Men to take the lead in HIV prevention
By Charlotte Sutherland(1)
It is often assumed that HIV & AIDS prevention is women’s responsibility only, but several voices recently pointed out men as the ones who should step up to the challenge of preventing HIV infection. Although changing irresponsible behaviour and so-called cultural beliefs is no simple task, the mammoth challenge of curbing HIV & AIDS desperately requires the involvement of those who most often have the power to determine the conditions of sexual intercourse - men. This month’s newsletter explores the complexities that define the HIV & AIDS prevention crisis, with a view to portray men as powerful agents who need to take seriously their own health risks as well as the risks they can subject other community members to.
MEN SHOULD TAKE RESPONSIBILITY FOR PREVENTION
In Namibia, World AIDS Day on 1 December was commemorated with an international theme of “leadership” and more specifically, the national theme “Men take lead to care”. This theme attempts to establish a clear link between men, leadership and HIV & AIDS prevention. It is hoped that men will make use of condoms more consistently and reduce infidelity if they take leadership on the prevention front. This call on men is underpinned by the fact that, according to Namibia’s Ministry of Health and Social Services, only 30% of people who have been tested for HIV & AIDS in the Caprivi area are men. Knowing your status is obviously integral to taking responsibility for preventing the spread of HIV & AIDS, but in this case men seem oblivious to the urgent necessity that underpins prevention campaigns.
The role of men in the spread of HIV & AIDS is further highlighted in South Africa by the latest ‘Real Men Don’t Rape’ advert. This advert uses the popular music star, Zola, to talk about things that South Africans can be proud of, such as the Rugby World Cup victory. While he folds and puts away the South African flag that citizens are so proud of, Zola says that South African men cannot be proud of the country’s rape statistics – they are held accountable for the fact that 500,000 women are raped in South Africa each year. Kevin Aspoas, the Managing Director of Jupiter Cape Town, the company behind the concept for the advert, feels that "it is time that men start to take ownership. Rape is an issue that is usually addressed by women in the media. It needs to start becoming a male issue". A shift is occurring in public discourse, from women as victims of rape to men as powerful agents who can change rape statistics.
The opening ceremony of the 16 Days of Activism for No Violence Against Women and Children in South Africa echoed the identified link between violence against women and children and HIV infection rates. Women and children are portrayed as increasingly vulnerable to violence. This is true not only in South Africa, but also in Africa as a continent. The contexts that women have to negotiate are often characterised by gender-based violence, but interventions designed to reduce women’s risk of contracting the virus often neglect this fact. Interventions are not always designed to fit the contexts they are applied to: “…it ignores the adverse effects sexual relationships between men and women have on a woman’s ability to adopt and maintain HIV/AIDS preventive behaviour”. This is according to Dr. Bosom Tumusiime from Mulago Hospital, who spoke at a United Nations Women’s Fund (UNIFEM) event in Uganda in December 2007.
RISKY BEHAVIOUR AND ECONOMIC CONTEXT
Changing the socio-cultural perceptions that inform sexual behaviour is a daunting challenge faced by African societies. These perceptions vary according to historical context, hence each society needs to address specific issues unique to its history. For example, a study in the South African Lowveld(2) found that the attribution of blame for HIV & AIDS reveal gendered concerns: while women subscribed to a biomedical model of origin and generally blamed men for the spread of the virus, men used conspiracy theories to blame translocal agents. These gendered concerns illustrate women’s identification with the domestic and men’s identification with the political domain. Men’s humiliating experiences of the apartheid context and migrant labour system, as well as current job losses and deindustrialisation, inform their perceptions and hence risk behaviours. In this case the men completely distrust biomedical involvement in HIV & AIDS, while women, despite the fact that they are open to biomedical intervention and management of HIV & AIDS, struggle to negotiate the conditions of sex with men. This struggle intersects intimately with the fact that many African women are financially dependent on men and hence need to sacrifice their sexual health in order to maintain their livelihood.
The effects of deindustrialisation and unemployment on male behaviour are further documented in Tanzania and Kenya(3) , where, despite contextual differences between urban and rural settings, women find themselves increasingly responsible for maintaining households, while men struggle to fulfil the ideology that prescribes their role to be that of provider and head of the household. Men face unemployment and financial impotence and women utilise their amplified invaluable positions as providers to assert their rights against male dominance, for example by accusing men of being incompetent providers who let down their families. Economic marginalisation has been found to have a significant impact on men’s self-esteem and depression levels, a phenomenon men compensate for by developing “macho” attitudes that are accompanied by physical violence against women. When men feel that they have lost control over their wives and households, they turn to prostitutes and multiple sex partners. Men’s risky sexual behaviour must be understood as stemming from the disparity between the historical social construction of masculinity as tough and providing, and the context that currently sees that male financial power being eroded by broad structural processes they have no control over.
SOCIAL FACTORS AND HIV & AIDS
Besides these economic factors, the rationale behind male responsibility for HIV & AIDS prevention is complicated by many socio-cultural factors. Many myths exist around the origin and spread of the HIV virus. While some men see HIV & AIDS as a disease that punishes those who do not follow custom, others argue that only prostitutes carry the virus and hence that married men do not need to use condoms. At the same time, wives who request condoms are accused of infidelity and such accusations inflict shame and stigma on women. Male infidelity is common, however, and polygamy is also widely practiced. While women may perceive female condoms as empowering, men often regard it as a threat to their masculinity, and sometimes as used by women to collect sperm to bewitch men and even as laced with HIV(4).
