Men battling discrimination and HIV/AIDS

Date: January 1, 1970
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Long before anyone heard of HIV/AIDS, women and girls experienced discrimination and oppression based on gender related factors. HIV and AIDS merely exacerbated the prevailing situation of inequality and injustice in Southern Africa and many other parts of the world.

While analysis of gender often focuses on women, rigid gender roles affect the health of both men and women. Moreover, these roles affect the behaviours of both men and women, something national strategies and messages must consider if we are to contain the pandemic.
There are long standing socio-cultural factors that make women and girls in Southern Africa more vulnerable to HIV. They are often less able to protect themselves or fight for their rights.
Rape and sexual violence are quite common in the region. Though there has been some positive changes, women are usually less educated and by extension less economically independent than men, and more disproportionately saddled with household work. Moreover, in most Southern African countries, lack of good legal structures, or their poor implementation, still allow discrimination against women.
The question of unequal gender relations is one of the most serious underlying factors that fuel the pandemic. For example, many women are not able to either negotiate for safer sex nor make overall decisions about their reproductive health. This leaves them vulnerable to poverty, dependency to their male counter parts, and sexual violence.
Socio-cultural roles affect men as well. Researchers suggest that gender is one of the most important determinants of health behavior. Men often engage in fewer health-promoting behaviors and have less healthy lifestyles than women have.
Similarly, other studies document the effects of “masculine ideology” on condom usage and sexual and reproductive health in general. These indicate that traditional men’s gender roles lead to negative attitudes about condom use.
As is indicated by a number of recent studies, these gender roles leave men vulnerable to HIV and decrease the likelihood that they will seek voluntary counseling and testing services or access medical services until they are already very ill. 
A study of anti-retroviral (ARV) treatment in Johannesburg conducted between April and June of 2004 reported that women accessing ARV’s outnumbered their male counter parts. Many men only access ARV’s when they are very sick.
There are many mixed messages sent to the nation and few positive men as role models. By not teaching men to reform such behaviors, or not including them in projects, our efforts to curb the spread of HIV/AIDS will not work.
In South Africa research shows that HIV/AIDS messages have reached more than 80% of the population. Yet, why are we still having the highest number of new infections though we have adequate condom distribution rates? Why do we have high rates of stigma and gender based violence, and little behavioral change?
In Uganda, the central message for the nation over and above the ABC approach was that of no to multiple sexual partners including casual sex. South Africa sends out both messages that portray HIV as life threatening, and those that offer hope.
Different kinds of messages can cause confusion, particularly when people are struggling to identify their own gender roles.
Swaziland has recently launched centralised HIV messaging. One set of messages talks about the need for life and the other about being faithful to one partner. I believe that this will yield  a positive response from the nation.
I am not suggesting that we discard a holistic approach to our HIV prevention and care strategies, but am stressing the need to prioritise and centralize behavioural change messaging. Within this messaging, it is important to include strong male role models.
Most of our current HIV strategies focus on challenging men to stop certain behaviors, or point a finger of blame at men. This leaves men with a perception of being alienated.
It is also imperative to accept that men are not a homogenous group. Therefore, an inclusive approach is that provides spaces to work with men as solution seekers are crucial.
I am not suggesting that men who have perpetrated any form of violation or practiced injustice should be treated with soft gloves. Rather defining masculinity narrowly will miss the underlying factors of certain behaviors. These factors need urgent attention to fill in the gaps and redress harmful beliefs and perceptions.
Researchers and strategy formulators have done a lot, but I think it is time to focus efforts on increasing the capacity communities to be HIV and gender competent.
This will mean inclusive strategies that increase male involvement in gender and HIV programmes, addressing men’s fears and negative beliefs and perceptions. Perhaps one or two national HIV messages that the nation can identify, that include men, will help to encourage understanding.
We must work with communities to help build skills and educated people about gender equality and human rights, Communities should be included in planning and implementing HIV related projects.
Overall, as we develop these strategies, we must work to create safe spaces for men and women to dialogue, so that both genders can play their full role in coping with HIV/AIDS.
(Dumisani Rebombo is a gender activist working for EngenderHealth South Africa as a Program Officer within the Men as Partners (MAP) program. This is part of a series of articles produced by the Gender Links Opinion and Commentary Service for the Sixteen Days of Activism on Gender Violence.)

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