, revealed that among Tanzanians, Chagga men have a reputation for being less well trained than members of other ethnic groups in how to please their sexual partners. Participants’ explanation was often that other ethnic groups provided puberty training with more sexuality-related guidance for adolescent boys either now or in the past. We perceived a social preference among adolescent boys for receiving such instruction. Of potential concern was rural participants’ assertion that a good aspect of being a man was the ability to do anything they wanted to a woman. The implication was sexual or physical dominance. The genderbased violence statistics from the region, with higher levels of violence reported in rural than in urban areas, reinforce the problematic nature of this finding.18 Our participants’ descriptions of the bad things about being a man reinforced their 3 perceived positive aspects of manhood and sexuality and indicated characteristics of manhood that may be common but less socially valued. For example, urban students described a range of negative characteristics or practices of manhood, such as an inability to satisfy a woman sexually, men’s inclination to cheat, and a man’s risk of being cuckolded by his wife. They also described how men are “always being blamed as a rapist.” The latter finding should be explored in future research to more deeply understand the prevalence of sexual violence in this context and the existing gendered dynamics of sexual relations between young men and women. Findings from elsewhere in Tanzania suggest that sexual violence exists among young people, but the literature has primarily focused on young men and women, with less exploration of adolescent boys’ perspectives.40 Although a body of literature focuses on young men and sexual violence in South Africa,41,42 less data has been gathered on Tanzanian adolescent boys’ engagement in sexual violence and the masculinity norms and contextual influences, such as heavy alcohol use, that may influence such violence.43 Rural students similarly conveyed negative perceptions of a man who could not reproduce, but also expressed concerns about men being involved in rape. Out-of-school rural

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adolescent boys additionally highlighted the problems of men having “small houses” (mistresses) and of impregnating women with unwanted babies or contracting HIV infection. The multiple references made to the problem of a man not being able to demonstrate his fertility warrant additional exploration because of the potential role this gendered norm may have in inhibiting the use of condoms among adolescent boys and young men. Early anthropological writing on the Chagga suggests the strong linkage men perceive between producing offspring and ensuring their line and affirming their own place within society.36 Chagga clan lineage is also perpetuated predominantly through men. A discourse about men’s superior power and dominance underlay many of our participants’ descriptions of manhood and sexuality. This stood in contrast to some peer pressure stories written by adolescent boys in both sites that described girls as the initiators of sexual relations and adolescent boys regretting a forced first sexual experience. These stories echoed findings among the Sukuma in rural Mwanza, northwestern Tanzania.44 The vast majority of peer pressure stories that described sexual interactions emphasized the intense pressures exerted on adolescent boys by their male peers, indicating that to be a real man, they needed to have a girlfriend (which meant having sexual relations). Failing to acquire a girlfriend might, as a rural student described, lead to suspicion that a youth was gay, a continuing huge taboo in local society. Through the participatory group discussions, we tried to explore adolescent boys’ perceptions about same-sex relations, but social taboos appeared to hinder discussion of this topic. Our urban participants suggested that everyone knows when a given peer in their midst is interested in other adolescent boys. They reported that the general response is to call such a boy mocking names and to give him a wide berth socially.

Contradictory Masculinity Norms Across Social Contexts The social context of adolescent boys in modernizing Tanzania featured a variety of sources for the masculinity norms shaping their perceptions of sexuality and manhood, but generally failed to provide explanations to adolescent boys about the various new bodily

