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MEN, HIV & AIDS regional conference 2003
Regional AIDS Initiative
of Southern Africa/VSO
February 28, 2003
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Summary by Mercedes Sayagués
deep changes in society, what we need is a deeply spiritual transformation
in the identity of men."
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 Africaís estimated 13% prevalence
translates into 4.5- 4.7 million people infected.
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.
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.
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 womenís
rights. "Many men are feeling a bit hopeless, like thereís
no place for them in the world." The sense of loss undermines
menís 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 womenís new status, poverty and unemployment.
emerged in a survey by the University of Witwatersrand on risk taking
behaviour among youth in Soweto, South Africaís 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
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."
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 shouldnít blame men,
women or culture but take responsibility."
thread is the pervasive silence surrounding male sexuality. Parents
donít talk about sex with their children. Husbands donít 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."
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).
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 Menís Forum (SAMF). "We need to challenge this destructive
concept of manhood that men make all decisions, men need many sex
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.
at UNISA in South Africa and the Population Council in Kenya reported
on the sexual and
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
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.
was noted in menís 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.
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
Menís Network, formed in October 2002, seeks to amplify small local
initiatives into visible and structured actions, and to mobilise
national menís 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
After 20 years
of rampant spread, AIDS is driving changes in male behaviour in
Southern Africa. "Menís perceptions
of identities are changing." These changes need to be followed-up
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 womenís 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."
the VSO Zimbabwe fact sheet
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