Executive Summary

"Besides deep changes in society, what we need is a deeply spiritual transformation in theidentity of men."

This statement by a participant sums up the debates at a conference on Men, HIV & AIDS organised in Pretoria by the Regional AIDS Initiative of Southern Africa (RAISA) of Voluntary Service Overseas (VSO) between 11-13 February 2003. Seventy-one participants, mostly from Southern African countries with a few from East and West Africa, examined how to engage men in the response to the HIV/AIDS pandemic.

In the region, national adult HIV prevalence has risen, says UNAIDS, "higher than thought possible, exceeding 30% in Botswana (38.8%), Lesotho (31%) and Zimbabwe (33.7%)." Namibia follows (22.5%), Zambia (21.5%) and Malawi (15%). South Africa's estimated 13% prevalence translates into 4.5- 4.7 million people infected. Twenty years into the pandemic, the bulk of studies and interventions have centred on women and girls. There is greater understanding of the gender dimensions of HIV/AIDS but little funding and effort has gone into working with men, especially young men. Many interventions fail because they do not take into account the identity constructions of the men who interact with women and girls as partners, husbands, fathers, teachers and so forth.

The VSO-RAISA conference provided an unusual and very needed space for reflection and discussion amongactivists, researchers, and people involved in service delivery and/or advocacy around HIV/AIDS. The conferencewas structured around 10 parallel streams: Enlisting men as people living with HIV/AIDS; Men in preventionand advocacy; Marketing; Home based care; Man to man transmission; Male reproductive health; Boy child andconstruction of masculinity; Boy child and peer pressure; Men and cultural beliefs; Stigma and Violence.A description of the main threads of analysis follows, weaving patterns of how men in Southern Africa relate toHIV/AIDS. A key issue is that deeply held notions of masculinity lead to high-risk behaviour for HIV infection amongmen and women. Research and surveys across the region show that men are socialised into a notion of masculinityas sexual prowess, risk taking behaviour and male dominance and superiority over women. At the same time,men perceive their privileged space in society to be under threat from socio-cultural changes taking place in theregion. These include rural/urban migration, Western culture seeping through mass media and the entrenchment ofwomen's rights. "Many men are feeling a bit hopeless, like there's no place for them in the world." The sense of lossundermines men's motivation for safe sex.

A study of how masculinity is constructed in schools in KwaZulu Natal found that the conflict between traditionaland contemporary gender roles generates in boys and men a sense of displacement and irrelevance that cutsacross race and class. White students and teachers feel threatened by the advancement of blacks and women.Black pupils and teachers fear women's new status, poverty and unemployment.Similar findings emerged in a survey by the University of Witwatersrand on risk taking behaviour among youth inSoweto, South Africa's largest township, where nearly half of young men are unemployed. "If you have no job and nofuture, life becomes cheap, and sex is a dangerous entertainment fuelled by boredom, alcohol and poverty."From the other end of the social spectrum, a survey among traditional healers, chiefs and Zionist priests by thePromotion of Traditional Medicine Association of South Africa (Pro-me-tra) found that men feel socially disorientedthrough a loss of leadership position in family and community. "Men have become spectators, irresponsible andindifferent." Traditional practices, however, make up male identity and to attack them is self-defeating, says Prome-tra. Better to tap into the traditional notion of men being responsible for their families. Male circumcision, wifeinheritance, scarification and polygamy can be managed responsibly "in safe and best practice" if people areaccurately informed about HIV infection risks.

Many, if not most men, do not engage in risk behaviour - i.e. promiscuity, irregular or no condom use, violence,alcohol and drug abuse - but they have little visibility in the predominant discourse of "men as drivers of theepidemic."

According to the Centre for the Study of Aids at the University of Pretoria, which works with marginalised youngmen - unemployed, junkies, bodybuilders, drag queens and male sex workers, negative male images channelledby the media and by society are internalised by young men and turn into a self-fulfilling prophecy. "There is morerejection than inclusion. As a result, young men feel blamed for all social evils and withdraw."There was consensus that blaming and scapegoating are not productive or helpful and undermine male selfesteem."The men-drive-the-epidemic slogan has outlived its usefulness." "We shouldn't blame men, women orculture but take responsibility."

