Sex and Sensibility: Meeting the sexual and Reproductive Health Needs of People Living with HIV (PLHIV) Positive Perspectives: HIV positive men as Partners in Sexual and Reproductive Health Adam Garner HIV Officer: Youth, IPPF CO From choice, a world of possibilities

Why the SRH Rights of Men Living with HIV (MLHIV) Number of MLHIV leading longer more productive lives Live happy, fulfilling healthy sexual lives Contributes to ‘Positive Prevention’ It is time for men to be more than just ‘partners’ (for the benefit women) with regard to sexual and reproductive health Number of MLHIV leading longer more productive lives Approximately 13.3 million men living with HIV ARVs more widely available and more effective Live happy, fulfilling healthy sexual lives To enable men living with HIV to lead healthy and fulfilling sexual lives which many men feel they don’t deserve or are denied Positive Prevention MLHIV are an essential part of positive prevention – to protect their sexual health avoid other STIs delay HIV and AIDS progression avoid passing HIV on to others – partners, children It is time for men to be more than just ‘partners’ with regard to sexual and reproductive health MLHIV have rights and needs in their own rights – not just seen as a vehicle for addressing women’s needs To have equal access to information and services as women

Factors affecting SRH seeking behaviour of men Traditional associations of SRH Pre existing gender stereotypes “I don’t believe it’s necessary” Stigma and discrimination Traditional associations of SRH SRH has traditionally been an issue associated mainly associated with women and girls Service labelling Pre existing gender stereotypes Gender stereotypes Machismo/Masculine Gender Norms I don’t believe it’s necessary Association with the “sick” Lack of understanding of issues Stigma and Discrimination Men Living with HIV (MLHIV) also face stigma and discrimination Lack of specific training for staff Lack of specific services aimed at men Internalised stigma – self stigma

SRH Needs of Men Male specific needs – Premature ejaculation Prostate cancer Certain areas of SRH (historically associated with women) where men need to be better engaged Contraceptive services Peri-natal Care Safe Abortion Services Different ages and groups have different needs Other SRH services: STIs, GBV, Sexual Pleasure. There are certain SRH needs specific to all men: Male specific needs Reproductive system cancers Premature Ejaculation Some needs of men overlooked – (historically been linked principally to women’s SRH) Contraceptive methods – not just condoms! Safe abortion services Different ages and groups have very different needs Sexuality – orientation and behaviours Family planning and fertility issues Other SRH services STI – diagnosis treatment and care Sexual Dysfunction Sexual and gender based violence Sexual Pleasure Infertility Family Planning

However MLHIV have more complex considerations: Remaining sexually active once diagnosed Relationships – sexuality - love Disclosure Stigma and Discrimination Family Options Sero discordant and concordant relationships (Prevention and Positive Prevention) HIV Diagnosis is often coming earlier and earlier in a mans life Often before sexual maturity has been reached – still experimental with sexuality Support and advice – role of network of PLHIV (MLHIV) and SRH service providers Finding a partner Remaining Sexually active once diagnosed self stigma external stigma Appropriate psychosocial support and counselling Stigma and Discrimination Stigma from Health Care Providers: Barrier to accessing services for all men – more so for MLHIV Stigma from family/friends/partners Self stigmatisation Key populations: MSM, IDUs, Male sex workers, prisoners, migrants Disclosure to sexual partners Disclosing - fear of rejection Family Planning All men have the right to be fathers – recognising diversity among fathers Fertility treatment and care Contraceptive services Safe abortion services Shared Responsibilities

Fulfilling Fatherhood “Positive fathers can be advocates and educators to other men and fathers, to guide them to take care of themselves appropriately after learning their HIV status…” Adul, Thailand Fulfilling Fatherhood Qualitative Study of Fathers Living with HIV in12 countries (IPPF, GNP+, GCWA)

Involved in decision making Equals in all SRHR matters MLHIV as partners Role models Involved in decision making Equals in all SRHR matters For MLHIVs own sexual health benefits Addresses genders inequalities and access barriers to women Role models Be role models for other men living with HIV Be willing to share their experiences of fulfilling their SRH rights and desires Involved in decision making Become involved in developing strategies and programmes that are aimed at specifically delivering relevant services to MLHIV Men must be identified as equals: in prevention of HIV and other STIs in safe abortion services in access to services in eliminating Gender Based Violence PMTCT Home Based Care

Recommendations for policy makers Meaningful involvement of MLHIV in SRHR Sensitisation Tailoring services Improved training Use existing advocacy platform for SRH of PLHIV - Living 2008… Involve MLHIV in all levels of decision making Sensitise all men on their SRH rights Increase tailored services for MLHIV – according to specific needs (IDUs, male sex workers, migrants, husbands, youth) Improve training for service providers and counsellors Recognition in HIV strategies and policies Use existing advocacy platform for SRH of PLHIV - Living 2008… Use the existing advocacy platform for the sexual and reproductive health rights of PLHIV as an entry point established through Amsterdam consultation of PLHIV and Living 2008…

Leadership summit for PLHIV SRH of PLHIV – a key theme Living 2008 Leadership summit for PLHIV SRH of PLHIV – a key theme 2 of the key messages from the working group were: The Right to Reproduction, Sexuality and Desire Articulating the sexual and reproductive dreams and desires of people living with HIV 1. The Right to Reproduction, Sexuality and Desire PLHIV have the right to pleasurable & enjoyable sexual life; the right to intimacy, to have children, to love. 2. Articulating the sexual and reproductive dreams and desires of people living with HIV PLHIV do not form an homogeneous group. Issues facing YPLHIV are very different from those of adults. 3. Linking HIV and Sexual and Reproductive Health is part of the core business of the HIV community. The HIV community, in particular networks and associations of PLHIV need to embrace and guide this agenda 4. A shared responsibility for Prevention Safer and responsible sexual behaviour is the responsibility of all partners – irrespective of status. 5. Challenging the changing face of Stigma and Discrimination Stigma and discrimination has become more subtle – PLHIV need to think of new ways to stand up for their rights.

“. we are still fathers that love our children “...we are still fathers that love our children. HIV is part of us, but only a part of us.” Gustavo Fulfilling Fatherhood

Cheers!!