Masculinity, sociability, and health: Theorizing gathered spaces

Building on the premise that masculinity in sociability arises from local conceptions of personhood, gender is defined here as a social construct that assigns specific cultural roles and expectations to individuals (Tsang and Wassersug Reference Tsang and Wassersug2018). This definition underscores the role of social structure in shaping both gender and personhood. Anthropologically, Western worldviews typically regard the individual as autonomous and complete, whereas non-Western perspectives often conceptualize the person as a “dividual” interconnected with the community (Young Reference Young2019, 96). Therefore, social context is fundamental to understanding interpretations of personhood.

Social processes, such as socialization and identity formation, are central to the concept of personhood (Molefe Reference Molefe2018; Nkechi and Benjamin Reference Nkechi and Benjamin2023). In his critique of the bioethical principle of “respect for autonomy,” rooted in Western thought, Behrens (Reference Behrens2018, 128) argues that it is limited because it overlooks African worldviews, which understand persons primarily through their relationships. In African communities, as Molefe (Reference Molefe2018) argues, the community plays a vital role in shaping personhood. Similarly, Nkechi and Benjamin (Reference Nkechi and Benjamin2023, 310) concur that “existence entails other beings” in the African context, underscoring the relational dimension of personhood. However, persons who are racialized, disabled, elderly, belong to lower social classes, or are marginalized due to gender, sexuality, or illness are often perceived as having diminished personhood. As Wolf-Meyer (Reference Wolf-Meyer2025) observes, individuals often assess personhood by adherence to social norms.

Niehaus (Reference Niehaus2013) demonstrates relational personhood empirically by showing that African funeral rites, including night vigils, ritual cleansing, and communal ceremonies, reaffirm and redefine social bonds that persist beyond death. Conceptions of personhood must therefore recognize the influence of both material and intangible forces and the importance of considering the individual’s “existential situation in its totality” (Manganyi Reference Manganyi2019, 530). Additionally, Young (Reference Young2019) observes that personhood develops through active interactions within social and corporeal contexts, implying that masculine identities are similarly constructed through interpersonal engagement and cultural influences.

From an indigenous knowledge perspective, Morrell and Swart (Reference Morrell and Swart2005) contend that postcolonial African frameworks prioritize communal and environmental bonds over Western individualism. In essence, the social context in which individuals are embedded significantly shapes the conception of personhood. Mfecane (Reference Mfecane2018) further explains that masculinity stems from both material and spiritual origins, with ancestors playing a crucial role within the individual’s self-conception. Masculinity is regarded as an active performance contingent on context, rather than an immutable essence (Tsang and Wassersug Reference Tsang and Wassersug2018). While the material environment is important, masculinity is equally rooted in cultural and spiritual values. Applying gender theory, I analyze the concept of “masculinity” to understand men’s ongoing preoccupation with identity, a process shaped by societal norms and expressed at personal, interpersonal, and structural levels.

Karp (Reference Karp1980, 109) contends that sociability “exists in and, for itself,” creating environments where social bonds and identities are continuously formed and renegotiated, often unconsciously. Building on this, Mager (Reference Mager2010) argues that sociability in shebeens extends beyond recreation and actively reinforces masculine solidarity. Rich, Nkosi and Morojele (Reference Rich, Nkosi and Morojele2015) similarly note that drinking spaces are not merely leisure venues but also foster social bonding, provide men with respite from personal challenges, and occasionally offer social support. Suggs (Reference Suggs1996, 599) describes beer in southern Africa as a “special food” integral to social life, playing a central role in events such as marriages and labor cooperation within patrilineages. Among the Iteso of Uganda and Kenya, Karp (Reference Karp1980) finds that beer drinking is intrinsic to social and cultural practices. While Mager (Reference Mager2010) emphasizes beer drinking’s role in cultivating masculine solidarity, this study highlights how rituals of sharing beer, cigarettes, and zol within gendered spaces not only forge masculine identities and sociability but also contribute to plausible pathways for TB transmission.

To appreciate masculine identity in African contexts, Mfecane (Reference Mfecane2018) recommends developing theories grounded in local perceptions of reality rather than uncritically adopting external frameworks. These theories should treat masculinity as a social construct shaped by the intangible aspects of personhood inherent in traditional African thought. Existing research (Karp Reference Karp1980; Mager Reference Mager2010; Mfecane Reference Mfecane2011; Scherz, Mpanga and Namirembe Reference Scherz, Mpanga and Namirembe2024; Suggs Reference Suggs1996) indicates that beer consumption is a significant element of masculine identity. Building on these insights, the study demonstrates that masculinity in sociability is culturally informed and grounded in Sepedi values of seriti, botho, maitshwaro, and seemo.

