Men and HIV - masculinity are fuelling the global HIV/AIDS pandemic

July 19th, 2009

 

Introduction:

Traditional ideas of masculinity are fuelling the global HIV/AIDS pandemic. Around the world men continue to wield the power in the majority of sexual relationships, an imbalance that often robs women of the ability to make decisions relating to their health or status. In Africa, traditional gender roles often leave women with the sole burden of caring for those suffering from AIDS-related illnesses.

The percentage of men participating in HIV prevention, care and support efforts has typically been lower than that of women. For example, men test for HIV and access ARV treatment in significantly smaller numbers than do women. Enlisting men in the fight against HIV is imperative to lowering vulnerability to the virus for both sexes.

The Numbers:

In sub-Saharan Africa, at least 9,200,000 men aged 15 or older are estimated to be HIV-positive, according to the UNAIDS 2006 Report on the Global AIDS Epidemic. At the beginning of the epidemic in sub-Saharan Africa, HIVinfected men vastly outnumbered HIV-infected women; today, the situation in most countries is reversed. According to the same UNAIDS report, African women are being infected at an earlier age than men, and the gap in HIV prevalence between men and women continues to grow.

The Issues:

1. What role do male attitudes and behaviours play in HIV transmission?

Research has found men’s beliefs about manhood are the strongest predictor of risk-taking behaviour. These beliefs include the idea that “real” men have uncontrollable sexual needs, multiple and often younger partners, drink alcohol, and use violence or intimidation to get what they want. Expectations that men should be more knowledgeable and experienced than women about sexual matters may also prevent them from seeking information about sexual health problems.

Studies demonstrate the link between these attitudes and behaviours, and women’s increased vulnerability to HIV/AIDS: A 2004 survey of 1,500 South African women found those with violent or controlling partners were at a higher risk of HIV infection.

Traditional gender roles also increase the risk of a man being infected by and passing on HIV. Driven partly by stereotypes equating an increased number of sexual partners with increased sexual prowess, UNAIDS says that men - regardless of culture - tend to have more sexual partners than women. Although men might be aware of the dangers posed by HIV, ingrained notions of masculinity will often lead them to put themselves - and their partners - at risk. For example, the idea that “real” men have only “skin on skin” (unprotected sex) thrives in many African countries. Stereotypes also put men and their partners at greater risk: some men believe only promiscuous women carry condoms. Men might also be pressured by their peers to use alcohol or drugs, which often results in lower condom use and riskier, more careless behaviour. In one South African survey, young men were twice as likely as women to report having sex under the influence of alcohol

See: “HIV and Sexual Behaviour Among Young South Africans: A National Survey of 15-24 Year-Olds”

http://www.kff.org/southafrica/upload/HIV-and-Sexual-Behaviour-Among-Young-South-Africans-A-National-Survey-of-15-24-

Year-Olds.pdf

2. Why do men tend to be less involved in HIV/AIDS care and support efforts?

Persistent gender stereotypes often mean that women are expected to be sole caregivers for orphans, children, or other community members suffering from AIDS-related illnesses. Young girls are being forced to leave school  in growing numbers to care for sick relatives or help with household chores. Grandmothers are often left with the sad task of raising their orphaned grandchildren.

Why are men not working alongside women to care for the sick? In focus groups and workshops organised by the Men as Partners Network, South African men said they feared being ostracised or ridiculed by other men if they participated more actively in domestic activities, including care and support. Some even said their female partners did not want their help. They said their partners were worried others would accuse them of being lazy, incompetent or even of bewitching their husbands. Other men said they simply never learned the skills necessary to care for someone living with HIV/AIDS (Peacock, D, 2003).

3. Why aren’t more men seeking out HIV testing, prevention and treatment services?

Voluntary counselling and testing (VCT) services are cornerstones of HIV/AIDS prevention and treatment efforts, yet men test in much lower numbers than women.

