th6 SA AIDS Conference

18– 21 June 2013

Contact: misselhorn@ukzn.ac.za

HCW and PWD profit from training on the interrelationship of disability and HIV. Through sensitising both groups, service providers and users have the opportunity to initiate change. As table 1 shows both groups were able to identify a number of issues that they felt comfortable to address depending on budgets. The developed training approach needs to be mirrored by budget allocations from the department of health or related departments. While PWD in particular profit from knowledge around disability and HIV as well as human rights related issues, HCW profit from disability sensitisation as well as knowledge about disability. HCW however need a more intense training on disability screening tools, use of referrals as well as resources that can facilitate access to prevention, treatment care and support (e.g. picture material).

Conclusions

1Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal. , University of KwaZulu-Natal; Private Bag x54001, DURBAN, 4000, South Africa,2 Gender and Health Research, Medical Research Council, Private Bag x385, Pretoria, 0001;

3School of Public Health, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa

CURRICULUM ACTIVITIES that have sufficient strength to improve selected risk /protective factors

LEARNING OBJECTIVESRelating to one or more of:1. Knowledge 2. Attitudes, values

and beliefs3. Perceptions of peer

norms4. Intentions

SELECTED KEY BEHAVIOURS having causal impact on livelihood goals. Criteria: Behaviour AND risk/protective factor:1. Strongly and directly affects the goal2. Defined precisely3. Bring change which is measurable4. Can be realistically changed by our

intervention

RISK AND PROTECTIVE FACTORS having causal impact on behaviours - categorised as follows:1. Macro-economic and political2. Biological, physical, historical3. Personal/household economic4. Community/social/cultural/ family5. Personal/individual - knowledge,

perceptions, attitudes, perceptions of norms, self-efficacy and intentions

GENERAL BEHAVIOURS linked to goals (e.g. getting employment linked to financial

LIVELIHOOD GOALS

LOGICAL FLOW OF IMPACT OF CURRICULUM ACTIVITIES

Funding was provided by:

Masculinity, Livelihood and HIV Risk in Urban Informal Settlements in South Africa

1 2,3 2 Andrew Gibbs, Rachel Jewkes, Yandisa Sikweyiya

Studies from South Africa and

across Africa suggest that men

living in urban informal settlements

have higher HIV risk behaviours

including intimate partner violence

and multiple partners compared to

other men (Madise et al., 2012). In

understanding potential reasons

why an argument has been made

that in contexts of economic

insecurity and poverty, men

r e s p o n d b y c o n s t r u c t i n g

masculinities that glorify sexual

risk-taking, physical violence and

control of partners.

Men all felt that successful masculinity was linked to achieving two inter-linked ideals: earning a decent income and control of a female partner. These were mutually reinforcing; through work one could be a 'proper' man who would provide for a woman and in return expected to be respected. Gwedi, when asked about what a successful man in his community was, replied:

You know there is no other way my brother you must have a wife, a house and money, and again to see how well behaved you are when you are a man you must be straight (strict)

Yet in contexts of high unemployment, achieving these idealised notions of what it means to be a man were difficult. The majority of men survived through four main livelihood strategies: being given money by family members, temporary formal work, informal work and petty crime. Despite differences, these men were all insecure and paid poorly. Men recognised how these types of work positioned them as failing to achieve what was expected of them as men in their families and communities. Due to financial dependency on others, men perceived/ described themselves as children, as did other community members and felt stuck unable to become men.

As part of a larger study to evaluate

the impact of a combined gender

transformation and livelihoods

strengthening intervent ion -

Stepping Stones and Creating

Futures - we undertook 18 in-depth

interviews and 4 focus group

discussions with young black men

(18-30) from three urban informal

settlements to understand the

intersections between masculinities,

livelihoods and HIV risk. Data was

translated from isiZulu to English

and transcribed and analysed using

thematic analysis.

Background MethodsResults

“

Alcohol use

Young men spent a lot of time hanging out in their community and knowing they were 'looked down on' by other women and men. Many used alcohol as a way to cope with these periods of boredom and the 'stresses' they felt:

Interviewer: does not having money cause problems to you as a man?Bheka: yes it does because it causes lack of confidenceInterviewer: How can you give me an example?Bheka: like when you have kids, and they come asking for money when you don't have one then they end up going to their mother for it. After that you as man don't feel comfortable being in that situation of not being able to help your child because you are not working, then you end up consuming alcohol just so that you can take the stress away

Multiple partners

The majority of men had a large number of main, on-going and once-off partners. Materially, men struggled to fulfil their side of the bargain through providing for their girlfriends - a central aspect of love suggested by Mark Hunter (2010) - making them less able to retain main girlfriends:

Sandile: most of the time women depend on men, so if you are a man and you don't have money, even when a woman is asking for, something to wear or a perfume and you are not able to provide with that, it becomes a problem, it is an embarrassment. Interviewer: what happens to you as a man when that happens?Sandile: your dignity is crushed and women badmouth you, like saying "that man is just using me he does not give me money he doesn't do anything for me he is just using me" (for sex)

Importantly in these relationships with main female partners, the emphasis on trust and love meant condom use was limited:

Male respondent (focus group): I will make an example with the guys I hang out with, they say they don't use condoms with their main partners because they trust them, then the other girlfriends they don't care about, they use condoms with them.

Yet relationship turnover was quite high, with main partner status being an indication of social relationship rather than longevity. As many other authors have suggested, multiple partners with women were a way in which these young men could 'prove' themselves as men, when they could not do it through the dominant approach.

Violence against partners

Men's use of violence against girlfriends was predicated by men's concerns around the lack of respect they felt women showed to them. Broadly this was a function of the fact that they were viewed as children and often laughed at by women, for not being able to provide. They used violence as a way of re-establishing the gender order in relationships:

Mthobisi: when a girl like she is working and I am not working and she starts disrespecting and being rude to me, we then fight then like I end up hitting her because I try to defend my dignity as a man

“

“ “

Impact on HIV risk behaviours The impact of men's weak and insecure livelihoods was material and psychological, in turn shaping their HIV risk behaviours. We identify three major risks.

“

Acknowledgements: Thanks to the rest of the project team: Alison Misselhorn, Milly Mushinga, Laura Washington, Mpume Mbatha and Samantha Willan.

ReferencesHUNTER, M. 2010. Love in a Time of AIDS, Durban, UKZN.MADISE, N., ZIRABA, A., INUNGU, J. & KHAMEDI, S. 2012. Are Slum Dwellers At Heightened Risk of HIV infection than other urban residents? Health and Place, 18, 1144-1152.

Men's HIV risk behaviours were at the intersection of gender inequalities, inequitable

masculinities and livelihood insecurity. Working with men in urban informal settlements to

reduce HIV risk needs to link working for gender equality with working around men's

economic disempowerment if changes are to occur. HEARD, the Gender and Health Unit at

the MRC and Project Empower have been implementing and evaluating the Stepping

Stones and Creating Futures intervention that seeks to do this.

Conclusion