WORLD AIDS DAY 2001

Male involvement in the fight against AIDS

Marleen Temmerman, RUG

"I care... Do you?"

• is the slogan for the second year of a two-year Campaign

• intended to create a sustained focus on the role of men in the AIDS epidemic and culminates on 1 December, World AIDS day.

The Campaign aims to involve men more fully in the efforts against AIDS

• to bring about a much-needed focus on men in national responses to the epidemic

• to involve leaders both as politicians and in their personal lives in the response to the HIV epidemic.

Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000

South-Africa

35

40

45

50

55

60

65

1950-55 1955-601960-651965-701970-751975-801980-851985-901990-951995-00

Lif

e e

xp

ecta

ncy

at

bir

th,

in y

ears

Botswana

Uganda

Zambia

Zimbabwe

Source: United Nations Population Division, 1998

Nu

mb

er

of

Peo

ple

L

ivin

g w

ith

HIV

/AID

S

(in

mil

lio

ns

)

The World Health Organization (WHO) launches the Special Programme on AIDS

The International Council of AIDS Service Organizations (ICASO) and the Global Network of People Living with HIV/AIDS are founded

The first therapy for AIDS

- azidothymidine (AZT) - is

approved for use in the USA

In 1991-1993, H IV prevalence in young pregnant women in Uganda begins to

decrease, the first major downturn in a

developing country

An HIV outbreak in Eastern Europe

is detected (among injecting

drug users)

Highly Active Antiretroviral Therapy (HAART) is

discussed for the first time

The first efficacy trial of a potentia l HIV vaccine in a developing country starts in Thailand

In Africa, a heterosexual

AIDS epidemic is

revealed

The Human Immuno-deficiency Virus (HIV) is identified as the cause of

AIDS

Acquired Immuno- deficiency Syndrome

(AIDS) is defined for the first time

In the USA, the first HIV antibody

test is approved by the Food and Drug Administration and HIV screening of blood donations

starts

UNAIDS is created

Scientists develop the first treatment regimen to reduce

mother-to-child transmission

Brazil becomes the first developing country to

provide antiretroviral therapy through its

public health system

The UN Security Council discusses HIV/AIDS for

the first time

UN Secretary-General Kofi Annan maps a plan of action,

and calls for the creation of a global fund on AIDS and health

Rock Hudson becomes the first public figure to disclose he has AIDS

At least one case of HIV/AIDS has been

reported from each region of the world

The first cases of unusual immune deficiency are

identified among gay men in the USA

2 0 y ea rs o f H IV /A ID S

June 2001

Factors influencing HIV transmission

• Social inequalities• Power relations• Poverty• Migration• Urbanisation• Social background• Race• Gender

Gender

• Refers to the social shaping of femininities and masculinities, and challenges the idea that relations between the sexes are ordained by biology or nature

• Unequal gender relations are particularly visible in special vulnerability of women to HIV, and in men’s risk taking behaviour

• Gender relations affect not only the development of the AIDS epidemic but the manner in which individuals and societies respond

Gender is not a woman’s issue

• Whereas ‘sex’ is referring to biological differences between males and females, gender refers to social and cultural notions of masculinity and femininity

• A gender order where men dominate women, cannot avoid constituting men as an interest group concerned with defence, and women as an interest group concerned with change (Connell 1995)

• Not having to think about gender is a patriarchal dividend that men gain from their position in the gender order. This is one of the reasons why ‘gender’ is often dismissed as a women’s issue

Sex and reproduction

• A man’s right, a woman’s duty?– Women carry the burden of pregnancy and

childbirth– They are responsible for contraception and

infertility, but men have the decision-power– Difficult diagnosis of STD in women– Women have little economic and sexual power– Violence against women

• Patrilineal societies often have power relations skewed in favour of men and this is also reflected in the realm of sexuality

HIV and women: multiple jeopardy

• Society: blame on women, economic dependent

• Nature: diagnosis and treatment of STD more difficult, sequelae worse, transmission rates higher

• Partner: no sexual power, scapegoat for diseases

• Science: still no female controlled methods

Social context of STD/HIV risk

• Reproductive health decisions remain the ‘male domain’ in many countries

• Women are often recipients of male-based decisions

• Women are more accessible to health education than men as users of health services

• Yet, they have limited options in light of the STD and HIV epidemic

The STD/AIDS epidemic

• Brought into sharp relief the absence of information on men

• Highlighted the patriarchal structures that benefit men who often remain passive and non-participatory in reproductive health that is considered as a woman’s issue

• Resulted in the introduction of STD/HIV into the framework of reproductive health necessitating the incorporation of men as participants, partners and consumers of services

HIV in pregnant women: prevalence in South HIV in pregnant women: prevalence in South Africa, 1990 to 1999Africa, 1990 to 1999

Source: Department of Health, South Africa

0.71.7 2.1

4

7.6

10.4

14.2

17

22.8 22.4

0

5

10

15

20

25

90 91 92 93 94 95 96 97 98 99

HIV

pre

vale

nc

e (%

)

Prevention of Mother to Child Transmission (PMTCT). during late pregnancy. during labor. through breast-feeding

Prevention of

unwanted pregnancies

(Family Planning)

Primary HIV prevention in parents to be

Three Integrated Strategies to Reduce Paediatric AIDS

Perinatal HIV transmission

• Interventions include VCT during pregnancy, antiretroviral drugs and replacement feeding

• This is visible to the partner, difficult to implement without his understanding and consent

• Major concern in VCT in pregnant women is the adverse consequences following disclosure of their status: stigmatisation, violence, isolation

Violence against women

• High levels of ‘background’violence in women in Tanzania (54% in HIV+ and 32% in HIV- women

• Violence was high in HIV + women in Nairobi

• Beating and abuse of women in Mumbai after disclosure

Poor uptake of PMTCT interventions

• UNICEF study: only 30% of women offered VCT were not tested. Out of the women tested 30% did not take adequate doses of drugs

• Low disclosure rates all over Africa (30-50%)

• Key barrier: blame on the one who brings HIV into the family

Responses

• Involvement of partners, family …into reproductive health services

• Greater efforts to reach men

• Addressing the issue of violence

• Couple counselling and testing

• Education of both men and women

• Empowerment of women

Conclusions

• Men have to be more actively involved in HIV/STD prevention work and reproductive health

• The burden of responsibilities should be carried by both men and women

• The complex inequalities of gender and sexuality which facilitate HIV/STD transmission should be challenged by men and women

Conclusions

• ‘If development is not engendered, it is endangered’(Human development report, 1977)

• Increasing interest in men as potential agents of change, and not merely objects of blame. ‘Time is ripe to start seeing men not as some kind of problem, but as part of the solution’ (Peter PIOT, 2000)