A 2004 South African study found that, of 11,900 young men and women surveyed, only 15 percent of the men reported having had an HIV test, compared to 25 percent of the women. The large gap is partly explained because women are more likely than men to come into contact with VCT services at antenatal clinics and other womenonly health services. But the lack of male-centred VCT clinics is only part of the story. Gender stereotypes also act as a deterrent - men who show emotion or seek medical help are often seen as “weak” or simply “unmanly”.

Men’s reluctance to be tested can have devastating effects on their partners. Lack of male involvement has been identified as a major impediment to the success of prevention of mother-to-child transmission (PMTCT) programmes.

Studies show that pregnant women are less likely to agree to an HIV test if they fear their partner’s reactions. For those who do, participation in PMTCT programmes or their freedom to make appropriate feeding choices may be limited without disclosure to partners.

A smaller percentage of men than woman know their HIV status, which may explain why they are less likely to seek and use antiretroviral (ARV) treatment and why they wait until much later stages of HIV infection to seek any government treatment. A 2006 assessment of South Africa’s treatment programme found more than twice as many women as men were accessing ARVs through public healthcare facilities. Consequently, NGOs such as the Imbizo Men’s Health Project in the Johannesburg township of Soweto have identified the need for free male-only clinics where men can test and receive counselling from male staff.

4. Why are men who have sex with men particularly vulnerable to HIV?

Widespread denial and stigmatisation of homosexuality in much of Africa has often caused men who have sex with men (MSM) to be overlooked as a vulnerable group. South Africa alone has enacted laws against discrimination based on sexual orientation. In other countries, homosexuality is still illegal and often considered a corrupt “unAfrican” practice.

Openly gay men often face social ostracism and a greater threat of violence, increasing their HIV risk. According to a Kenyan study, nearly 40 percent of surveyed MSM had been raped. The dangers associated with living as an openly gay man mean that many MSM don’t identify as gay and often have female partners, in addition to their male partners. The necessity of living their lives in the shadows may push them to put themselves and their female partners at risk.

The stigmatisation and isolation of homosexuals in Africa makes them more difficult to reach with HIV/AIDS prevention messages and treatment services. The Kenyan study noted above found that many MSM do not possess vital information about the danger of condom-breakage when used with oil-based lubricants. Meanwhile, HIV prevalence among MSM is often much higher than in the general population.

See: “SENEGAL: HIV-positive gays face double stigma”

http://www.plusnews.org/AIDSreport.asp?ReportID=5696&SelectRegion=West_Africa

5. What role might male circumcision play in HIV prevention?

A 2005 clinical trial conducted in South Africa found circumcised men were 61 percent less likely to contract HIV, leading campaigners to call for national male circumcision programmes. Most countries are postponing a decision on such a programme until the results of two additional trials underway in Kenya and Uganda become available around September 2007. Swaziland and Zambia have, however, already launched national programmes encouraging men to be circumcised. Botswana has passed legislation requiring maternal counselling about the potential protective benefits of circumcision for infant boys.

The social and cultural implications of implementing large-scale circumcision programmes in countries where it is not traditionally practiced will require more study and discussion. Experts and governments have also voiced concerns that without sufficient counselling, men may view circumcision as an alternative to using condoms rather than an additional protection against HIV.

Male-focused HIV programmes

In the last decade, research linking gender, gender-based violence and HIV has resulted in a greater incorporation of men into HIV programmes in Africa. It has also led to the emergence of programmes specifically targeting men.

Details of some of the programmes are listed below.

Nigeria

Pathfinder International

www.pathfind.org

Pathfinder International is using male involvement initiatives to enhance the effectiveness of its reproductive health services in Nigeria. They are working with army and police officers in Kaduna, transport workers in Patani, and male business leaders in Aba.

Malawi

National Association of People Living with HIV/AIDS in Malawi (NAPHAM) Olive Moyo, Communications Officer

Tel: +265 (0)9 510 706

Email: omoyo@napham.malawi.net

The National Association of People Living with HIV/AIDS in Malawi (NAPHAM) is targeting men at their workplaces and social settings to be tested in greater numbers, and counselling those who test positive to disclose to their partners. NAPHAM also runs training sessions for men on how to live positively and cope with their status, how to provide home-based care and run income-generation projects such as vegetable gardens.

