[gender-aids] Men, HIV and AIDS Regional Conference 2003

[gender-aids@healthdev.net]

Men, HIV and AIDS Regional Conference 2003
Regional AIDS Initiative of Southern Africa/VSO
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Posted August 7, 2003 on Aids-Africa 
[http://www.yahoogroups.com/group/aids-africa]

Executive Summary by Mercedes Sayagues

Full conference report available at: 
http://www.kubatana.net/docs/hivaid/vso_men_aids_2003.pdf

"Besides deep changes in society, what we need is a deeply spiritual
transformation in the identity of men."

This statement by a participant sums up the debates at a conference on
MEN, HIV & AIDS organised in Pretoria by the Regional AIDS Initiative of
Southern Africa (RAISA) of Voluntary Service Overseas (VSO) between 11-13
February 2003. Seventy-one participants, mostly from Southern African
countries with a few from East and West Africa, examined how to engage men
in the response to the HIV/AIDS pandemic.

In the region, national adult HIV prevalence has risen, says UNAIDS,
"higher than thought possible, exceeding 30% in Botswana (38.8%), Lesotho
(31%) and Zimbabwe (33.7%)." Namibia follows (22.5%), Zambia (21.5%) and
Malawi (15%). South Africa's estimated 13% prevalence translates into 4.5-
4.7 million people infected.

Twenty years into the pandemic, the bulk of studies and interventions have
centred on women and girls. There is greater understanding of the gender
dimensions of HIV/AIDS but little funding and effort has gone into working
with men, especially young men. Many interventions fail because they do
not take into account the identity constructions of the men who interact
with women and girls as partners, husbands, fathers, teachers and so
forth.

The VSO-RAISA conference provided an unusual and very needed space for
reflection and discussion among activists, researchers, and people
involved in service delivery and/or advocacy around HIV/AIDS. The
conference was structured around 10 parallel streams: Enlisting men as
people living with HIV/AIDS; Men in prevention and advocacy; Marketing;
Home based care; Man to man transmission; Male reproductive health; Boy
child and construction of masculinity; Boy child and peer pressure; Men
and cultural beliefs; Stigma and Violence.

A description of the main threads of analysis follows, weaving patterns of
how men in Southern Africa relate to HIV/AIDS. A key issue is that deeply
held notions of masculinity lead to high-risk behaviour for HIV infection
among men and women. Research and surveys across the region show that men
are socialised into a notion of masculinity as sexual prowess, risk-taking
behaviour and male dominance and superiority over women. At the same time,
men perceive their privileged space in society to be under threat from
socio-cultural changes taking place in the region. These include
rural/urban migration, Western culture seeping through mass media and the
entrenchment of women's rights. "Many men are feeling a bit hopeless, like
there's no place for them in the world." The sense of loss undermines
men's motivation for safe sex.

A study of how masculinity is constructed in schools in KwaZulu Natal
found that the conflict between traditional and contemporary gender roles
generates in boys and men a sense of displacement and irrelevance that
cuts across race and class. White students and teachers feel threatened by
the advancement of blacks and women. Black pupils and teachers fear
women's new status, poverty and unemployment.

Similar findings emerged in a survey by the University of Witwatersrand on
risk-taking behaviour among youth in Soweto, South Africa's largest
township, where nearly half of young men are unemployed. "If you have no
job and no future, life becomes cheap, and sex is a dangerous
entertainment fuelled by boredom, alcohol and poverty."

From the other end of the social spectrum, a survey among traditional
healers, chiefs and Zionist priests by the Promotion of Traditional
Medicine Association of South Africa (Pro-me-tra) found that men feel
socially disoriented through a loss of leadership position in family and
community. "Men have become spectators, irresponsible and indifferent."
Traditional practices, however, make up male identity and to attack them
is self-defeating, says Prometra. Better to tap into the traditional
notion of men being responsible for their families. Male circumcision,
wife inheritance, scarification and polygamy can be managed responsibly
"in safe and best practice" if people are accurately informed about HIV
infection risks.

Many, if not most men, do not engage in risk behaviour - i.e. promiscuity,
irregular or no condom use, violence, alcohol and drug abuse - but they
have little visibility in the predominant discourse of "men as drivers of
the epidemic."

According to the Centre for the Study of Aids at the University of
Pretoria, which works with marginalised young men - unemployed, junkies,
bodybuilders, drag queens and male sex workers, negative male images
channelled by the media and by society are internalised by young men and
turn into a self-fulfilling prophecy. "There is more rejection than
inclusion. As a result, young men feel blamed for all social evils and
withdraw."

