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The basics: Sex, gender and sexuality

The links between sex, gender and sexuality can be numerous and complex. And while many people are unaware of the differences between sex and gender, often lumping the two together, sex, gender and sexuality are crucial to understanding how and why HIV spreads. And gaining further understanding of the epidemic, especially as it applies to specific groups like men who have sex with men (MSM), is important in curbing the spread of HIV.


Sex is the biological or physical make-up of the person that makes them male or female. This means that most people have either male or female sex organs and characteristics.

Some people may have ambiguous genitalia (a mix of male and female sex organs) and physical features. This is known as being intersexed.


Gender is the socially constructed (socially constructed means that these differences are not natural but are created by society) differences between men and women. 

Gender is manifest in the different behaviours and roles that are assigned to men and women. For example in many societies women are expected to have different and even polar-opposite characteristics to men. Men and women are often expected to fulfill different roles too. For example women are expected to be caregivers, while men are looked at as providers.

Gender, like sex, is split into two categories that are closely tied to each biological sex.

Male Masculine
Female Feminine





However gender and physical sex do not always 'match-up'.

Because gender is socially constructed and not natural or given it is something that is very fluid or changeable. In more liberal contexts women might take on characteristics usually associated with men or pursue hobbies and jobs which were once reserved for men and are still done predominantly by men. Some people might even have traits of both genders displaying a mix of feminine and masculine gender identities.

Sexual orientation

Sexual orientation refers to whether a person is sexually attracted to men or women or both.

Sexual orientation is generally divided into three groups;

  • heterosexual or straight individuals are attracted to people of the opposite sex;
  • homosexual or gay people are attracted to individuals of the same sex;
  • bisexual people may be attracted to people of either sex.

There are many theories as to why some people are heterosexual and some people are homosexual. These range from biological and scientific arguments to do with hormones and brain chemistry to social-science arguments which put sexual orientation down to socialisation.

How sex, gender and sexual orientation intersect

Most societies and many cultures expect the three attributes defined above to ‘line-up’ in a way that has come to be considered natural, normal and even ‘right’ and ‘good’. This involves gender and sex to flowing 'naturally' from a male or female sexed person.

Female Feminine Attracted to men (heterosexual)
Male Masculine Attracted to women (heterosexual)





However for many people these three attributes do not line as up as neatly as heteronormative (this means that heterosexuality is 'dominant' and considered normal) societies expect them to.

The most common example of these attributes not lining up in what is considered to be a normal way is when someone is homosexual or ‘gay’. This means that there is what society deems as a ‘mismatch’ between a person’s sex and their sexual orientation.

Female Attracted to women (homosexual)
Male Attracted to men (homosexual)

In other cases people’s sex and gender do not ‘match up’ in a typical way.

These people might not act in a way that exactly expresses their outward sex e.g. a woman might behave in a way that is considered masculine and perform a role/s largely associated with men.

In other instances people might feel that they are trapped in the wrong body and seek to have a sex change.

Female Masculine
Male Feminine

It is important to note that like the 'mismatches' that might occur between sex and gender, sexual orientation does not imply a particular gender idenitity and an ambigious gender identity does not imply a particular sexual orientation.

In other words, just because a woman is homosexual does not mean she does has a masculine gender identity and just because a woman might act in what is considered a masculine way does not mean she is necessarily homosexual.

Female Masculine Attracted to men (heterosexual)
Female Feminine Attracted to women (homosexual)


Wits Journalism Anova Health

The project is jointly managed by the Anova Health Institute and the Journalism and Media Studies Programme at the University of the Witwatersrand. The project is funded by by the Health Communication Partnership based at the Johns Hopkins Bloomberg School of Public Health Centre for Communication Programmes and the President’s Emergency Plan for AIDS relief through the United States Agency for International Development under terms of Award No. JH/HESA-02-05 and through the Anova Health Institute through PEPFAR via USAID under Award No. AID-674-A-12-00015.