Another common thread is the pervasive silence surrounding male sexuality. Parents don't talk about sex withtheir children. Husbands don't talk with their wives. Men generally feel uncomfortable discussing intimacy. Theirreproductive health needs remain invisible.At the National Association for People Living with HIV/AIDS in Malawi (NAPHAM), nine out of ten male memberswould not disclose their HIV status to their spouses. Secrecy brought stress, risk of infection for the wife throughunprotected sex, and inability to change lifestyle and live positively. But when NAPHAM started support groups forcouples, 65% of men brought their wives. Male membership increased. "The groups enabled men to talk.""Men need opportunities to explore and talk about their sexuality in non-threatening environments," concluded aregional survey by Southern African AIDS Information and Dissemination Service (SAfAIDs).Zimbabwe's Men Forum Padare/Enkudleni reaches boys and men in schools, pubs, sports clubs and churches,where they can debate, in a non-threatening space, issues of sexuality, masculinity and power. So does SouthAfrican Men's Forum (SAMF). "We need to challenge this destructive concept of manhood that men make alldecisions, men need many sex partners."

The wall of silence is finally crumbling around the last taboo topics in Africa - male rape and male-to-male sex.Some political and religious leaders have denounced gay men and women as un-African although 19th centuryethnographic research documents sex between men in Africa. Politically constructed homophobia has a negativeimpact on public health because it excludes homosexuals from prevention and awareness campaigns, making themvulnerable to HIV infection. A combination of research and activism is breaking the silence about men who have sexwith men across race and class.

Researchers at UNISA in South Africa and the Population Council in Kenya reported on the sexual andreproductive health needs of men who have sex with men. A study of black, gay and bisexual men in Katuturatownship, Namibia, found they experience verbal, physical and sexual forms of assault and discrimination fromhospital staff, police, army and church officials. Facing barriers in employment, they turn to (unsafe) commercial sexwork.

That sex happens among male prisoners is now acknowledged even by correctional services. The PrisonFellowship of Zambia described its project to bring AIDS awareness, peer counselling and condoms into prisons.With HIV prevalence of 27-30% in its crowded prisons, Namibia offers counselling to prisoners but not condomsbecause it could be seen as encouraging sodomy, which is a criminal offence.Male rape, possibly the last frontier in public debate, was brought into the conference by Men United, a SouthAfrican group dedicated to breaking the silence about male rape, providing support and care for survivors and theirfamilies, and educating youth to speak out against all sexual abuse.Some success was noted in men's involvement in home based care, reversing the tradition that nursing the sickis a female domain. Tovwirane in northern Malawi and Kara Counselling in southern Zambia have growing numbersof male care givers. Chiefs and church leaders help identify volunteers who are provided with training, bicycles andteam support.

The conference showcased a number of male-centred AIDS awareness initiatives in the region, with migrantminers in Zimbabwe, through soccer games in Zambia, and with adolescents in Malawi. The Southern African Men'sNetwork, formed in October 2002, seeks to amplify small local initiatives into visible and structured actions, and tomobilise national men's movements.A vigorous debate centred on the role of African culture(s) in shaping masculinity. A consensus emerged thattraditional culture is dynamic, it changes and adapts, and can accommodate and shape a different construction ofmasculinity.

After 20 years of rampant spread, AIDS is driving changes in male behaviour in Southern Africa. "Men'sperceptions of identities are changing." These changes need to be followed-up and supported.Participants agreed that the concept and practice of masculinity needs to be reconstructed in ways that fit newsocio-economic realities, from rural-urban migration to women's advancement, AIDS and unemployment. A newway of perceiving manhood would empower men to live their sexuality differently and to take active communityresponsibility. Such efforts should be grounded in a culture of human rights that can bridge cultural differences andspan the variety of situations men experience, i.e., rural and urban, old and young, heterosexual and gay, single andmarried, etc. The notions set out in the UN Declaration of Human Rights provide a common ground for the complexand conflictive task of renegotiating gender power relations.Summing up the conference, oneparticipant said: "Men should think not about what we stand to lose butwhat we stand to gain."

To download the full conference report in PDF, please click here

Contact

VSO South Africa

PO Box 2963, Parklands 2021

Johannesburg

vsosouthafrica@vsoint.org