Rathete’s ethnography of Northern Sotho cosmology elucidates a three-part ontology of personhood comprising mmele (body), moya (soul), and seriti. Although seriti is translated as “shadow,” Rathete (Reference Rathete2007, 30) clarifies that it transcends this literal interpretation to denote a metaphysical facet of existence, embodying a supernatural expression of an individual’s spiritual and social identity within Bapedi belief systems. Building on this tripartite framework, Niehaus (Reference Niehaus2013, 131) introduces madi (blood) to describe a four-dimensional model of personhood in South Africa’s Lowveld. He posits that moya, associated with ancestors and the Holy Spirit, resides within the body, whereas seriti exists externally, representing a person’s dignity and reputation within the community. While these components typically coalesce into a single person, Niehaus (Reference Niehaus2013) asserts that they can occasionally remain separate and be transferred to others. This exemplifies a flexible conception of personhood shaped by relational dynamics. Collectively, Rathete and Niehaus demonstrate that Northern Sotho cosmology integrates the physical body, spiritual essence, and social bonds into a cohesive yet constantly evolving notion of personhood.

To examine how sociocultural values shape the notion of personhood, I asked my interlocutors about their perspectives on what it means to be a man in Modimolle. Their responses were as follows:

These excerpts examine participants’ perceptions of masculine personhood by integrating tangible elements, such as actions and provider roles, with sociocultural values, including seriti, maitshwaro, seemo, and botho, as expressed in quotidian social interactions. Notably, these frameworks are flexible rather than rigid. Although maitshwaro encompasses a broad array of conduct guidelines, it is closely associated with civility and approachability. Seemo pertains to social standing and influence, whereas botho, akin to Ubuntu, reflects shared human dignity and responsibility. Morrell and Swart (Reference Morrell and Swart2005) highlight Ubuntu’s principles of brotherhood, sharing, and respect, and Molefe (Reference Molefe2018) notes that Ubuntu’s value is primarily earned through one’s conduct and is highly esteemed.

Overall, participants’ accounts and Molefe’s interpretation indicate a relational conception of personhood. Within this framework, masculinity is evaluated by an individual’s adherence to community values and practices rather than by personal autonomy. As a result, masculinities grounded in cultural traditions that are manifested through rituals of gathering, shared consumption, and reciprocity have concrete effects. These social interactions influence men’s vulnerability to tuberculosis, highlighting the relationship between health outcomes and the cultural values shaping masculine identity. The following section situates tuberculosis within South African and global contexts, focusing on the intersection of gender, space, and health.

Tuberculosis, men, and space: A South African perspective

Often referred to as the “ancient scourge” (Abel Reference Abel2007, 1), tuberculosis primarily manifests in two forms—pulmonary, affecting the lungs, and extrapulmonary, impacting bones, joints, the brain, kidneys, or spine (Barberis et al. Reference Barberis, Bragazzi, Galluzzo and Martini2017; Bynum Reference Bynum2012; Sontag Reference Sontag1977). In 2016, tuberculosis was the leading cause of death from infectious diseases and ranked among the top ten causes of death globally (Olaleye and Beke Reference Olaleye and Beke2018). The COVID-19 pandemic altered these trends, making TB the thirteenth leading cause of death in 2021; however, it remained the second deadliest infectious disease after COVID-19 (World Health Organization 2021). As the threat of COVID-19 waned, TB regained its position as the leading cause of death attributable to a single pathogen, as confirmed in 2023 (World Health Organization 2024). The 2023 estimates indicate approximately 10.8 million cases worldwide, with 55 percent in men, 33 percent in women, and 12 percent in children (World Health Organization 2024, 2). This gender disparity reflects complex sociocultural and behavioral factors, including health-seeking behaviors influenced by gender norms.

Gender shapes TB patterns. Broom (Reference Broom and Germov1998) argues that gender both restricts and empowers individuals, thereby influencing risks and benefits at personal and societal levels. Similarly, gender affects exposure and vulnerability, which in turn influence the risk of infection and disease progression (Thorson and Garcia-Moreno Reference Thorson, Garcia-Moreno, Simon Schaaf and Zumla2009). Empirical evidence supports these assertions. For example, men are more likely to experience delayed diagnoses (Chikovore et al. Reference Chikovore, Hart, Kumwenda, Chipungu, Desmond and Corbett2017; Meintjes et al. Reference Meintjes, Schoeman, Morroni, Wilson and Maartens2008) and to interrupt treatment (Ramaliba et al. Reference Ramaliba, Tshitangano, Akinsola and Thendele2017). These behavioral and structural constraints worsen health outcomes and may increase community transmission by prolonging infectious periods. These findings affirm that gender is a critical factor in understanding the epidemiology of TB.

