Men’s Sexual and Reproductive Health: The Need for Gender Transformative Approaches. Dean Peacock, Sonke Co-Director & MenEngage Co-Chair. Masculinities, SRH and HIV.
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Dean Peacock, Sonke Co-Director & MenEngage Co-Chair
Ideas of manhood that equate ‘being a man’ with sexual risk-taking, and being in control, are associated with more negative attitudes towards condoms and less use, more sexually transmitted infections, more partners, including more casual partners, more frequent sex, more abuse of alcohol and more transactional sex.
Men--married & single, heterosexual, homosexual and bisexual-- have higher reported rates of partner change than women.
A significant proportion of men with STIs do not inform their sexual partners.
Men all too often prevent women’s from determining whether or how sex takes place.
In Swaziland, 34% of women reported not being permitted to use a condom by a sexual partner at least once in the past year.
In Botswana, 30% of women reported that their partner
alone made the decision whether or not to have sex.
MRC study: Representative sample in EC and KZN (2009)
44% self reporting perpetrating domestic violence, 14% in last year.
28% of men self reporting having raped, 5% in the last year.
Almost one-third of women reported that they did not want to have their first sexual encounter and that they were coerced into sex.
Women who have experienced physical/sexual intimate partner violence are 54% more likely to have HIV.
Men who have perpetrated physical/sexual intimate partner violence are more than twice as likely to have HIV
In South Africa, 40 per cent of men and 15 per cent of women consume alcohol.
Alcohol consumption is a risk factor for gender-based violence and for the sexual disinhibition that contributes to the spread of HIV/AIDS.
Frequency of taking four/five drinks on one occasion, by sex
Percentage of males and females who had more than one partner in the past month, by age
Globally, men underepresented in testing and treatment ; they access ART later than women, with more compromised immune systems and at greater cost to the public health system and with significant burden on the women who usually take care of them.
“Efforts to understand men’s health-seeking behaviour are poorly understood in the AIDS epidemic, and encouraging men to get tested and into treatment is a major challenge, but one that is poorly recognised. Addressing these issues effectively means moving beyond laying blame, and starting to develop interventions to encourage uptake of prevention, testing, and treatment for men—for everyone’s sake.” Expanding HIV care in Africa: making men matter. The Lancet Vol 374 July 25, 2009, Mills et al
South Africa 2009 NCS: Very few men know anything about how to avert vertical transmission or about how to support their partners.
New South Africa National Guidelines on PMTCT do not include any of the following words: men, male, father.
New WHO PMTCT vision encourages male involvement.
Men who are economically disempowered report:
Participatory reflection on male socialisation and costs for men and women.
Focus on moving from reflection to internalisation to sustained actionGroup Education
Solid evidence that interventions can bring about positive gender, SRH and HIV related changes amongst men and boys
Stepping Stones: after two years men reported fewer partners, higher condom use, less transactional sex, less substance abuse and less perpetration of intimate partner violence
Programme H: participants between four and eight times less likely to report STIs and 2.4 times as likely to use condoms.
Men As Partners and PMTCT in Ethiopia: 46% increase in men testing with their partners and 87.6% increase in the number of men joining their partners for PMTCT visits.
One Man Can Workshop: 27% tested for HIV soon after the workshop and 2/3rds increased use of condoms.
Formative research + extensive testing of messages
Engage local boys/men in constructing the messages
Critical reflection about masculinity
Skills building/experiential learning
Creating a safe space
Clear and positive messages Boys and Men from 2007
Promoting a gender-equitable lifestyle or alternative male identity
High quality media
At least 4-6 months in duration
10-16 sessions recommended
Generally more effective when combined with media campaigns
What Works? Key Elements in Effective Group Education with Boys and Men from 2007 WHO Report
Training for policy makers and implementers at country level on male involvement (WHO tools in development) with specific attention to:
Improve access and promote greater use by men of HIV services.
Linking programmes with sustainable delivery mechanisms: schools, clinics, uniformed services etc.
Integrate gender equality education into Medical Male Circumcision
Increased male involvement in PMTCT