In this volume, Matthew Gutmann aims to bring greater attention to and encourage more studies on the sexual health of both men and women. Although based on fieldwork in Oaxaca, this is not so much an ethnography as a sociological overview that pulls in examples from the work of others from various places in Mexico and Latin America. Few men in Mexico are prepared to take responsibility for birth control. They generally dislike using condoms; as one put it, it's like eating candy with the paper still on. In Oaxaca, Gutmann found that the myth that male sexuality is uncontrollable was very prevalent and was even reiterated in the public health literature. Women have thus had to take on the task of controlling family size using what Gutmann calls the ‘female contraceptive culture’ as provided by the state (p. 203). Much of Gutmann's fieldwork time was spent in two clinics which offered men free vasectomies. The possibility of obtaining one of these was small, however, and many did not want the procedure in part because of another prevailing myth that they would thereafter be less able to have good sex and would lose status in the eyes of their peers (should they find out). Wives also worried that their husbands could then be unfaithful with impunity!

Currently vasectomy is seen as a method of last resort after wives have tried the rhythm method or IUDs, which frequently cause bleeding (in part because they are not changed regularly enough), or after many pregnancies, when their husbands can sometimes be prevailed upon to take responsibility (the wives often making the appointment for the operation). The whole situation is complicated by AIDS. Many men in Oaxaca (as in other parts of Mexico) work in the United States, where they frequently live in conditions as primitive or more primitive than those encountered in the rural villages and where they tend to become involved in extramarital sex, another prevailing belief being that most Mexican men have a woman ‘on the side’ even when at home. This myth was furthered by the staff at the various clinics Gutmann assisted at; in general he found that the doctors had a racist attitude, particularly towards indigenous people. I clearly remember in the early 1980s the attitude of trainee doctors on secondment from Mexico City to rural Chiapas who had little idea about how indigenous people lived and tended to consider them to be irrational and ignorant. A similar attitude seems to prevail too among nurses, health psychologists and social workers in Oaxaca today, who are trained to ‘especially denigrate the indigenous people they are charged to heal’ (p. 22).

Another of the myths that Gutmann hopes to dispel is the notion that men tend to become HIV-positive because of homosexual encounters. Rather, he suggests that many Mexican men in the United States may well get the disease because they have sex with the same prostitute in rapid succession. Once they return to Mexico, AIDS is often rapidly passed on to their wives, and many (both males and females) know little about the provisions available for its treatment partly because they may live in remote villages and partly because little effort is put into information dissemination; the attitude of the clinics seems to be that these individuals wouldn't be able to cope with the knowledge. In a state that has an overall population of 3.5 million, most clinics are located in Oaxaca City, which may be an overnight bus ride away for some. Although by 2001 some 15,000–20,000 cases of AIDS had been diagnosed, by 2005 there was only enough funding to give antiretroviral drugs to 200 people; this is because (rather shockingly) the Mexican government, although boasting that treatment is free to all, does not supply generic drugs for the treatment of AIDS (unlike Brazil) but rather the full-price pharmaceutical brands. Gutmann emphasises that the problems in Oaxaca are far from unique and are contingent on decisions made in government offices and pharmaceutical boardrooms not just in Mexico City, but also in Washington and Europe.

The various clinics proved to be rather limited sites for the gathering of ethnographic data: often the interlocutors would be seen only once or twice, although Gutmann was sometimes able to arrange follow-up visits to their homes. To ameliorate this situation, Gutmann talked to the group of men he worked with as a gardener in the ethnobotanical gardens. They were happy to share reminiscences about the sexual aspects of their lives and led him (as far as I can gather) to contacts in other localities, often with more traditional healers. Thus, rather late on in the book (from my point of view and apparently that of various people who reviewed the manuscript) in a chapter on indigenous doctors and midwives, the difference between the indigenous model of sexuality and that of the prevailing macho mestizo one is discussed. Interestingly, Gutmann found the binary, myth-based thinking he'd become accustomed to did not apply in the context of traditional rural medicine: the distinction was not between males and females, but between individuals. The point often made to him was that it was people, regardless of gender, who varied in their sexual desires and activities. What I felt was missing overall, however, was a discussion of how traditional medicine linked up with the allopathic: did men who went to the AIDS clinic also visit traditional curers (for there must be quite a few of the latter in Oaxaca City)?

This is a welcome addition to the literature on male sexuality, which is an area of research fraught with complications. If urban Mexicans find it difficult to talk about their sexual problems in marriage, indigenous people probably find it even more so. As Gutmann indicates in his conclusion, it is very difficult to know who is telling the ‘truth’. One worker in the AIDS clinic who had been questioning Gutmann about his own experiences indicated that if he had had sex with another man, he would never admit to it!