sensations they were experiencing. At the individual level, we found that adolescent boys were grappling, not surprisingly, with the new experience of sexual desire. This was often perceived to be uncontrollable and problematic, although some participants’ puberty stories described the ultimate realization (later in adolescence) that this was a normal part of manhood and was to be embraced. They expressed some regret that they had not been provided guidance on such sensations earlier in adolescence, and they believed that adolescent boys in earlier historical times, or in other ethnic groups today, received guidance on sexuality and were better equipped for enacting their manhood. Other participants discussed the need to suppress sexual desires, because of the dangers of impregnating a girl or becoming infected with HIV. A few participants had grown up among adolescent boys from other ethnic groups who received sexuality guidance at puberty (frequently through a sequestered training for an extended period). They expressed a concern that such adolescent boys returned from their month’s seclusion very focused on practicing their newfound sexual expertise (or enactment of masculinity) with as many girls as they could find. Our Chagga informants were uncertain that these peers from other ethnic groups were given any guidance on the importance of using condoms, which they found problematic because of the high risk of HIV infection and unwanted pregnancy. This finding was similar to reports about the Xhosa in South Africa, which described increases in adolescent boys’ risky sexual behaviors subsequent to pubertal rites.45 It also delineates the intersection (and potential challenges) of the continued practice of traditional puberty rites with other societal shifts, such as the advent of formal schooling delaying the age of first marriage and the more recent dangers of diseases such as HIV/AIDS. At the interpersonal level, regarding dating and romantic relationships, our participants experienced pressures from adolescent girls to engage in sexual relations and male peer pressure to have a girlfriend.46 Most of the literature from sub-Saharan Africa describes adolescent boys and men as the initiators of (and even aggressors in) sexual relations. Although our field observations suggested that

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a similar dynamic operates in the Kilimanjaro region, our participants wrote stories and embedded questions in the peer pressure stories describing confusion about how to rebuff sexually assertive adolescent girls or even older (sometimes divorced) women. Adolescent boys’ other descriptions of regretted sexual encounters were often linked to overuse of alcohol and subsequent engagement in unsafe sex, with its inherent risks of impregnating a girl or acquiring HIV. Participants’ easy access to alcohol in both study sites was an important contextual factor in sexual risk-taking behaviors and violence, which has been described elsewhere.27 Although descriptions of past sexual encounters came from our older participants, many described their first sexual encounter at a younger age as having been enabled by an empty house (because of lack of parental supervision), a visiting female relative (with whom they had sexual relations and, upon probing, described as a distant relative), the use of alcohol, or other contextual factors. At the familial level, we found little direct conveyance of masculinity norms to adolescent boys with regard to sexuality. Ethnographic observation, however, revealed some concerns about the shared bedrooms of adolescent boys and their parents in Chagga homesteads. We perceived that adolescent boys were observing sexual activity between their parents because of their close quarters and lack of privacy and then wanting to copy the activity with girls. The political economic realities of the region, with diminished incomes from the coffee trade and decreasing amounts of inheritable land for sons, has led to smaller living quarters for many families.5 Informal conversations with local elders during ethnographic observations indicated that in the past, adolescent boys at puberty were provided with their own room, to prevent them from observing the sexual experiences of their parents (among other reasons). However, for economic reasons, this is now a less commonly reported arrangement. Most adolescent boys reported that upon reaching young manhood, parental monitoring of their whereabouts diminished, allowing them much more freedom to engage in peer activities and potentially high-risk behaviors. In the larger community, we observed many Internet cafes and video huts that our informants told us showed pornographic movies,

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which male youths clustered around during the afternoons and evenings. As reported elsewhere, among the Chagga and the Luo, Sukuma, and other ethnic groups in Tanzania, growing exposure to Western (or less conservative) images of sexuality, dress, and sexual interactions appears to be influencing adolescent boys’ expectations for their own current or future sexual interactions with adolescent girls and young women.47,48 Mass media messages also influence young adolescents’ perceptions of manhood and its link to virility, such as those from national HIV prevention campaigns, including the recent introduction of a US Agency for International Development---funded condom project in which the brand of the new condom is translated from the Swahili into English as “be a real man.” This phrase appears on advertisements on large billboards in urban areas and is heard in radio advertisements. Similar norms are conveyed on billboards advertising alcohol and global telecommunications companies (mobile phones), with photographs of romantically posed attractive and well-dressed young men and women. Yet our ethnographic observations revealed continued traditional norms, even among the urban population of unmarried (and even married) men and women, which discourage demonstrations of physical affection in public.