Prostitution is another complex role player in the spread of HIV & AIDS. The sex industry shows women no mercy – most of them are in it due to poverty and lack of opportunity and the competition between sex workers has several dimensions. On the one hand, the cheapest offer gets the job; on the other, the sex worker is stigmatised as HIV positive if she insists on condom use. Such stigma will directly influence her livelihood. This way, men get sex the way they want it – unprotected and cheap, with no consideration of the ripple effects of their actions as they go home and spread the virus to others.
It is imperative that men take leadership on this issue, not because women are too weak to take leadership themselves, but because the power dynamics in relationships do not always allow women to negotiate their sexual health. In Zambia, for example, a social structure where women have lesser land rights and are financially dependent on men, combined with patriarchy, results in a socio-cultural-economic environment that seriously hamper women’s efforts to visit clinics and take HIV & AIDS related medication. According to a Human Rights Watch report(5) , husbands who become cognisant of their wives’ positive status often divorce them and lesser land rights then result in impoverishment of the woman, since she ends up with no land and often, no income. Wives who are not divorced upon their husband’s realisation of their status are subjected to physical and emotional abuse. As a result women who dare to seek treatment resort to keeping secret their clinic visits and HIV status and hide their medication in plant pots and in mealie meal, in order to avoid the severe physical abuse and impoverishment that follows, should a husband find out his wife’s HIV-related activities. In this case, the Zambian state fails its women: there are laws that protect women against domestic abuse, but customary practice keep women dependent on males by preventing them from owning substantial, if any, pieces of land.
Africa is and has been host to many wars. Sexual violence is regularly used as a weapon of war, yet even members of peacekeeping forces such as the United Nations have been found guilty of raping the women they were supposed to protect. In Sudan, the Janjaweed militia is not only responsible for thousands of deaths, but have also raped countless women, spreading the HIV virus and re-infecting women. Darfurian women recently called for international action to address this issue, which they perceive as a massive obstacle in the way of implementing their human rights.
MALE INVOLVEMENT
What does ‘male involvement’ mean when we talk about HIV & AIDS prevention? And more importantly, how do we operationalise it, given the complex contextual factors that harness the gendered dynamics that permit the spread of HIV & AIDS? No easy solutions exist, but we must keep in mind that all men are not alike. The male category should not be essentialised in support of portraying women as victims and men as perpetrators. Raising awareness of the fact that men and women will benefit equally from responsible sexual behaviour is a step towards focusing on the fact that men, too, are putting themselves at risk when they engage in unsafe sex. Some argue that education alone cannot change beliefs, cultures and traditions, but within the human rights framework, little can be done that does not impede on the freedom to choose. It is now common academic knowledge that men should reduce the number of sex partners they have, use condoms consistently and get tested for HIV, but community interventions that chase these goals have yet to manifest effectively to a significant extent. Ultimately, the onus rests on present day society to educate the adults of tomorrow about HIV & AIDS and the devastating effect this epidemic has on communities.
(1) Charlotte Sutherland is Gender Specialist: Gender Issues in Africa, at Consultancy Africa Intelligence (officesa@consultancyafrica.com)
(2) Niehaus, I. & Jonsson, G. 2005. “Dr. Wouter Basson, Americans, and Wild Beasts: Men’s Conspiracy Theories of HIV/AIDS in the South African Lowveld.” in Medical Anthropology, 24:179-208.
(3) See Silberschmidt, M. 2004. “Men, male sexuality and HIV/AIDS: Reflections from studies in rural and urban East Africa” in Transformation 54.
(4) Niehaus, I. & Jonsson, G. 2005. “Dr. Wouter Basson, Americans, and Wild Beasts: Men’s Conspiracy Theories of HIV/AIDS in the South African Lowveld.” in Medical Anthropology, 24:179-208.
(5)The report was released in 2007 and is called “Hidden in the Mealie Meal: Gender-Based Abuses and Women’s HIV Treatment in Zambia”.
(2) Niehaus, I. & Jonsson, G. 2005. “Dr. Wouter Basson, Americans, and Wild Beasts: Men’s Conspiracy Theories of HIV/AIDS in the South African Lowveld.” in Medical Anthropology, 24:179-208.
(3) See Silberschmidt, M. 2004. “Men, male sexuality and HIV/AIDS: Reflections from studies in rural and urban East Africa” in Transformation 54.
(4) Niehaus, I. & Jonsson, G. 2005. “Dr. Wouter Basson, Americans, and Wild Beasts: Men’s Conspiracy Theories of HIV/AIDS in the South African Lowveld.” in Medical Anthropology, 24:179-208.
(5)The report was released in 2007 and is called “Hidden in the Mealie Meal: Gender-Based Abuses and Women’s HIV Treatment in Zambia”.
Visit Consultancy African Intelligence
Subscribe to one of our Newsletters Today
| Attachment | Size |
|---|---|
| Consultancy Africa Intelligence - Gender Issues in Africa - Newsletter - February 2008.pdf | 131.28 KB |