Furthermore, gender disparities in health literacy lead to different health outcomes. Surveys in Lesotho and South Africa indicate that women generally have a better understanding of TB etiology, symptoms, and transmission than men (Luba et al. Reference Luba, Tang, Liu, Gebremedhin, Kisasi and Feng2019; Shamu et al. Reference Shamu, Kuwanda, Farirai, Guloba, Slabbert and Nkhwashu2019). These knowledge gaps are associated with more proactive health-seeking behaviors, suggesting that greater awareness may reduce infection risk and promote treatment adherence. Consequently, gender-sensitive interventions are essential to address the structural inequalities and behavioral patterns that perpetuate the tuberculosis burden.

Although tuberculosis cases increased following the COVID-19 pandemic, evidence indicates that the global death rate attributable to TB has decreased. The World Health Organization (2024) estimates that tuberculosis caused approximately 1.25 million deaths in 2023, down from roughly 1.32 million in 2022. Mortality statistics reveal a notable gender disparity: in 2023, around 568,000 adult men died from TB, while 352,000 adult women and 166,000 children also died (World Health Organization 2024, 13–14). These data highlight gender disparities in tuberculosis mortality but provide limited insight into the underlying reasons for the higher mortality rates among men.

Horton et al. (Reference Horton, White and Rein2018) highlight the global neglect of men in tuberculosis control efforts. Likewise, Allotey and Gyapong (Reference Allotey and Gyapong2008) emphasize the importance of understanding how gender relations influence the management of communicable diseases, including tuberculosis. Such understanding is essential for addressing health disparities between women and men. In regions with high disease burdens, such as South Africa, overlooking these dynamics may perpetuate transmission cycles. Analyzing constructs of masculinity and men’s perceptions of the disease is imperative, as these factors significantly influence health behaviors associated with tuberculosis transmission.

The risk of TB infection depends on exposure patterns, including proximity to infectious individuals and the duration of contact in high-risk, poorly ventilated environments, as well as the prevalence of disease within the community, which reflects regional epidemiological trends (Davies Reference Davies2005; Mathema et al. Reference Mathema, Andrews, Cohen, Borgdorff, Behr, Glynn, Rustomjee, Silk and Wood2017; Olaleye and Beke Reference Olaleye and Beke2018). To gain a comprehensive understanding of these risks, sociocultural norms, such as gendered spatial practices, may offer additional insights. Therefore, beyond biological susceptibility, external determinants—including the infectiousness of source cases, social behaviors such as smoking and alcohol consumption, and environmental factors like indoor air pollution—also contribute to increased transmission risk (Narasimhan et al. Reference Narasimhan, Wood, MacIntyre and Mathai2013; World Health Organization 2024). Significantly, environments that facilitate the transmission of Mycobacterium tuberculosis—characterized as enabling the bacilli’s “transit from one host to the next” (Bothamley Reference Bothamley2005, 527)—are often shaped by social factors.

Smoking impairs immune function and increases the risk of TB. Smokers with TB are nine times more likely to die than non-smokers (Wessels, Walsh and Nel Reference Wessels, Walsh and Nel2019). Alcohol similarly increases the likelihood of TB infection and non-adherence to treatment protocols (Louwagie et al. Reference Louwagie, Wouters and Ayo-Yusuf2014). These issues attracted renewed attention during South Africa’s stringent COVID-19 lockdown, beginning in March 2020 and extending through successive phases of restrictions. This period was marked by an unprecedented five-month ban on the sale of alcohol and cigarettes (Albernaz et al. Reference Albernaz, da Cruz and Dias2023; Egbe et al. Reference Egbe, Ngobese, Barca and Crosbie2022). The 2020 regulations prohibited the sale of “tobacco, tobacco products, e-cigarettes and related products” (South African Government 2020, 22), driven by concerns that communal practices such as sharing cigarettes or pipes in densely populated townships could facilitate virus transmission and that smokers faced an increased risk of severe COVID-19 illness, potentially overwhelming healthcare facilities (Filby, van der Zee and van Walbeek Reference Filby, van der Zee and van Walbeek2022; Saloojee and Mathee Reference Saloojee and Mathee2022). As Dr. Nkosazana Dlamini-Zuma, then Minister of Health, noted, sharing tobacco products not only impairs lung function but also hinders social distancing measures, thereby promoting viral spread (Savides and Hunter Reference Savides and Hunter2020). These measures exemplify how sociocultural practices, especially those embedded in masculinized public spaces, influence the dynamics of infectious diseases. Just as COVID-19 restrictions underscored the dangers of shared smoking rituals, TB intervention strategies must also address the sociocultural norms that endorse high-risk behaviors within male-dominated environments. Accordingly, analyzing constructs of masculinity within these settings is vital for understanding the transmission and enduring presence of TB among men.