There was consensus that blaming and scapegoating are not productive or
helpful and undermine male selfesteem. "The men-drive-the-epidemic slogan
has outlived its usefulness." "We shouldn't blame men, women or culture
but take responsibility."

Another common thread is the pervasive silence surrounding male sexuality.
Parents don't talk about sex with their children. Husbands don't talk with
their wives. Men generally feel uncomfortable discussing intimacy. Their
reproductive health needs remain invisible.

At the National Association for People Living with HIV/AIDS in Malawi
(NAPHAM), nine out of ten male members would not disclose their HIV status
to their spouses. Secrecy brought stress, risk of infection for the wife
through unprotected sex, and inability to change lifestyle and live
positively. But when NAPHAM started support groups for couples, 65% of men
brought their wives. Male membership increased. "The groups enabled men to
talk."

"Men need opportunities to explore and talk about their sexuality in
non-threatening environments," concluded a regional survey by Southern
African AIDS Information and Dissemination Service (SAfAIDs).

Zimbabwe's Men Forum Padare/Enkudleni reaches boys and men in schools,
pubs, sports clubs and churches, where they can debate, in a
non-threatening space, issues of sexuality, masculinity and power. So does
South African Men's Forum (SAMF). "We need to challenge this destructive
concept of manhood that men make all decisions, men need many sex
partners."

The wall of silence is finally crumbling around the last taboo topics in
Africa - male rape and male-to-male sex. Some political and religious
leaders have denounced gay men and women as un-African although 19th
century ethnographic research documents sex between men in Africa.
Politically constructed homophobia has a negative impact on public health
because it excludes homosexuals from prevention and awareness campaigns,
making them vulnerable to HIV infection. A combination of research and
activism is breaking the silence about men who have sex with men across
race and class.

Researchers at UNISA in South Africa and the Population Council in Kenya
reported on the sexual and reproductive health needs of men who have sex
with men. A study of black, gay and bisexual men in Katutura township,
Namibia, found they experience verbal, physical and sexual forms of
assault and discrimination from hospital staff, police, army and church
officials. Facing barriers in employment, they turn to (unsafe) commercial
sex work.

That sex happens among male prisoners is now acknowledged even by
correctional services. The Prison Fellowship of Zambia described its
project to bring AIDS awareness, peer counselling and condoms into
prisons. With HIV prevalence of 27-30% in its crowded prisons, Namibia
offers counselling to prisoners but not condoms because it could be seen
as encouraging sodomy, which is a criminal offence.

Male rape, possibly the last frontier in public debate, was brought into
the conference by Men United, a South African group dedicated to breaking
the silence about male rape, providing support and care for survivors and
their families, and educating youth to speak out against all sexual abuse.

Some success was noted in men's involvement in home based care, reversing
the tradition that nursing the sick is a female domain. Tovwirane in
northern Malawi and Kara Counselling in southern Zambia have growing
numbers of male care givers. Chiefs and church leaders help identify
volunteers who are provided with training, bicycles and team support.

The conference showcased a number of male-centred AIDS awareness
initiatives in the region, with migrant miners in Zimbabwe, through soccer
games in Zambia, and with adolescents in Malawi. The Southern African
Men's Network, formed in October 2002, seeks to amplify small local
initiatives into visible and structured actions, and to mobilise national
men's movements.

A vigorous debate centred on the role of African culture(s) in shaping
masculinity. A consensus emerged that traditional culture is dynamic, it
changes and adapts, and can accommodate and shape a different construction
of masculinity.

After 20 years of rampant spread, AIDS is driving changes in male
behaviour in Southern Africa. "Men's perceptions of identities are
changing." These changes need to be followed-up and supported.

Participants agreed that the concept and practice of masculinity needs to
be reconstructed in ways that fit new socio-economic realities, from
rural-urban migration to women's advancement, AIDS and unemployment. A new
way of perceiving manhood would empower men to live their sexuality
differently and to take active community responsibility. Such efforts
should be grounded in a culture of human rights that can bridge cultural
differences and span the variety of situations men experience, i.e., rural
and urban, old and young, heterosexual and gay, single and married, etc.
The notions set out in the UN Declaration of Human Rights provide a common
ground for the complex and conflictive task of renegotiating gender power
relations.

Summing up the conference, one participant said: "Men should think not
about what we stand to lose but what we stand to gain."


Source: AFRICA ACTION - Africa Policy E-Journal, August 17, 2003

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