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

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

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.

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.

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.

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

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]

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%)

Project 2: Youth to Youth Project in Uganda 1. Coverage: Funded by IPPF & DSW and implemented in Uganda since 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]

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

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

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.

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.) b. 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.

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?