Social context shapes masculinities, and men’s spatial interactions provide critical insights into TB transmission within this demographic. South African TB research has traditionally focused on mining, particularly gold mining, where exposure to silica dust is a primary cause of TB. The incidence among South African gold miners is estimated to be four to ten times higher than in the general population (McCulloch Reference McCulloch, Beinart, Charlton, Coplan, Delius, Dlamini and Harries2014; Mutendi and Macdonald Reference Mutendi and Macdonald2018). The movement of mineworkers between workplaces and residential communities facilitates the spread of TB beyond mining regions. Although these structural factors are significant, the emphasis on mining often overshadows gender-specific and sociocultural transmission pathways, especially those rooted in men’s social interactions. This study argues that men’s frequenting of entertainment and social venues fosters sharing practices that reinforce masculinity and belonging, while simultaneously creating conditions conducive to TB transmission. While previous research highlights workplace hazards, malnutrition, and overcrowded hostels in mining environments (McCulloch and Miller Reference McCulloch and Miller2023), this study draws attention to poorly ventilated, male-dominated entertainment spaces as overlooked sites for TB spread.

The burden of tuberculosis predominantly affects low-income countries and areas marked by pronounced inequality, thriving in resource-limited settings where poor living conditions facilitate transmission. As a disease intrinsically associated with poverty, TB proliferates in environments where systemic disparities such as substandard housing, overcrowding, and limited healthcare access promote transmission. For example, in Limpopo province, the location of this study, approximately 55 percent of TB patients are co-infected with HIV, highlighting interconnected epidemics driven by social deprivation (Matakanye et al. Reference Matakanye, Tshitangano, Mabunda and Maluleke2021). Similarly, research in the Eastern Cape indicates a correlation between poor housing quality, overcrowding, and elevated TB rates (Cramm et al. Reference Cramm, Koolman, Møller and Nieboer2011; Kapwata et al. Reference Kapwata, Breetzke, Wright, Marcus and Eales2022). These findings emphasize TB’s status as a quintessential disease of poverty, both reflecting and perpetuating social and economic inequality. South Africa, with a Gini coefficient of 0.63 (World Bank, 2018), exemplifies a critical social context for examining how structural inequalities shape TB transmission, patient experiences, and strategies to reduce its incidence. Within this framework, which considers TB a condition rooted in structural deprivation, the subsequent section investigates how taverns—as gendered spaces where beer, belonging, and breath intersect—influence men’s susceptibility to infection.

Taverns as gendered spaces: beer, belonging, and breath

South Africa ranks fifth globally in alcohol consumption among drinkers, with the average individual imbibing about 30 liters of pure alcohol annually (Eighty20 2023). Nationally, consumption patterns are predominantly male: about 62 percent of men drink weekly or monthly compared to 36 percent of women (Eighty20 2023). These gender disparities are reinforced by social norms that normalize regular and heavy drinking among men while paradoxically framing dependence or overt intoxication as a sign of weakness (Fontes Marx et al. Reference Marx, Mayara, Harker and Ataguba2021). In Modimolle, both healthcare practitioners and men living with tuberculosis identified collective beer drinking and smoking in taverns and shebeens as key social practices that shape masculine identity and increase TB risk.

In my discussion with community health worker Linda Ndlovu, she said:

Linda’s observations are consistent with extensive evidence on the gendered dimensions of alcohol consumption. They corroborate Suggs’s ethnographic research among the BaTswana, which identifies public beer drinking as a marker of “masculine behavior” (Reference Suggs1996, 608), and support Mager’s historical analysis of the development of “cultures of masculine beer drinking” in South Africa (Reference Mager2010, 9). Notably, Linda’s assessment underscores the duality of masculinity in sociability—while men forge and reinforce identities through sharing, they also increase their risk of contracting TB.

To illustrate the gendered and spatial distribution of taverns and shebeens in Modimolle, I refer to Figure 1 to highlight how male-dominated spaces not only foster shared social practices that shape masculine sociability but also serve as venues that heighten TB risk. The shebeen depicted, which attracts men, is privately owned by Mr. Tshepo Motau,Footnote ⁵ who built a “stop-nonsense”Footnote ⁶ barrier around his property. This is a common practice to conceal activities from authorities and enhance security. Additionally, Mr. Motau operated a spaza shop on the premises, managed by his spouse. Despite the ongoing COVID-19 pandemic, patrons frequently disregarded health guidelines, including social distancing, mask-wearing, and the use of hand sanitizer. I was noticeable for wearing a face mask while patrons drank beer, smoked, and socialized in close proximity.

