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Current Spanish usage describes any kind of competition between two people where they both compete trying to outdo each other.
Within the Doce Pares Eskrima fighting system, it is one of the three ranges of engagement, specifically the closest one. This does not indicate solely unarmed combat.
This term has been adopted in English with similar meaning, possibly by Ernest Hemingway. The English adoption can be likened to the phrases "one on one", "head to head", or "single combat" and conveys the idea of intense competition.
It is commonly misunderstood as a cognate by English speakers who think that the term means "man to man", such as in the 2009 MTV Movie Awards, where presenters for Best Kiss, Sandra Bullock and Ryan Reynolds, referred to two gay kisses nominated as "mano a mano".
French sometimes use this expression in a blend of the Portuguese and Spanish meaning. “Donner quelque chose de mano y mano” means to give something to someone in person, with direct physical contact (as opposed to using an intermediary, be it a common friend, a phone call or an e-mail).
Mano a Mano International is a non-profit organization which transfers surplus medical equipment from the US to Bolivia.