/ 15 December 2016

Male engagement crucial against HIV

The panelists at the Critical Thinking Forum on November 30: Moderator Xolani Gwala with Dean Peacock
The panelists at the Critical Thinking Forum on November 30: Moderator Xolani Gwala with Dean Peacock

In what is considered a male-dominated world, men and boys in eastern and southern Africa are extremely reluctant in terms of seeking HIV testing and treatment. Social stigma, a healthcare system dominated by women and high levels of gender-based violence all contribute to 960 000 new HIV infections in 2015 in eastern and southern Africa.

While, according to UNAIDS, AIDS-related deaths have fallen by 45% since the peak in 2005, at the end of 2015 an average of 36.7 million people were living with HIV worldwide and, by June 2016, just over half were accessing antiretroviral therapy.

Just one of the problems in eastern and southern Africa is that men choose to get tested for HIV by proxy, through their partners getting tested, or they test at a late stage. Then add socioeconomic issues such as unemployment, poverty, gender inequality and the reluctance to seek and continue treatment due to a healthcare system that has mainly female nurses at testing and treatment clinics. “More than 30 years into the AIDS epidemic, the world is committed to one principle — that no one is left behind,” said Pierre Somse, deputy director of the UNAIDS Regional Support Team for Eastern and Southern Africa, in his opening of a UNAIDS and Mail & Guardian Critical Thinking Forum on male engagement in HIV prevention and sexual and reproductive health, held in Sandton, Johannesburg on November 30.

Continued Somse: “This commitment includes adolescent girls, young and older women, men and boys, lesbian, gay, bisexual, transgender and intersex people and people who use drugs. They are left behind for many reasons such as economic factors, violation of human rights, gender inequality and more. “Evidence is showing that more men are dying than women. They are less likely to test for HIV, get treatment, and more likely to drop out of treatment and achieve viral load suppression.

“UNAIDS recognises that given these factors, we need to consider male engagement as a critical game-changer. Recently, and because of this, UNAIDS has published a global report on engaging men. Our approach to reaching men is threefold: men as clients, men as partners and parents; and men as agents of change.”

Emasculated and alienated

Broadcast journalist Xolani Gwala, the moderator for the event, took this up: “Men feel emasculated by new laws and there is a sense that men are complaining bitterly about being alienated by systems — and that applies to men and boys. The question here is how we bring them on board.”

“Let us separate out the issues,” said Fareed Abdullah, chief executive of the South African National AIDS Council. “The fact that men are not seeking treatment has two components. Firstly they get sick and die, and secondly the fact that access to treatment plays a pivotal role in the cycle of HIV transmission.”

Abdullah described the scenario of a 28-year-old man having sex with an 18-year-old woman, infecting her and then, when the woman is around the age of 26 and is looking to settle down with a life partner, she infects him in turn. He also raised the issues of men who rape women and have a lifestyle of multiple partners.

“A patriarchal attitude leads to sexual violence and coercion — which is a big problem,” continued Abdullah. “In those circumstances, we need good policing and [an] effective [sentence] that is applied to those violating the law.

“There are some good ideas in the national strategic plan, such as Saturday morning clinics and after-hours services from 4pm to 8pm to accommodate men in the workplace. It is actually easy to do testing in the workplace, which offers ways of getting out and reaching men and communicating with them in the right way.

“There is nothing wrong with a feminised health service — it should be feminised — but the system does need to adapt for men and boys, [though] not necessarily [by having] different clinics. However, the hard part is changing attitudes [such as men] testing through partners and denying that they can get sick.”

“There are three issues we need to draw attention to,” said Dean Peacock, co-founder and executive director of Sonke Gender Justice. “Firstly, gender norms contribute to the chain of violence. Then, secondly, access to treatment usually means [being treated] by women and is determined by the nature of services — the when and how. Finally, we must recognise men of all diversities, such as prison inmates and men [who have sex] with men.”

Repeat offenders

Just prior to this forum a research report, from the Sonke CHANGE trial based in Diepsloot, revealed that more than half — 56% — of men in Diepsloot have raped or beaten a woman in the past year. Rape and physical abuse rates of more than double those reported in national studies have been recorded in this northern Johannesburg township.

The Sonke CHANGE trial, a partnership between the University of the Witwatersrand and Sonke Gender Justice, was conducted this year among 2 600 men in Diepsloot. The men were between the ages of 18 and 40 years, with an average income of R1 500 a month.

Only half had been employed in the three months before the study was conducted. Of those men who had raped or beaten a woman, 60% said they had done so several times over the past year. This raises the likelihood that around half the women in Diepsloot experience violence at least once a year.

“It is not that we are not achieving [change], but it is about whether there is political will to do this at [this] scale,” said Peacock. “I have had the chance to see how masculinity works in community settings,” said Christopher Colvin, head of the social and behavioural sciences division at the University of Cape Town.

“The academic me is always thinking critically about the worlds we are living in — all the varieties and diversity and what we mean by masculinity. The practical part of me is for creating change. If gender and sex are thought to be fundamental aspects of how we order our world and lead our lives, [they must be part of] a process of change.

“There are men who feel fatalistic, disempowered. It is very important to get men doing things differently in the world, but it is easy to be fatalistic if no one is opening the space. Even the most fatalistic will open up in the right circumstances,” concluded Colvin.


  • The numbers in eastern and southern Africa
  • Adult women of all ages (15+) are more likely to have ever tested for HIV than their male counterparts, at 51% compared with 40% of males.
  • Fifty-nine percent of women living with HIV are on antiretroviral treatment, compared to 44% of men living with HIV (15+) .
  • Of all recorded AIDS deaths among adults (15+) in 2015, 54% were among men and 46% among women.

Quotes from the forum

“It is very true to say that it is mainly women in AIDS health care services and they need training on how they treat patients to bring it to a professional level […] Men feel belittled and [have] insufficient privacy. The ‘strong’ guys get their partners to go for testing.” — Simiso Msomi, ambassador for Brothers for Life, UNFPA Youth Advisory Panel

“Healthcare settings have been very feminised and women benefit from regular clinical check-ups, birth control visits and preparation for the different stages of their lives, but there are gaps in mainstreaming health for men, such as separate spaces for HIV treatment and testing so that their masculinity is not threatened. Research also tells us fear, not of the needle prick, but of the outcome, factors into what stops people getting tested.” — Sara Chitambo, project manager, ZAZI Women and Girls Campaign.

“Providing testing in the workplace means the gender disparity falls away.” — Dean Peacock, co-founder and executive director of Sonke Gender Justice

“There is a pilot project in a Namibian treatment centre. A patient is assigned to a health worker who speaks their language and that nurse becomes the nurse to that patient, which also builds a case history and relationship. What we have seen is waiting times go down, improved services and the stigma is lifted.” — Richard Delate, HIV/SRH programme specialist, UNFPA


A previous version of this article contained a draft of the article with messages that were not approved by UNAIDS. The Mail & Guardian apologises for the error.