Figure 1.

A group of men engaging in a game of dice and socializing outdoors at a shebeen. Source: Personal photos, February 7, 2021.

One Sunday afternoon, Mr. Motau’s shebeen yard was bustling with revelers. Outside the stop-nonsense on the dusty street, a group of young men gathered to play dice while others socialized, as shown in Figure 1. Inside the yard, patrons reclined on empty beer crates, enjoying their drinks. Beyond the open yard stood an informal, poorly ventilated zinc-sheet structure where more patrons sat shoulder to shoulder, danced, and watched television. Although the outdoor scene of men playing dice appeared well-ventilated, the close proximity and shared activities—whether rolling dice or dancing—demonstrate the duality of masculinity in sociability. Social bonds among men are built and nurtured while conditions conducive to TB transmission are created.

Ethnographic observations reveal that drinking establishments can deter men from seeking health care. For example, on a Monday morning, before taverns opened at 10 a.m., I accompanied two community health workers to locate Charles, a TB patient who had missed a follow-up appointment. Although he was not at home, his brother directed us to a house across the street from a tavern where Charles was found drinking beer with a group of men. The brother’s familiarity with the location highlights how taverns function as daily venues for masculine socialization, opening early and attracting regular patrons. Even on weekday mornings, men’s drinking serves as both a performative display of masculinity and a social lubricant that facilitates interaction and community bonding while also posing a risk factor for TB.

These observations corroborate broader research findings. Mfecane (Reference Mfecane2011) notes that in Mpumalanga, beer consumption is deeply embedded in daily life and symbolizes masculinity. Similarly, Albernaz, Lage da Cruz and Dias (Reference Albernaz, da Cruz and Dias2023) suggest that alcohol helps strengthen social bonds. Scherz, Mpanga and Namirembe (Reference Scherz, Mpanga and Namirembe2024) portray Ugandan bars as crucial venues for male socialization, recreation, friendship, and the mobilization of social initiatives. Rich, Nkosi and Morojele (Reference Rich, Nkosi and Morojele2015) investigate tavern patrons in South Africa’s North West province and find that although some men visit primarily to socialize without necessarily consuming alcohol, the majority are encouraged to develop a high tolerance for alcohol and feel compelled to demonstrate it among their peers. Together, these studies highlight that spaces centered on beer are vital for male sociability and identity throughout sub-Saharan Africa, providing platforms for men to bond, share concerns, and seek support.

Dumisani Chauke, one of two male nurses in the local clinic’s HAST unit, highlighted the structural risks of TB infection associated with men’s sociability:

Dumisani’s account shows that masculinized social environments promote sociability but also contribute to nutritional neglect among male patrons. With women and children generally at home, taverns function as key social spaces for men, which may partly explain the challenges many face in reducing alcohol consumption (Scherz, Mpanga and Namirembe Reference Scherz, Mpanga and Namirembe2024). In an informal discussion, community health worker Salome described eating a nutritious breakfast before visiting tuberculosis patients to strengthen immunity and reduce infection risk. During fieldwork, I adopted a similar routine, consistently having a substantial breakfast before engaging with participants. The contrast between Salome’s preventive approach and Dumisani’s portrayal of men’s late-night tavern attendance highlights a behavioral distinction: while women and health workers prepare for the day, men often prioritize social interactions over self-care.

Unemployment drives many men to frequent taverns and other male-oriented spaces not solely for leisure but also for networking and exchanging limited employment information. In these environments, beer serves as a social lubricant, uniting men from different social classes and enabling them to negotiate their status and identity through shared rituals (Dumbili Reference Dumbili2022; Mager Reference Mager2010). As James Moeng, a twenty-eight-year-old TB patient, recalled:

James’s account illustrates that beer bridges social hierarchies and provides access to broader masculine networks, consistent with Karp’s observation that beer signifies “diffuse solidarity and unencumbered sociability” (Reference Karp1980, 84). Although James earned a modest income from piecework at a car wash—a male-dominated environment—beer enabled him to connect with wider masculine groups. Even unemployed men participate in beer drinking through reciprocity, as reflected in the Sepedi proverb: “Bana ba motho ba ngwathagana hlogo ya tšie” (“One’s children share everything, no matter how small”).

