should think not about what we stand to lose but what we stand
MEN, HIV & AIDS regional conference 2003
Regional AIDS Initiative of Southern Africa/VSO
Executive Summary by Mercedes Sayagués
"Besides deep changes in society, what we need is a
transformation in the identity of men."
This statement by a participant sums up the debates at a
on MEN, HIV & AIDS organised in Pretoria by the Regional
Initiative of Southern Africa (RAISA) of Voluntary Service
(VSO) between 11-13 February 2003. Seventy-one participants,
from Southern African countries with a few from East and West
examined how to engage men in the response to the HIV/AIDS
In the region, national adult HIV prevalence has risen, says
UNAIDS, "higher than thought possible, exceeding 30% in
(38.8%), Lesotho (31%) and Zimbabwe (33.7%)." Namibia
(22.5%), Zambia (21.5%) and Malawi (15%). South Africa's
13% prevalence translates into 4.5- 4.7 million people
Twenty years into the pandemic, the bulk of studies and
have centred on women and girls. There is greater
the gender dimensions of HIV/AIDS but little funding and
gone into working with men, especially young men. Many
fail because they do not take into account the identity
of the men who interact with women and girls as partners,
fathers, teachers and so forth.
The VSO-RAISA conference provided an unusual and very needed
for reflection and discussion among activists, researchers,
people involved in service delivery and/or advocacy around
The conference was structured around 10 parallel streams:
men as people living with HIV/AIDS; Men in prevention and
Marketing; Home based care; Man to man transmission; Male
reproductive health; Boy child and construction of
child and peer pressure; Men and cultural beliefs; Stigma and
A description of the main threads of analysis follows, weaving
patterns of how men in Southern Africa relate to HIV/AIDS. A
issue is that deeply held notions of masculinity lead to
behaviour for HIV infection among men and women. Research and
across the region show that men are socialised into a notion
masculinity as sexual prowess, risk taking behaviour and male
dominance and superiority over women. At the same time, men
their privileged space in society to be under threat from
cultural changes taking place in the region. These include
rural/urban migration, Western culture seeping through mass
the entrenchment of women's rights. "Many men are feeling
hopeless, like there's no place for them in the world."
The sense of
loss undermines men's motivation for safe sex.
A study of how masculinity is constructed in schools in
found that the conflict between traditional and contemporary
roles generates in boys and men a sense of displacement and
irrelevance that cuts across race and class. White students
teachers feel threatened by the advancement of blacks and
Black pupils and teachers fear women's new status, poverty and
Similar findings emerged in a survey by the University of
Witwatersrand on risk taking behaviour among youth in Soweto,
Africa's largest township, where nearly half of young men are
unemployed. "If you have no job and no future, life
and sex is a dangerous entertainment fuelled by boredom,
From the other end of the social spectrum, a survey among
healers, chiefs and Zionist priests by the Promotion of
Medicine Association of South Africa (Pro-me-tra) found that
socially disoriented through a loss of leadership position in
and community. "Men have become spectators, irresponsible
indifferent." Traditional practices, however, make up
and to attack them is self-defeating, says Prometra. Better to
into the traditional notion of men being responsible for their
families. Male circumcision, wife inheritance, scarification
polygamy can be managed responsibly "in safe and best
people are accurately 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
abuse - but they have little visibility in the predominant
of "men as drivers of the epidemic."
According to the Centre for the Study of Aids at the
Pretoria, which works with marginalised young men -
junkies, bodybuilders, drag queens and male sex workers,
male images channelled by the media and by society are
by young men and turn into a self-fulfilling prophecy.
"There is more
rejection than inclusion. As a result, young men feel blamed
social evils and withdraw."
There was consensus that blaming and scapegoating are not
or helpful and undermine male selfesteem. "The
slogan has outlived its usefulness." "We shouldn't
blame men, women
or culture but take responsibility."
Another common thread is the pervasive silence surrounding
sexuality. Parents don't talk about sex with their children.
don't talk with their wives. Men generally feel uncomfortable
discussing intimacy. Their reproductive health needs remain
At the National Association for People Living with HIV/AIDS in
(NAPHAM), nine out of ten male members would not disclose
status to their spouses. Secrecy brought stress, risk of
for the wife through unprotected sex, and inability to change
lifestyle and live positively. But when NAPHAM started support
for couples, 65% of men brought their wives. Male membership
increased. "The groups enabled men to talk."
"Men need opportunities to explore and talk about their
non-threatening environments," concluded a regional
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
does South African Men's Forum (SAMF). "We need to
destructive concept of manhood that men make all decisions,
many sex partners."
The wall of silence is finally crumbling around the last taboo
in Africa - male rape and male-to-male sex. Some political and
religious leaders have denounced gay men and women as
although 19th century ethnographic research documents sex
in Africa. Politically constructed homophobia has a negative
on public health because it excludes homosexuals from
awareness campaigns, making them vulnerable to HIV infection.
combination of research and activism is breaking the silence
men who have sex with men across race and class.
Researchers at UNISA in South Africa and the Population
Kenya reported on the sexual and
reproductive health needs of men who have sex with men. A
black, gay and bisexual men in Katutura township, Namibia,
experience verbal, physical and sexual forms of assault and
discrimination from hospital staff, police, army and church
officials. Facing barriers in employment, they turn to
commercial sex work.
That sex happens among male prisoners is now acknowledged even
correctional services. The Prison Fellowship of Zambia
project to bring AIDS awareness, peer counselling and condoms
prisons. With HIV prevalence of 27-30% in its crowded prisons,
Namibia offers counselling to prisoners but not condoms
could be seen as encouraging sodomy, which is a criminal
Male rape, possibly the last frontier in public debate, was
into the conference by Men United, a South African group
breaking the silence about male rape, providing support and
survivors and their families, and educating youth to speak out
against all sexual abuse.
Some success was noted in men's involvement in home based
reversing the tradition that nursing the sick is a female
Tovwirane in northern Malawi and Kara Counselling in southern
have growing numbers of male care givers. Chiefs and church
help identify volunteers who are provided with training,
The conference showcased a number of male-centred AIDS
initiatives in the region, with migrant miners in Zimbabwe,
soccer games in Zambia, and with adolescents in Malawi. The
African Men's Network, formed in October 2002, seeks to
local initiatives into visible and structured actions, and to
mobilise national men's movements.
A vigorous debate centred on the role of African culture(s) in
shaping masculinity. A consensus emerged that traditional
dynamic, it changes and adapts, and can accommodate and shape
different construction of masculinity.
After 20 years of rampant spread, AIDS is driving changes in
behaviour in Southern Africa. "Men's perceptions of
changing." These changes need to be followed-up and
Participants agreed that the concept and practice of
needs to be reconstructed in ways that fit new socio-economic
realities, from rural-urban migration to women's advancement,
and unemployment. A new way of perceiving manhood would
to live their sexuality differently and to take active
responsibility. Such efforts should be grounded in a culture
rights that can bridge cultural differences and span the
situations men experience, i.e., rural and urban, old and
heterosexual and gay, single and married, etc. The notions set
the UN Declaration of Human Rights provide a common ground for
complex and conflictive task of renegotiating gender power
Summing up the conference, one participant said: "Men
not about what we stand to lose but what we stand to