1. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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…

10. 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.

11. “. 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

12. Cheers!!