DISCUSSION In our case study comparing rural and urban Tanzanian adolescent boys, we observed a significant lack of guidance and support for the pubertal transition throughout adolescence. The context was a modernizing society that retains many of its traditional gendered norms about sexuality. The increasing influx of Western images of sexuality and sexual interactions through video huts, mobile phone downloads, billboards, and, as in the nearby town of Arusha, discos where young people model the dress they see in such images, is creating a potentially problematic clash of conservative and modern values and expectations.49 Although traditional culture among the Chagga and other Tanzanian ethnic groups may have encouraged sexual virility, it also maintained a powerful system to supervise and control both male and female adolescents’ initial sexual interactions and to provide clear

guidance on the gendered roles within the society. This has shifted with increased school attendance by adolescent girls and boys and with changes in extended family structures resulting from urbanization and the HIV epidemic. Although problems were unquestionably inherent in former traditions, such as female circumcision and, even longer ago, castration of a person who impregnated a premarital girl (anonymous oral communication, October 2011), adolescent boys growing up in their absence today appear to be caught in a confusing web of contradictory messages about manhood. Strong traditional norms influence and encourage the demonstration of virility, sexual prowess, and fertility, abetted by simultaneous messaging from national HIV campaigns, such as the real man US Agency for International Development---funded condom project. Although the messaging may be a well-tested mechanism for increasing the use of condoms among older adolescents and men, for very young adolescent boys, these are powerful messages of virile manhood. Little exists in current school curricula to counter this message of virility for very young adolescents, because most of the HIV and sexual and reproductive health formal education, if available in schools, is aimed at students aged 15 years and older. The physiological and emotional aspects of puberty, which have been shown to be confusing and worrisome to adolescent boys, are often not addressed.36 Similarly, an emphasis on self-reliance in the larger society that was promoted by former president Julius Nyerere at independence,50 a characteristic many of our participants described as a fundamental part of manhood, may hinder their ability to seek guidance on pubertal or sexual and reproductive health from older adolescent boys and men or at health care clinics. Although family planning programs across sub-Saharan Africa increasingly aim to involve men, the society still needs to recognize the fertility pressures that may be felt by adolescent boys seeking to demonstrate and enact their manhood. Surprisingly, we identified few differences between rural and urban adolescent boys’ experiences of the pubertal transition and the meaning of manhood and sexuality. Participants in both sites reported insufficient

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guidance during early adolescence and intense pressure to demonstrate their virility and fertility in the future (if not the present) as older adolescents. Participants in both sites described feeling the natural intense sexual desires of adolescence and confusion over how to manage the desires. Numerous participants similarly reported pressure from peers, both male and female, to engage in sexual relations. More common in the rural area were descriptions of a manhood that included dominance over women and emphasized being able to handle a woman. One possible reason for the similarity in findings in the 2 sites is that the permeation of globalizing influences on notions of manhood through mass media, the Internet, and mobile technologies may no longer be limited to urban areas.51 We describe additional findings from this study related to the globalizing influences shaping adolescent boys’ transitions into puberty elsewhere.28 Our sample from the urban site, although primarily of Chagga and Pare ethnicity, also included other ethnic groups (e.g., Masaai, Gogo). Although some of the adolescent boys from other ethnic groups reported experiencing pubertal training or rites, the majority of our participants grew up in contexts in which the traditions that provided guidance were fading. They nevertheless described the same pressures to demonstrate sexual skill, virility, and fertility as did the Chagga and Pare adolescent boys.

