MALE INVOLVEMENT IN ADDRESSING HIV & AIDS: EXPERIENCES FROM IPPF AFRICA REGION Jan. 22, 2007

1. MALE INVOLVEMENT IN ADDRESSING HIV & AIDS: EXPERIENCES FROM IPPF AFRICA REGIONJan. 22, 2007 Dr. Wilfred Ochan, Technical Adviser, HIV/AIDS IPPF Africa Regional Office From choice, a world of possibilities

2. Presentation Outline • Why male involvement? • Initiatives used to involve men • Lessons learned • Conclusion

3. 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.

4. 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.

5. 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 .

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

7. 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]

8. 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%)

10. 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]

12. 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

13. 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

14. 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.

15. 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.

16. 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?