Mozambique

Jovens para Mudança e Acção (JOMA)

Joma.pcmoz.org

Bern Moorehead

Tel: +258 847 460-103

Email: moorehead@alumni.unc.edu,

Jovens para Mudança e Acção (JOMA), or ‘Young Men for Change and Progress’, was started in 2005 by a group of Peace Corps volunteers in partnership with several local organisations. It targets young Mozambican men in secondary schools with the aim of developing their capacity to think critically about gender roles in Mozambique and then develop healthy behaviours. The young men are encouraged to design and implement ‘microprojects’ such as forming theatre groups, painting murals or making documentaries to raise awareness in their schools and communities.

South Africa

Men as Partners Programme (MAP)

The Men as Partners Programme (MAP) uses educational workshops, community mobilisation and awareness-raising events to challenge gender stereotypes that contribute to HIV infection, and to increase male participation in HIV/AIDS prevention, care and support.

EngenderHealth

www.engenderhealth.org

Mokgethi Tshabalala, Country Director for South Africa

Tel: +27 (0)11 833-0504

Email: mtshabalala@engenderhealth.org

EngenderHealth is an international reproductive health NGO that coordinates a network of local affiliates to implement MAP programmes. Interviews with men who have participated in MAP activities found that the programme has been effective in increasing knowledge of HIV/AIDS, changing gender attitudes and reducing risky sexual behaviour.

Zimbabwe

Padare/Enkudleni/ Men’s Forum on Gender

Charles Chigwada, Home-based Care Male Involvement Officer

Tel: +263 (0)4 799-047

Email: padare@mweb.co.zw

Padare/Enkudleni/ Men’s Forum on Gender brings men together to discuss cultural and social issues related to gender justice and equality. The group trains men to provide home-based care to people living with HIV and runs high school clubs aimed at getting boys involved in HIV prevention, care and support.

Kenya

Movement of Men Against AIDS in Kenya (MMAAK)

www.mmaak.or.ke

Michael Onyango, Executive Director

Tel: +254 020 787-836

Email: monyango@mmaak.or.ke

The Movement of Men Against AIDS in Kenya (MMAAK) encourages “positive masculinities” and supports men’s greater involvement in the fight against HIV/AIDS. The organisation has established groups for men infected and affected by HIV in Nairobi, Mombassa, Karatina, Kericho and Kisumu. They’ve also worked with schools to start young men’s groups and with employers to create Positive Workers’ Unions.

MMAAK recently published a training manual to help organisations start their own men’s HIV/AIDS support groups.

Key Web Sites and Documents

The Interagency Gender Working Group (IGWG), a network of NGOs and international agencies including USAID, has produced an electronic brochure listing many of the key resources for working with men in the context of sexual and reproductive health: http://www.igwg.org/pdf/IGWG_SysteMALEtizing.pdf

Barker, G & Ricardo, C: Young Men and the Construction of Masculinity in Sub-Saharan Africa: Implications for HIV/AIDS, Conflict and Violence, Social Development Papers, No. 26/June 2005. (Link to file from IGWG document above).

Chege, J: Interventions linking gender relations and violence with reproductive health and HIV: rationale, effectiveness

and gaps, Agenda Special Focus 2005 (http://www.popcouncil.org/pdfs/frontiers/journals/Agenda_

Chege05.pdf).

Peacock, D: Men as Partners: Promoting Men’s Involvement in Care and Support Activities for People Living with HIV/AIDS, prepared for the Expert Group Meeting on the Role of Men and Boys in Achieving Gender Equality, 2003.

The Population Council conducted a study in Nairobi, Kenya, to better understand the levels of vulnerability to HIV of men who have sex with men, a group often overlooked by policymakers in Africa and elsewhere. The document, ‘Understanding the HIV/STI risks and prevention needs of men who have sex with men in Nairobi, Kenya’ can be downloaded at (http://www.popcouncil.org/pdfs/horizons/msmkenya.pdf).

 

source.www.irinnews.org