HIV & AIDS prevention as a future oriented endeavour
By Charlotte Sutherland(1)
Following on from last month’s discussion on the complexities surrounding the prevention of HIV & AIDS, this month’s newsletter explores HIV & AIDS prevention as a future oriented endeavour particularly looking at those who hold the key to an HIV & AIDS free generation: male youth. Targeting the men of tomorrow is central to curbing HIV infection rates. However, the intergenerational dynamic that occurs in the learning of behaviour and acceptance of conceptions complicate the prevention of HIV & AIDS. The adults of tomorrow grow up with the men of today, watching them, listening to them, and ultimately deciding for themselves what kind of attitude and behaviour to adopt towards women and sexual practice. In the light of this intergenerational dynamic, multi-level interventions are needed. It is crucial for these interventions to target men and boys, not as perpetrators, but as powerful agents who are imperative to communal well being, and women and girls, not as victims but as agents who optimise and negotiate their well being as best they can. Moving beyond the perpetrator-victim dichotomy poses many challenges to intervention planners, but considering contextual specificities, could be a first step towards creating interventions that encourage responsible and non-violent sexual behaviour.
MASCULINITY AND CONDOM USE
Men generally have the power to enact safe sexual practice, but despite the availability of condoms, they remain unpopular among men. Several reasons for the ‘hated’ status of condoms among African men have been documented and can be argued to constitute a foundational issue in the quest to render adult men responsible role models. In sum, condom use stands in sharp contradiction to present day conceptions of masculinity. For example, males feel they are expected to exercise sexual control and be more knowledgeable than women, but using a condom means changing behaviour on a woman’s request and admitting to a degree of ignorance about sexual health. Condom use furthermore implies that men should de-prioritise the defining principle of heterosex - male sexual pleasure - in the interests of health. Condom use also entails a degree of control over one’s sexuality, but men are brought up to see male sexuality as a ‘natural’, barely controllable force. These are just some of the reasons for male aversion to condom use. Contextual specificities obviously complicate gender dynamics when it comes to HIV & AIDS prevention and it is useful to keep in mind that, despite being agents with choice, men may be trapped in societal conceptions of masculinity. Interventions would thus have to target conceptions of masculinity in order to reconfigure it as gender-just, non-violent and responsible.
YOUTH AND SEXUAL BEHAVIOUR
Interventions and campaigns need to consider contextual specificities. Research in the former Transkei region of South Africa2 found that conceptions of forced sex and rape held different definitional connotations. Sexual coercion thus occurs on different levels and this complicates interventions and campaigns against sexual violence, since definitions of coercion and rape are contestable. The study found that ‘forced sex’ meant different things to young men and pertains to various forms of sexual coercion as well as more consensual sex. An act defined as rape implied forced sex specifically by a stranger and revealed significant conceptions of exchange and sexual entitlement, love, intention, violation and ‘deserving’ victimhood. Only when such complexities are taken into account will interventions and campaigns be relevant to those they target. Youth especially need to be encouraged to question communal definitions and conceptions relating to sexual health and practice. Interventions can draw effectively on such young men and women who question prevailing sexual norms.
Impoverished contexts pose unique challenges to HIV & AIDS prevention. Low socio-economic status positions girls as especially vulnerable. It is associated with earlier sexual activity, low chances of open discussion, improbable condom use and increased chances that first sexual experiences are not consensual. Many teens were born with HIV – how are they to lead fulfilling adult lives? A yet unpublished United Nations study focuses on the desires and need of HIV infected teens in Uganda. Many of them were deprived of education because they were expected to die from AIDS. However, due to the increasing availability and effectiveness of antiretroviral (ARV) medication, many of them expect to become sexually active and even want to have children in the future. The study found that the teens desire to be responsible and are afraid of infecting others. The issue of youth living with HIV & AIDS should be addressed specifically, since they are a valuable resource to the community when it comes to setting examples, not only of how the virus affects ones life but also on how to cope with it. These youth should be empowered to become spokespeople for the prevention of HIV & AIDS infection. Sadly, the opposite is often the case; infected youth are marginalised and stigmatised to lead lonely unfulfilled lives.
CAMPAIGNS AND INTERVENTIONS
In South Africa, the Love Life campaign has been active for several years and focuses on youth specifically, with ideas like ‘an HIV-free generation’, ‘Talk about it’ and ‘HIV loves skin on skin’. The campaign regularly presents new and dynamic ideas nationally. Several campaigns aim to recast conceptions of masculinity. A campaign in New South Wales uses common sporting terms to simultaneously affirm and challenge masculine practice, and carry the message that violence against women “is against all the rules”. An American campaign makes similar attempts with slogans like “My strength is not for hurting”.
Two programmes are currently running in Uganda, which promote male leadership in infection prevention. The first is called ‘Men make a difference’ and this programme focuses on three broad goals: 1) To raise awareness of the relationship between men’s behaviour and HIV, 2) to encourage men and adolescent boys to commit to preventing the spread of HIV and care for the infected, and 3) to promote programmes that respond to the needs of both men and women. ‘Men in the Know’ is a CareUganda project in Lira, that aims to promote safer sex within relationships by promoting knowledge of the physiology of sex and challenging the socio-cultural factors that shape sexual encounters. A pilot study involving 2000 men in this programme found that men were pleased to make responsible decisions. However, the men still decided when and where sex would happen.
THE FUTURE AND HIV & AIDS PREVENTION
Youth and their role models should receive specific attention in the fight against HIV & AIDS. This newsletter mainly considered men as role models for boys, but women must be equally empowered to set a standard to girls and boys alike, a standard that prioritises equal gender practice and the important role that men and women play in advancing community health. A holistic yet contextually specific approach should thus emphasise the equal benefit that men and women, girls and boys, will gain from responsible and non-violent sexual practice. Such a goal is idealistic, but nonetheless sets a fair yardstick against which interventions and campaigns can measure their goals and achievements. The call on men to take responsibility and leadership on prevention issues is a good first step and an initiative that must be expanded to take on a national and popular character that especially focuses on setting examples for the adults of tomorrow. This is the only way we can ensure the existence of a healthy and functional society for future generations.
(1) Charlotte Sutherland is Gender Specialist: Gender Issues in Africa, at Consultancy Africa Intelligence (officesa@consultancyafrica.com)(1) Charlotte Sutherland is Gender Specialist: Gender Issues in Africa, at Consultancy Africa Intelligence (officesa@consultancyafrica.com)
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