Male engagement in Uganda

1. Male engagement in Uganda Dr Cissy Kityo Mutuluuza Joint Clinical Research Centre, Uganda Engaging Men in Care in HIV Treatment- Closing the Treatment and Survival Gap' AIDS 2016- Thursday 21 July, 16:30 – 18:00

2. Background • ART coverage in Eastern & Southern Africa

3. Background • Seeking for ART services with advanced HIV disease • REALITY trial from 2013 – 2015 in Uganda, Kenya, Zimbabwe & Malawi • Enrolled 1803 ART-naïve HIV-infected adults, adolescents and children >5 years with CD4<100 cells/mm3 • 53% were male

4. The first Step: National Policy Framework • Uganda National Strategy for male involvement for 2011 – 2016 • Goal: To improve male involvement/participation in • Child Health Care • Sexual and Reproductive Health and Rights • HIV/AIDS • National Implementation framework to all stakeholders in the Health Sector • National Training Manual for male action groups on male involvement • Monitoring and Evaluation framework

5. Effective Implementation: Examples from the field • 27 organizations have formed the Uganda men engage network called UGAMEN • They promoted the establishment of MENENGAGE Uganda Network (MENU) in 2010 led by Mama Club • MENU is a member of the global networks • Global MenEngage Alliance • MenEngage Africa Alliance • Developed Strategic Plan 2013 – 2018

6. Peer mentor father groups • Men (mainly HIV+ve) are mobilized through formation of male action groups • Formed at county and sub-county levels (Health 111 & IV) • Trained to enhance their role for • Themselves • Families • Fellow men • community in and outside health facilities • Supported to mobilize and also form groups at parish and community level

7. Peer mentor father groups • 6 groups of 30 members each have been trained • 2492 Male Champions of Change have been recruited at the grass root • These continue with community mobilization • holding fellow men accountable. • Their mobilization strategy; reach men • in the drinking places, • at work • gatherings like funerals, religious gatherings and clan meetings.

8. Male community leaders; “Emanzi”

9. Male community leaders; “Emanzi” • EGPAF partnered with FHI to engage men in PMTCT & FP services in Western Uganda • Experts from EGPAF and FHI 360 led the Emanzi training sessions • Emanzi formed community-based groups of men to participate in a 10-week course of discussions on gender topics from Feb 2013 • Curriculum designed to transform gender norms and motivate men to engage in FP and HIV services • Over 1900 men recruited and work in 96 groups

10. Male community leaders; “Emanzi” • Cross-sectional surveys were conducted before & after implementation using the Gender Equitable Men (GEM) Scale • Intervention achieved negligible changes in responses to GEM items • Improvements in some gender-influenced health-seeking behaviors and practices in men were noted • .

11. Why is the involvement of men in HIV programs limited? • Uptake of HIV services is influenced by • Stigma • Masculinity • Cultural gender norms • Economic circumstances International HIV/AIDS Alliance Siu, Seeley et al

12. Way Forward • Multi-pronged approach to gender programming • Institute gender transformative interventions that help men to reject masculinity signifiers • Link these to stigma-reduction interventions • Stimulate community dialogue to educate men • Continue to form & support peer support groups

13. Way Forward • Inclusion of skills and livelihood activities in HIV programs • Direct investments in approaches that have maximum impact