This dynamic echoes Nkechi and Benjamin’s (Reference Nkechi and Benjamin2023) argument that reciprocity is central to personhood, as individuals are socialized into systems of mutual obligation that bind their fates and shape their identities. Consequently, James’s access to encouragement for TB treatment exemplifies Menkiti’s (Reference Menkiti2018) assertion that personhood is formed through lived morality and reciprocal recognition, where equality endures despite social differences. This aligns with Flikschuh’s (Reference Flikschuh2016, 439) philosophical claim that “moral membership in communal life” forms the foundation of personhood. Molefe (Reference Molefe2018, 226) also notes that “the idea of personhood entails a morality of duties to others.” Scherz, Mpanga and Namirembe (Reference Scherz, Mpanga and Namirembe2024) similarly remind us that in contexts of scarcity, the bar fosters indulgence and unchecked generosity, a theme evident in South African settings, where, as Casper (Reference Casper2017) notes, men often spend limited resources on alcohol for peers, not necessarily expecting returns. Collectively, these insights highlight how reciprocity—through advice, drink, or smoke—fosters belonging, affirms personhood, and sustains masculine solidarity.

If James highlights the supportive aspect of reciprocity, Thabo Dube’s account reveals its more fragile side:

Thabo’s story illustrates how taverns function as both social hubs and sites of TB exposure. While biomedical explanations often emphasize poor ventilation or overcrowding, the social rituals themselves, such as prolonged drinking, sharing cigarettes, and communal activities, also create conditions that facilitate TB transmission. Men gather around a single bottle, passing it from mouth to mouth and literally sharing breath. Dice games, singing, and dancing also bring people into close contact. For unemployed men like Thabo, these gatherings are essential to social life, strengthening masculine bonds while inadvertently increasing their risk of contracting TB.

These ethnographic insights are consistent with Casper’s (Reference Casper2017) observations on male friendships and alcohol consumption in South Africa, where drinking symbolizes masculinity and shapes social interactions. The narratives of James and Thabo further demonstrate how reciprocity—through shared drinking, smoking, and social support—fosters solidarity, affirms personhood, and shapes gendered vulnerabilities to TB. The next section explores personhood values by examining smoking rituals as extensions of sharing practices that reinforce masculine bonds while increasing TB risk.

Seriti, botho, and the rituals of sharing cigarettes and zol

Personhood is not an abstraction; in this context it is informed by cultural values. Seriti, often translated as “personality and dignity” among the Bapedi of Limpopo (Rathete Reference Rathete2007, 30), also signifies respect and integrity. My discussion with thirty-two-year-old Thapelo, whom I met at a local tavern, reveals that:

Thapelo associates seriti with respect, dignity, self-restraint, and composure, framing it as a relational value that diminishes when control is lost. This view reinforces the idea that personhood is achieved through social conduct. The expression of seriti also clarifies botho, as the self-respecting individual is expected to treat others with respect. In this study, men enact these values through reciprocal sharing of cigarettes, zol, and braaied or barbecued meat. Such sharing is not just habitual but a performative act of seriti and botho, reinforcing masculine solidarity. Similarly, Karp (Reference Karp1980) found among the Iteso that sociability is marked by a willingness to engage in social exchanges. Fannie Mashishi, a fifty-one-year-old participant, offers insight into sharing and its implications for TB exposure. Reflecting on his diagnosis, he remarked:

Fannie’s rhetorical question, “Isn’t it true that we share?” presumes a collective understanding of this norm and highlights the expectation of communal smoking, a practice locally known as “skyf.”Footnote ⁷ In township slang, calling for a skyf means sharing a drag on a cigarette or a zol. Refusing to share a cigarette or zol breaches the ethics of botho (humanness) and undermines the social expectations of being a “sociable person.” Like beer, tobacco and zol circulate not just as commodities but as tokens of belonging and happiness, binding men through what Karp (Reference Karp1980, 109) calls “the exclusion of individualizing interests.” Such rituals are especially common in spaces where prolonged proximity facilitates TB transmission (Morrison, Pai and Hopewell Reference Morrison, Pai and Hopewell2008). For Fannie, communal smoking was not just a habit but the very space of masculine belonging. However, this social belonging heightened individual vulnerability to TB and facilitated possible transmission among group members.

Similarly, Timmy Mabunda and Charles Mashaba attributed their TB exposure to the social aspect of smoking:

Timmy’s hesitant introduction: “Erm, eish, I cannot say,” reveals an awareness that even routine acts like sharing a cigarette can have serious health consequences. He quickly frames sharing as an almost inevitable masculine ritual: “As men we share cigarettes a lot.” His observation that “TB is very common among men” presents the disease as both a statistical reality and a result of gendered social habits. Charles’s account is similarly vivid, directly linking a friend’s death and another’s illness to shared smoking and drinking customs. His statement, “We shared everything,” shows how norms of reciprocity extend beyond gestures of friendship to practices that can transmit disease. There is also a sense of collective resignation, as smoking and drinking with close friends are so ingrained that their health consequences seem an unavoidable aspect of brotherhood.

