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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



"Men should think not about what we stand to lose but what we stand
to gain."

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 deeply spiritual
transformation in the identity 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 among activists, researchers, and
people involved in service delivery and/or advocacy around HIV/AIDS.
The conference was structured around 10 parallel streams: Enlisting
men as people living with HIV/AIDS; Men in prevention and advocacy;
Marketing; Home based care; Man to man transmission; Male
reproductive health; Boy child and construction of masculinity; Boy
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 key
issue is that deeply held notions of masculinity lead to high-risk
behaviour for HIV infection among men and women. Research and surveys
across the region show that men are socialised into a notion of
masculinity as 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 the region. These include
rural/urban migration, Western culture seeping through mass media and
the entrenchment of women's rights. "Many men are feeling a bit
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 KwaZulu Natal
found that the conflict between traditional and contemporary gender
roles generates in boys and men a sense of displacement and
irrelevance that cuts across 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

Similar findings emerged in a survey by the University of
Witwatersrand on risk taking behaviour among youth in Soweto, South
Africa's largest township, where nearly half of young men are
unemployed. "If you have no job and no future, life becomes cheap,
and sex is a dangerous entertainment fuelled by boredom, alcohol and

From the other end of the social spectrum, a survey among traditional
healers, chiefs and Zionist priests by the Promotion of Traditional
Medicine Association of South Africa (Pro-me-tra) found that men feel
socially disoriented through a loss of leadership position in family
and community. "Men have become spectators, irresponsible and
indifferent." Traditional practices, however, make up male identity
and to attack them is self-defeating, says Prometra. Better to tap
into the traditional notion of men being responsible for their
families. Male circumcision, wife inheritance, scarification and
polygamy can be managed responsibly "in safe and best practice" if
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 drug
abuse - but they have little visibility in the predominant discourse
of "men as drivers of the epidemic."

According to the Centre for the Study of Aids at the University of
Pretoria, which works with marginalised young men - unemployed,
junkies, bodybuilders, drag queens and male sex workers, negative
male images channelled by the media and by society are internalised
by young men and turn into a self-fulfilling prophecy. "There is more
rejection 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
or culture but take responsibility."

Another common thread is the pervasive silence surrounding male
sexuality. Parents don't talk about sex with their children. Husbands
don't talk with their wives. Men generally feel uncomfortable
discussing intimacy. Their reproductive health needs remain invisible.

At the National Association for People Living with HIV/AIDS in Malawi
(NAPHAM), nine out of ten male members would not disclose their HIV
status to their spouses. Secrecy brought stress, risk of infection
for the wife through unprotected sex, and inability to change
lifestyle and live positively. But when NAPHAM started support groups
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 sexuality in
non-threatening environments," concluded a regional 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 South African Men's Forum (SAMF). "We need to challenge this
destructive concept of manhood that men make all decisions, 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 century ethnographic research documents sex between men
in Africa. Politically constructed homophobia has a negative impact
on public health because it excludes homosexuals from prevention and
awareness campaigns, making them vulnerable to HIV infection. A
combination of research and activism is breaking the silence about
men who have sex with men across race and class.

Researchers at UNISA in South Africa and the Population Council in
Kenya reported on the sexual and

reproductive health needs of men who have sex with men. A study of
black, gay and bisexual men in Katutura township, Namibia, found they
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 (unsafe)
commercial sex work.

That sex happens among male prisoners is now acknowledged even by
correctional services. The Prison Fellowship 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 condoms because 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 South African group dedicated to
breaking the silence about male rape, providing support and care for
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 care,
reversing the tradition that nursing the sick is a female domain.
Tovwirane in northern Malawi and Kara Counselling in southern Zambia
have growing numbers of male care givers. Chiefs and church leaders
help identify volunteers who are provided with training, bicycles and
team support.

The conference showcased a number of male-centred AIDS awareness
initiatives in the region, with migrant miners in Zimbabwe, through
soccer games in Zambia, and with adolescents in Malawi. The Southern
African Men's Network, formed in October 2002, seeks to amplify small
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 culture is
dynamic, it changes and adapts, and can accommodate and shape a
different construction of masculinity.

After 20 years of rampant spread, AIDS is driving changes in male
behaviour in Southern Africa. "Men's perceptions 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 new socio-economic
realities, from rural-urban migration to women's advancement, AIDS
and unemployment. A new way of perceiving manhood would empower men
to live their sexuality differently and to take active community
responsibility. Such efforts should be grounded in a culture of human
rights that can bridge cultural differences and span the variety of
situations men experience, i.e., rural and urban, old and young,
heterosexual and gay, single and married, etc. The notions set out in
the UN Declaration of Human Rights provide a common ground for the
complex and conflictive task of renegotiating gender power relations.

Summing up the conference, one participant said: "Men should think
not about what we stand to lose but what we stand to gain."