Strengths and Limitations The use of participatory methods to elicit adolescent boys’ personal experiences of the masculinity norms influencing their perceptions of manhood within society was critical to deepening our understanding of the varying contextual influences shaping the pubertal transition in northern Tanzania today. Although we tried to explore the possibility of homosexual encounters, particularly in the boarding school dormitories of secondary schools, our participants made little to no reference to their existence. This was a bit surprising in light of literature from Mwanza describing forced or play homosexual encounters among street boys as young as 8 years.52,53 However, we did not focus directly on eliciting such findings, and an exploration of alternative masculinities, same-sex desire, and sexual

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experiences remains an important area for future research. Other contextual influences, including peer dynamics, the easy availability of alcohol, the presence of increasing numbers of Internet cafes, and rural or urban background, appeared to influence adolescent boys’ transitions through puberty in different ways. The generalizability of our findings is limited by the in-depth nature of our methods, which required time to gain participants’ trust, and by the small number of participants, who were primarily of Chagga ethnicity. The religious secondary school in the peri-urban area could have introduced some bias in sampling in the urban area; however, the students attending were generally at the private school because of failing the national exams and therefore being ineligible to attend the free government school. Thus, the private school represented an alternative route for completing their schooling and additional diversity for our purposive sampling method. We gained important insights on the present-day experiences of a subset of Tanzanian adolescent boys transitioning into young manhood, and many of our findings supported observations from other sub-Saharan African countries where adolescent boys and young men are caught between tradition and modernity.54 An in-depth study conducted with adolescent boys in Zambia reported similar results, supporting the broader implications of our findings for sub-Saharan (or Eastern) Africa.55 Our findings were also similar to Parikh’s ethnographic documentation of the experiences of Ugandan youths in a context of tradition and modernity, which focused less on the lived experiences of adolescent boys coming of sexual age.56

Recommendations Our key findings—insufficient guidance and support for adolescent boys during puberty, intense masculinity norms about demonstrating virility and fertility, and the influence of a shifting social context on the transition into young manhood—are of great relevance for public health. Our findings indicate that both additional research and improved programming are needed. Further research is needed in rural and urban Tanzania on the norms and contextual factors contributing to sexual violence among

young people; on alternative masculinities in the local society that are less centered on power, dominance, and virility (and may offer socially sanctioned pathways to less risky behaviors); on the fertility pressures experienced by adolescent boys growing up in Tanzanian society (and their implications for interactions with girls and women); on parental monitoring (or lack thereof) of adolescent boys’ sexual encounters; and on the sexual socialization of very young adolescents and its implications for male and female adolescents’ burgeoning sexuality in modernizing and urbanizing Tanzania. This research will in turn provide insights for future programming. Improved programming is needed to address the gap in puberty guidance currently provided to young adolescent boys in both rural and urban Tanzania. On the cusp of young adulthood, they are exposed to increasingly intense masculinity norms and messaging regarding the importance of demonstrating virility through unsafe sexual behaviors and various forms of violence. Interventions should aim to counter the messages increasingly reaching adolescent boys through pornographic videos and the Internet. In addition, the pressures on adolescent boys to demonstrate their fertility should be addressed in innovative approaches to encouraging safer sex through sexual and reproductive education that taps into the increasing use of social media. Information and support are needed for very young adolescent boys, to help counter and challenge the dominant heteronormative sexuality norms existing in Tanzania today. j

About the Authors Marni Sommer is with the Mailman School of Public Health, Columbia University, New York, NY. Samuel Likindikoki is with the Department of Psychiatry and Mental Health, and Sylvia Kaaya is with the School of Medicine, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Correspondence should be sent to Marni Sommer, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 537, New York, NY 10032 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted June 24, 2014.

Acknowledgments We gratefully acknowledge funding support from the National Institute of Child Health and Development. We extend our deepest gratitude to our research assistant, Daniel Maro, our Tanzanian colleagues in the Ministry of Education and in the field sites, and all the young men and adults in their lives who kindly provided time and information that made this research possible. They must remain anonymous for the purposes of this research, but we hope they will find the findings true to the insights they provided.

Human Participant Protection The study protocol was approved by the institutional review boards of Columbia University Medical Center, the National Institute of Medical Research, Dar es Salaam, Tanzania, and the Commission for Science and Technology, Dar es Salaam.

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