These accounts emphasize not only the mechanisms of TB transmission but also how men perceive risk in relation to their social obligations, which reinforce and reaffirm masculine identity. Here, smoking is best understood as a collective rather than an individual practice, as both interlocutors describe cigarette sharing as a communal activity among men. Molefe’s (Reference Molefe2018) conception of personhood as dialogical and other-regarding is instructive: being a person involves pursuing self-realization through responsibilities to others. Even when harmful, communal smoking in this context operates as a moral practice of recognition, validating masculine personhood through reciprocal sociability.

This observation was further confirmed during an interview with Thabang, a local DJ I met at a tavern, who reflected:

In this context, seriti and botho are inseparable, each shaping and sustaining the other. As Behrens (Reference Behrens2018) observes, Ubuntu or botho situates personhood within interdependence and communal life. Masculinity in sociability and personhood are inherently relational, expressed through sharing practices embedded in the moral framework of botho. Given the social and reciprocal nature of smoking, Thabang’s account underscores the centrality of empathy in sharing, reinforcing the concept of Verstehen as an interpretive understanding of social action (Ritzer, Reference Ritzer2011). In the African worldview, as Nkechi and Benjamin (Reference Nkechi and Benjamin2023) argue, personhood is not innate but socially and actively cultivated. Achieving masculine personhood through botho thus relies on empathetic engagement and sharing, which, as Nyirenda (Reference Nyirenda2024, 24) notes, is fundamental to attaining virtue and moral wisdom. Yet, this pronounced masculine expression of empathy also conceals an unintended risk of TB transmission.

The participants’ stories show that men’s understanding, rooted in seriti and botho, regards sharing as a moral duty, even when it risks their health. For them, not passing a cigarette or zol would be a betrayal of the community and a breach of normative values, illustrating how these social practices are closely linked to masculine identity, even as they unintentionally increase TB risk. This aligns with David Dickinson’s (Reference Dickinson2020) analysis of South African township life, where alcohol, tobacco, and zol promote social bonds but also create health vulnerabilities.

The tension between cultural norms and public health became more evident during South Africa’s COVID-19 lockdown. Minister Dlamini-Zuma’s ban on cigarettes, satirized in Max Hurrell’s song (Vivier Reference Vivier2020), highlighted how state paternalism clashes with masculinities rooted in shared rituals. Although COVID-19 and TB transmission differ, both expose the paradox of communal practices in which seriti and botho uphold dignity and humanness yet also increase disease risks in poorly ventilated spaces.

Terry Tlou’s story highlights this duality. Co-infected with HIV and TB, thirty-nine-year-old Terry, who appeared physically weak during our interview, shared his experiences with me:

Terry Tlou’s account of weekends filled with braaied meat, brandy, beer, and cannabis reveals a routine that fosters comradeship yet weakens immunity to TB infection. His braai practice with friends exemplifies seriti and botho, expressed through hospitality and embodying umuntu ngumuntu ngabantu (“a person is a person through others”) (Ntombana Reference Ntombana2009, 76; Rathete Reference Rathete2007, 43). Molefe (Reference Molefe2018) similarly stresses that within African moral thought, humanity is realized through responsibilities to others, and this ethic is reflected in Terry’s practices of drinking, smoking, and sharing food with friends. Still, the value of seriti must be seen along a continuum rather than as fixed. This is illustrated by Thabang, who remarked in relation to men’s practices in space:

Seriti and botho mediate sharing practices among men, fostering masculine bonding and comradeship. Thabang’s narrative reinforces the idea that masculine personhood, informed by these cultural values, entails responsibility to oneself and the community. Yet failure to adhere to the script diminishes personhood, ultimately heightening TB risk. Terry’s admission, “There is no way TB will not infect me,” highlights the health consequences of prioritizing communal belonging over personal well-being, particularly as he describes continuous drinking without nourishing his body. Terry’s story echoes global findings linking heavy smoking and alcohol consumption to TB (Soh et al. Reference Soh, Chee, Wang, Yuan and Koh2017) and reflects the nutritional neglect observed by Dumisani.

While structural factors such as HIV co-infection, malnutrition, and inadequate ventilation elevate tuberculosis risk, it is the reciprocal sharing practices grounded in dignity, humanness, and community that shape men’s daily exposure. Analyzing how masculinity, expressed through sociability, transforms shared cigarettes, zol, and meat into significant rituals reveals the structuring of TB among men. These sharing rituals are not just spontaneous acts of camaraderie; they are regulated by maitshwaro and seemo, as discussed in the following section.

