Patriarchal structures and stereotyped notions of gender hide the increasing disempowerment of many men in rural and urban East Africa. Socioeconomic change has left men with a patriarchal ideology bereft of its legitimizing activities. Unemployment or low incomes prevent men from fulfilling their male roles as head of household and breadwinner. Women's roles and responsibilities have increased. This affects men's social value, identity and self-esteem. Multi-partnered sexual relationships and sexually aggressive behavior seem to strengthen male identity and sense of masculinity. Strategies to improve sexual and reproductive health must take into account how socioeconomic changes have affected traditional gender roles and male sexual behavior.