Male involvement in addressing hiv aids experiences from ippf africa region jan 22 2007
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MALE INVOLVEMENT IN ADDRESSING HIV & AIDS: EXPERIENCES FROM IPPF AFRICA REGION Jan. 22, 2007. Dr. Wilfred Ochan, Technical Adviser, HIV/AIDS IPPF Africa Regional Office. Presentation Outline. Why male involvement? Initiatives used to involve men Lessons learned Conclusion.

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Dr. Wilfred Ochan, Technical Adviser, HIV/AIDS

IPPF Africa Regional Office

From choice, a world of possibilities

Presentation Outline

  • Why male involvement?

  • Initiatives used to involve men

  • Lessons learned

  • Conclusion

Why male involvement: concern for the risks & burden?

1. Sub-Saharan Africa - epicenter of HIV/AIDS, with main mode of transmission as sexual intercourse:

  • 57% of those infected are women & girls

  • 50% of new infections amongst young people are in SSA, young girls account for 75%

    2. Male sexuality increases susceptibility of women & girls to HIV infection:

  • Men abuse more substances, use more violence & have more explicit sex partners.

Why male involvement – a concern over dominance & masculinity?

3. Men control sexual, reproductive & fertility decisions and practices:

  • Most SRH information & services minimally involved men – yet, women needed approval of men to adopt a specific behavior being promoted

  • Information asymmetry: women with more information through SRH programs, yet without authority. Men with little, yet with authority.

  • Men control the resources essential for uptake & utilization of HIV & AIDS related services

  • Decision making on SRH at family & community levels are dominated by men & this has been exported into formal systems.

Why male involvement – a question of culture?

4. Socio-cultural expectations & position of men impose on them, practices that increase their own risk or those of women and/or condone their acts

  • Sexual prowess encouraged

  • Multiple sexual partner relations is praised as sign of manhood (though slowly dying)

  • Marrying of young girls is not sanctioned

  • Rapes, defilement & other acts of sexual violence is condoned .

Initiatives to Involve Men in addressing Gender Dimensions of HIV/AIDS

Project 1: Young Men as Equal Partners [YMEP] Project

1. Coverage: 4 year SIDA funded joint project between RFSU & MAs of: Uganda, Kenya, Tanzania & Zambia.

2. Purpose: To increase adoption of safer sex practices & utilization of HIV/AIDS/SRH services by young people (especially young men) within project sites.

3. Strategies:

  • BCC [community mobilization, young men as Peer educators; targeting gender issues, sexuality & SRH.

  • services delivery [male service providers, male dedicated clinic days; VCT post test clubs, etc.]

  • Capacity building [training] &

  • advocacy [local authority, school administration & community leaders]

Project 1: Young Men as Equal Partners [YMEP] Project

4. Evaluation Results:

  • Increased SRH service utilization including reported condom use by young women and young men.

  • Reduced pregnancy cases in schools.

  • Reduced incidences of STIs & Gender based Violence (reported by teachers & young women). In Zambia girls reporting sexual abuse dropped from 60% to 42%.

  • Reported reduction in # of sex partners by young men.

  • Improved communication & relationship between young men & women on gender & SRH (e.g. TZ: discuss with female choice of methods of protection: 23% to 47%)

  • Improved communication on sexuality issues between teachers & students.

  • Increased percentage of men accompanying their spouses for SRH services.

  • Improved trust on young men by communities.

  • Attitude to female use of condoms (Zambia: 50% to 85%)

Project 2: Youth to Youth Project in Uganda

1. Coverage: Funded by IPPF & DSW and implemented in Uganda since 2003.

2. Purpose: To increase proportion of young people who practice safer sex & utilize SRH services in a supportive socio-cultural environment.

3. Strategies:

  • BCC [community mobilization, young men as Peer educators, community level male dedicated workshops, community theatre, etc.];

  • Services delivery [static clinic, outreaches: event specific & routine

  • Capacity building [training, club formation, cascading & support];

  • Linkage to micro-credit & Income Generation Activity

  • Advocacy [local authority, school administration & community leader]

Project 2: Youth to Youth Project in Uganda

4. Annual reviews:

  • Increased level of knowledge on HIV/AIDS/SRH issues

  • Increased uptake of condoms & VCT by all, especially women during Sunday church-based VCT outreaches

  • Improved perception of members in the community & viable community groups formed.

  • Linkage to Poverty Alleviation Fund & some German based donors assisted some groups to establish own sources of livelihood: goat rearing, bee keeping; etc.

  • Ability to raise own income: hire of drama clubs for local functions: commemoration of international days

  • Roles of the youth clubs have extended to being used in community mobilization for other health programs: immunization

Project 3: Safe Blood Project in Botswana

1. Project

  • Project motivated by concern for high HIV infection rate and lack of safe blood.

  • The concern has been on how to recruit and maintain subsequent age cohorts of low risk & recurrent safe blood donors for Botswana’s blood bank.

    2. Approach:

  • A peer education, enter-educate & club based program that mobilizes young people (boys) for safer sex practices; VCT uptake (Positive Lifestyle Group) & pledge to donate blood until age of 25 years (Pledge 25), with adoption of behaviour to reduce risk of donating infected blood.

    3. Annual Reviews:

  • Increased uptake of VCT services

  • Increased uptake of condoms

  • Increased amount of blood donated from project sites

  • Reported reduction in number of sexual partners

Project 3: Other Projects

  • Male circumcision in Swaziland, coupled with sexuality education and youth friendly services.

  • Jua Kali project in Kenya targeting mainly the black smith with HIV/AIDS information and services.

  • etc.

Lessons learned

1. Programs that specifically target men/boys should aim at:

a. Transforming their risky behaviours by working with them:

  • As clients – using information, services & life skills.

  • As supportive agents of sex partners

  • As change agents – to address norms of masculinity (multiple sex partners, alcohol use, GBV, etc.)

  • Linking such programs to livelihood opportunities & other concerns for boys/men.

    c. Integrating HIV/AIDS with SRH in order to create window of opportunity for men to view traditional SRH service not only as for women, but also theirs; and to access & use such SRH/HIV/AIDS services.

    2. In African setting, programs that empower women & girls & address their SRH needs will not achieve much unless we involve men & boys in them, because of relative male control on decisions & practices on issues of sexuality, fertility & reproduction.

  • Conclusion & Recommendations

    • Girl child education remains the most strategic opportunity for addressing female vulnerabilities to HIV infection in both the near and long term measures.

    • Strategies to improve HIV must first focus on creating awareness of the true dimensions of the problem & its dire consequences amongst community leaders & men; and of their role in its prevention. With their support we can rapidly create awareness and services expansion for young girls and women and remove the prevailing “norms”

    • We need programs that involve non-formal cultural institutions to address socio-cultural beliefs & practices that create expectations for men & give them advantage positions on issues of sexuality, fertility & reproduction that put women at risk. Program approaches such as community conversations could be useful in such efforts.

    • We need to have a better understanding of female sexuality and other factors that increase their vulnerability, especially in the context of observed increase in sero-positivity amongst women in sero-discordant couples. What would explain their infections?

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