Maitshwaro and seemo in masculinized spaces

Building on the interplay of seriti and botho in shaping communal sharing rituals, maitshwaro (social conduct) and seemo (social standing) structure how such practices are valued. While maitshwaro emphasizes civility, approachability, and responsibility—extending to moral conduct—seemo reflects the influence and respect a man gains by adhering to these norms. Together, the two form a moral framework of masculine sociability in which maitshwaro prescribes ways of social engagement, while seemo outlines the social capital gained through these interactions. This aligns with Menkiti’s (Reference Menkiti2018) argument that, in the African worldview, moral function is central to the definition of personhood, a point echoed by Nkechi and Benjamin (Reference Nkechi and Benjamin2023, 309), who emphasize that among the Tiv, personhood is intertwined with moral probity. Put differently, social standing (seemo) depends on conduct (maitshwaro), enacted and performed through masculinities in masculinized spaces. These dynamics are vividly illustrated in the account of thirty-six-year-old Richard Mnisi, who lives in a subsidized government-built reconstruction and development programme (RDP) house and whose narrative reveals how gendered norms foster solidarity and produce risk. He recalls discovering his TB diagnosis mid-game in a cramped tin room:

In Richard’s story, maitshwaro is shown through deliberate disclosure, breaking the silence that many men fear could threaten their seemo (social standing). However, by choosing honesty, he also exhibits responsibility and concern for others, supporting Nkechi and Benjamin’s (Reference Nkechi and Benjamin2023) view that ethical relations are vital to being fully human. Seemo is evident as peers follow his lead in disclosing their concealed diagnoses, thereby augmenting his influence and social capital, with maitshwaro as the performance and seemo as the ensuing currency.

The mokhukhu’s appeal as a gendered space lies in its promise of exclusive brotherhood and comradeship, which are pertinent to men’s identity and personhood. Its tin-walled enclosure, dense with smoke and laughter, symbolizes belonging and masculine solidarity through shared rituals of smoking, gaming, and drinking beer. Rathete (Reference Rathete2007) similarly describes men’s informal gatherings, such as impromptu televised match viewings, as performative scripts of masculinity rooted in relationality rather than individualism (Morrell and Swart Reference Morrell and Swart2005). These practices, underpinned by maitshwaro’s emphasis on sharing, rely on collective approval, in which respect is earned solely by maintaining the in-group. This moral economy, however, carries unintended risks of TB transmission, further demonstrating the duality of masculinity in sociability. This is because the sharing behaviors occur when men congregate in close proximity under specific architectural conditions with inadequate ventilation. Indeed, the masculine scripts that unite men through shared space, secrecy, and loyalty create danger, as Richard’s stark reflection, “we were killing ourselves,” shows. Richard’s group, akin to Zambia’s TB-prone tented theatres (Murray et al. Reference Murray, Dodd, Marais, Ayles, Shanaube, Schaap, White and Bond2021), exemplifies how enclosed, male-dominated spaces facilitate disease spread even as they foster belonging. By leading the group outdoors, Richard questions and reaffirms communal rituals while renegotiating boundaries. His success demonstrates that maitshwaro and seemo are adaptable cultural values, showing that when an individual of sufficient standing redefines proper conduct, the group adheres accordingly.

This insight suggests broader potential for intervention. Instead of framing ventilation and hygiene as top-down directives from biomedical authorities, health campaigns should draw on existing moral frameworks, empowering respected community members to model new norms. Demonstrating that genuine maitshwaro and enhanced seemo arise from protecting each other’s health and social bonds can encourage the adoption of protective practices. In this way, these practices become acts of maitshwaro that increase seemo, transforming high-risk male spaces into environments of shared well-being.

In an interview I conducted with Kenny Sefako, he emphasized how the values of maitshwaro and seemo intersect and manifest in men, stating:

Using the proverb “lentswe la monna le tšwa ga tee…,” Kenny articulates the cultural foundation underpinning masculine personhood. Authority, consistency, and responsibility mark masculine personhood and what a man says must be obeyed. The proverb shows that personhood is relational and expressed through social conduct (maitshwaro). However, masculine personhood may diminish, especially when a man repeats himself. It is reciprocated at the household and community levels, as Kenny illustrates with the statement, “you don’t speak back to a man.” Kenny’s explanation gives substance to the rationale behind the group members’ adherence to Richard’s guidance on changing their gathering space. In other words, relational authority and social standing (seemo) operate within a framework of reciprocal responsibility and social conduct (maitshwaro). By relocating the group to an open space, Richard reduced the risk of TB transmission and infection while enhancing communal bonds. He exemplified how ethical conduct and social influence mutually reinforce one another in masculine sociability. Consequently, when respected community members display health-promoting behaviors that reflect maitshwaro and enhance seemo, groups tend to adopt safer social practices.