1. How to integrate work with men for promoting gender equality and the HIV response? Tim Shand, Dumisani Rebombo, Vanessa Fonseca & Steven Iphani 14-16 November, Istanbul

2. Part 1: Recommended language for NSPs and examples of good practices: men, gender inequalities and HIV

3. CRITERIA USED FOR ANALYSIS OF WHETHER NSPs ATTEMPT TO ENGAGE MEN AND BOYS IN ADDRESSING GENDERED DIMENSIONS OF HIV AND AIDS NSP attempts to challenge or transform gender norms Men, Masculinities and Condoms HIV and GenderMen’s use of VCT Engaging men for prevention of GBV Addresses the needs of marginalized men & boys Men’s support of PMTCT/Vertical Transmission Attempts to address barriers to men's use of treatment Male circumcisionAttempts to increase men's involvement in the care economy

4. Recommended language for NSPs on men, gender inequalities, GBV and HIV OverallGender norms to be addressed as root cause of HIV – focus on gender norms transformation (young men) GBV-Interventions to highlight role men can play in preventing GBV, supporting GBV victims, and be advocates for change - Address underlying gender-norms linked to violence PMTCT/ Vertical transmission - Encourage men to support PMTCT as partners and advocates (ensuring the do no harm and safety first principles) MMC-Interventions to be part of a broader package and include gender equality education - Interventions to guard against inhibition Condoms-Research on men’s attitudes towards condom use - changing men’s attitudes towards condom use

5. Recommended language for NSPs cont. Testing- Understand why men don’t test - Use innovative methods to increase men’s HIV testing Vulnerable men - condoms, lubrication, treatment and testing for prisoners - interventions tailored to migrants, refugees and MSM Treatment-Encourage male health-seeking behaviour, as part of strategy to improve their uptake of treatment - Challenge gender norm that sickness = weakness Care economy -Promote men in care work. Target for trained male care givers -Address gender-norms that caring is a female domain Education- Education on gender equality highlight benefits for men - Comprehensive sexuality education for boys and girls

6. NSP Best practice examples  Overall behaviour change: Zimbabwe  Involving men in HIV prevention.  Religious/trad. leaders as advocates/role models  Vertical transmission/PMTCT: Uganda  Service provision for men and women  Communication highlighting men & women roles  Condoms: Jamaica  Specific campaigns to promote the use of condoms by men

7. NSP Best practice examples  Testing: Zambia  Commits to increasing number of men testing from 15% to 50% by 2015  Couple counselling and testing seen and key  Home-based care: Zimbabwe  National volunteer motivation and training program (material & psysho-social needs)  Addressing gender equity so more men become involved as care givers

8. Supporting NSP Development & Implementation and strengthening accountability: - Advocacy for implementation/operational plans/targets - Community mobilisation/networking - Skills building

9. Part 2: Examples of Gender Transformative Interventions with Men and Boys

10. Moving towards a gender transformative approach  Gender neutral  Gender sensitive or gender-responsive  Gender transformative: Proposed long-term approach (Adapted from: Rao Gupta, et al 2002)

11. 1. Service/clinic based  Working on supply side:  Health providers skills and attitudes  Provision of SRH/clinical services for men:  Specific services for men /strengthened referrals  Working on demand side:  Promotion: information and mass media  Health Education: outreach, male community health workers Example: Men as Partners project (Engenderhealth)

12. One Man Can  Supports men to take action to end VAW, prevent HIV and promote healthy and equitable relationships  Action Kit: Workshop activities; fact sheets; posters; DVDs  Community mobilisation and branch building 3. Group education

13. Brothers for Life (BFL)  National media and community mobilisation campaign targeting men 30+ on HIV risk factors: GBV, alcohol, multiple partners.  BFL ambassadors in national television, radio and billboard ads (politicans, South African soccer, cricket and rugby teams, other celebrities) Partnership with JHHESA and others 2. Media Campaigns

14. Brothers for Life Reach 2.27million men (average 6 times each) Men & PMTCT campaign reached 2.5m men (9 times each). Outdoor media (messages on partner reduction, PMTCT and GBV) reached 6.5M people per month. One Man Can Reach 122 workshops across the country in 2009 25,000 workshop participants: 18,000 men & 7,000 women. 260,000 people through community mobilisation events, 90% men Impact on self-reported behavour: 25% accessed VCT, 50% reported GBV, 61% increased condom use, 80% spoke to friends/family

15. Program H: Group Education Provide a safe and comfortable environment for men and boys to discuss the “costs” of non- equitable gender norms, particularly in relation to core issues (e.g. HIV prevention, reproductive health) Discuss and “rehearse” alternative and healthier male attitudes and behaviors and identify ways to apply them in their lives Recognized as a global best practice in promoting gender equality by UNICEF, UNFPA, World Bank and PAHO

16. Program H: Media Campaigns

17. Program H: Changes in Attitudes in Brazil *p < 0.05 – t- test

18. COWLHA: Using Stepping Stones The Coalition of Women Living with HIV and AIDS (COWLHA) has implemented a project between 2010 and 2011 that have addressed the intersection of GBV and HIV by engaging couples in addressing the intersection. The focus of the projects was to protect the rights of women living with HIV and women in general from HIV vulnerability or its impact resulting from gender imbalances by engaging men.

19. Using Stepping Stones Cont…  Community Stepping Stones workshops involving couples were carried out to facilitate debate on why both men and women behave the way they behave in relation to HIV, stigma and discrimination, gender based violence.  Both men and women agreed in plenary on ways of addressing through community dialogues sessions.  Communication skills among couples were enhanced.

20. COWLHA: Case Study Mr. Masautso and Mrs. Loveness Nkhoma are a couple living with HIV from Mchinji district. Mrs. Nkhoma narrates that her husband forced her to have a baby and always refused to use condoms both as a contraceptive and positive prevention measure because his target was to have 8 children. But since engaging him through the stepping stones training, Mr. Nkhoma insists on condom use every sexual encounter and he acknowledges that stepping stones has helped him to understand the importance of respecting the sexual and reproductive health rights of his wife. Mr. Masautso is now satisfied with the 4 children that the couple has and has since gone for vasectomy.

21. What makes effective campaigns to change norms?  Use positive and affirmative messages.  Affirm that men and boys can change  Show what they can do to change  Show examples of men changing or acting in positive ways  Highlight benefits  Repeated messaging over 6-9 months

22. What Works? What do we mean by Gender Transformative Interventions? Combinations of community outreach, group education and mass media Relational approach – working with men and women Include critical reflection of gender norms and how these influence behavior – achieve tipping point Target most vulnerable Measure changes in attitudes toward gender norms + relevant behaviors. Links to laws and policies

23. The Final Message: Acknowledge and Tap into Men’s Self-Interest in Change

24. Resources www.genderjustice.org.za www.menengage.org www.engagingmen.net Contacts: tim@genderjustice.org.za dumi@genderjustice.org.za v.fonseca@promundo.org.br iphanisteven@gmail.com