WORLD AIDS DAY 2001

1. WORLD AIDS DAY 2001 Male involvement in the fight against AIDS Marleen Temmerman, RUG

2. "I care... Do you?" • is the slogan for the second year of a two-year Campaign • intended to create a sustained focus on the role of men in the AIDS epidemic and culminates on 1 December, World AIDS day.

3. The Campaign aims to involve men more fully in the efforts against AIDS • to bring about a much-needed focus on men in national responses to the epidemic • to involve leaders both as politicians and in their personal lives in the response to the HIV epidemic.

8. Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000 65 60 Botswana Uganda 55 South-Africa Life expectancy at birth, in years Zambia 50 Zimbabwe 45 40 35 1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00 Source: United Nations Population Division, 1998

10. Factors influencing HIV transmission • Social inequalities • Power relations • Poverty • Migration • Urbanisation • Social background • Race • Gender

11. Gender • Refers to the social shaping of femininities and masculinities, and challenges the idea that relations between the sexes are ordained by biology or nature • Unequal gender relations are particularly visible in special vulnerability of women to HIV, and in men’s risk taking behaviour • Gender relations affect not only the development of the AIDS epidemic but the manner in which individuals and societies respond

12. Gender is not a woman’s issue • Whereas ‘sex’ is referring to biological differences between males and females, gender refers to social and cultural notions of masculinity and femininity • A gender order where men dominate women, cannot avoid constituting men as an interest group concerned with defence, and women as an interest group concerned with change (Connell 1995) • Not having to think about gender is a patriarchal dividend that men gain from their position in the gender order. This is one of the reasons why ‘gender’ is often dismissed as a women’s issue

13. Sex and reproduction • A man’s right, a woman’s duty? • Women carry the burden of pregnancy and childbirth • They are responsible for contraception and infertility, but men have the decision-power • Difficult diagnosis of STD in women • Women have little economic and sexual power • Violence against women • Patrilineal societies often have power relations skewed in favour of men and this is also reflected in the realm of sexuality

14. HIV and women: multiple jeopardy • Society: blame on women, economic dependent • Nature: diagnosis and treatment of STD more difficult, sequelae worse, transmission rates higher • Partner: no sexual power, scapegoat for diseases • Science: still no female controlled methods

15. Social context of STD/HIV risk • Reproductive health decisions remain the ‘male domain’ in many countries • Women are often recipients of male-based decisions • Women are more accessible to health education than men as users of health services • Yet, they have limited options in light of the STD and HIV epidemic

16. The STD/AIDS epidemic • Brought into sharp relief the absence of information on men • Highlighted the patriarchal structures that benefit men who often remain passive and non-participatory in reproductive health that is considered as a woman’s issue • Resulted in the introduction of STD/HIV into the framework of reproductive health necessitating the incorporation of men as participants, partners and consumers of services

17. HIV in pregnant women: prevalence in South Africa, 1990 to 1999 25 22.8 22.4 20 17 14.2 15 HIV prevalence (%) 10.4 10 7.6 5 4 2.1 1.7 0.7 0 90 91 92 93 94 95 96 97 98 99 Source: Department of Health, South Africa

18. Three Integrated Strategies to Reduce Paediatric AIDS Prevention of unwanted pregnancies (Family Planning) Prevention of Mother to Child Transmission (PMTCT) . during late pregnancy . during labor . through breast-feeding Primary HIV prevention in parents to be

19. Perinatal HIV transmission • Interventions include VCT during pregnancy, antiretroviral drugs and replacement feeding • This is visible to the partner, difficult to implement without his understanding and consent • Major concern in VCT in pregnant women is the adverse consequences following disclosure of their status: stigmatisation, violence, isolation

20. Violence against women • High levels of ‘background’violence in women in Tanzania (54% in HIV+ and 32% in HIV- women • Violence was high in HIV + women in Nairobi • Beating and abuse of women in Mumbai after disclosure

21. Poor uptake of PMTCT interventions • UNICEF study: only 30% of women offered VCT were not tested. Out of the women tested 30% did not take adequate doses of drugs • Low disclosure rates all over Africa (30-50%) • Key barrier: blame on the one who brings HIV into the family

22. Responses • Involvement of partners, family …into reproductive health services • Greater efforts to reach men • Addressing the issue of violence • Couple counselling and testing • Education of both men and women • Empowerment of women

23. Conclusions • Men have to be more actively involved in HIV/STD prevention work and reproductive health • The burden of responsibilities should be carried by both men and women • The complex inequalities of gender and sexuality which facilitate HIV/STD transmission should be challenged by men and women

24. Conclusions • ‘If development is not engendered, it is endangered’(Human development report, 1977) • Increasing interest in men as potential agents of change, and not merely objects of blame. ‘Time is ripe to start seeing men not as some kind of problem, but as part of the solution’ (Peter PIOT, 2000)