The Role of Men and Boys in Challenging Gender in the Context of HIV and other STIs
Concepts, evidence and good practice: GBV The role of men and boys in challenging gender in thecontext of HIV and other STIs Klas Hyllander Men for Gender Equality Sweden & MenEngageRegional meeting on HIV and GBV, Bratislava, Slovakia – November 6-8, 2012
Overview• Gender norms and gender-based power differentials between men and women are key drivers of men’s and women’s vulnerability to HIV/STIs• Understanding/analysis of men and boys as gendered creates opportunities for prevention• Social gender norms/notions of manhood drive the behaviors of men and boys.• Link HIV-GBV: multi-country studies have found intimate partner violence to be significantly associated with women’s risk for STIs, including HIV.
Overview cont’d• A 2006 WHO multi-country study: women who reported physical or sexual violence by a partner ranged from 15 percent to 71 percent, with the majority of settings falling between 29 percent and 62 percent• 10-20% of women say their first sexual experience was coerced• Prevention of violence against women and GBV requires changing gender-inequitable norms• Growing consensus on need to focus on primary prevention: stopping violence before it begins by changing violence-supporting norms and behaviors, primarily perpetrated by men.
Overview cont’d• There is a growing evidence-base that primary prevention programming with men and boys works• Gender-transformative programming most efficient• Types of programming: – Service-Based – Group Education – Community mobilisation (Media campaigns, Community media: Digital storytelling) – Integrated• Multi-level approaches most efficient (e.g. policy, media campaigns, group education, service-based programs)
Concepts, evidence and good practice: GBV The role of men and boys in challenging gender in thecontext of HIV and other STIs Klas Hyllander Men for Gender Equality Sweden & MenEngage
The Global HIV/AIDS Epidemicand Men• In generalized or concentrated epidemics, sexual behavior of men key• Epidemic leveling off in some countries mostly when large groups of men change behaviors – e.g. Thailand, Brazil, Uganda• Young women 50% more likely to contract HIV than young men• HIV higher in conflict zones, in armed forces, prisons and in cases of gender-based violence and transactional sex• Men less likely than women in some settings to seek Voluntary Counseling and Testing and to disclose status
Men and Boys: Gendered• The concept of gender is often perceived to refer primarily to women and girls• But gender norms shape socially acceptable notions of masculinity as well as femininity• Gender norms help define what it means to be a man as well as a woman• Understanding masculinity norms creates prevention opportunities
Social norms and masculinitiesIn numerous sample survey studies, gender-related attitudes arecorrelated with men’s and boys’ .... Self-reported physical violence toward female partners Self-reported acts of delinquency Number of sexual partners Rates of self-reported STI symptoms Condom use Substance/alcohol useIn sum, how and to what extent boys and men internalize prevailing inequitable social definitions of manhood and gender-related norms affects their health and well-being and that of their partners and their use of violence against women.....
Social norms drive the behavior of men and boys: GBV andnorms about manhood – household sample data from Riode Janeiro % who used violence against partner 20% 17% 15% 10% 10% 4% 5% 0% High Equitable Medium Equitable Low Equitable *p < 0.001 - Chi-square test
Gender, Power and HIV/STIsGender norms and the gender-based powerdifferentials between men and women(and amongst different groups of men, and amongst different groups of women)are key drivers of men’s and women’s vulnerabilityto HIV/STIs.
Masculinities, SRH and HIV• Ideas of manhood that equate ‘being a man’ with sexual risk-taking, and being in control, are associated with more negative attitudes towards condoms and less use, more sexually transmitted infections, more partners, including more casual partners, more frequent sex, more abuse of alcohol and more transactional sex.• A significant proportion of men with STIs do not inform their sexual partners.• Men all too often prevent women’s from determining whether or how sex takes place.
Links GBV - HIV• A complex combination of biological and social factors links violence against women with increased risk of HIV.• Violence and threats of violence or coercion may limit women’s ability to negotiate safe sexual behaviors, particularly use of condoms during sex.• Multi-country studies have found intimate partner violence to be significantly associated with women’s risk for STIs, including HIV. – Women who have experienced physical/sexual intimate partner violence are 54% more likely to have HIV (Dunkle et al 2004). – Men who have perpetrated physical/sexual intimate partner violence are more than twice likely to have HIV (Jewkes et al 2008)• A 2006 WHO multi-country study: women who reported physical or sexual violence by a partner ranged from 15 percent to 71 percent, with the majority of settings falling between 29 percent and 62 percent• 10-20% of women say their first sexual experience was coerced
Prevalence of rape reported by adult men 30 25 20 South Africa 15 India Croatia 10 5 0 All rape SIPV Gang rape
Distribution of victim numbers among men who have raped 70 60 50 40 South Africa India 30 Croatia 20 10 0 1 2-3 4-5 6-10 11+
Reforming masculinities• Prevention of violence against women and GBV requires changing dominant gender norms• Growing consensus on need to focus on primary prevention: stopping violence before it begins by changing violence-supporting norms and behaviors, primarily perpetrated by men.• We start from the assumption that men and boys can change and are changing• New generation of boys and men influenced by the gains of women’s rights movement• New legislation in many countries – VAW, paternity leave, joint custody of children• Many boys and young men who show a mixture of more gender- equitable views mixed with inequitable views about women• The question is not if men can change, but how we can speed up the change
The International Mandate for Gender Equality and Engaging Men and BoysCSW 48th Session (2004) called for:• Gender equitable education;• Engaging men as fathers in gender equitable socialization of children and in care giving;• Institutionalizing the inclusion of men and boys in gender equality and gender mainstreaming policies;• Public information campaigns and engaging the media, including internet, in questioning inequitable and sexist views;• Engaging men and boys in HIV/AIDS treatment and prevention, and in sexual and reproductive health; and• Engaging men and boys to reduce gender-based violence
Growing evidence base that interventions withmen and boys work: WHO & Promundo 2008Type of Intervention n Effective Promisin Unclear gGroup Education 20 - 11 9Services-Based 8 2 4 2Community 8 6 2 -Outreach/MobilizationIntegrated (includes 21 6 5 10more than 1 of the above) TOTAL 57 14 22 21 (24.5%) (38.5%) (36.8%)
But Which Kinds of Programs Work Best in Engaging Men? Gender neutral: No distinction between men and women; men just another target group Gender sensitive: Recognize role of gender norms/structures but little attempt to transform them Gender transformative: Seek to promote equitable relationships, somehow change gender relations• (Adapted from: Rao Gupta, et al 2002)
Group Education • Participatory reflection on male socialisation and costs for men and women. • Focus on moving from reflection to internalisation to sustained action
Key Elements in Effective Group Education with Boys and Men Information + Critical reflection about masculinity Skills building/experiential learning Creating a safe space 10-16 sessions recommended More effective when combined with campaigns
Evidence• Solid evidence that interventions can bring about positive gender, SRH and HIV related changes amongst men and boysExamples• Stepping Stones: after two years men reported fewer partners, higher condom use, less transactional sex, less substance abuse and less perpetration of intimate partner violence• Programme H: participants between four and eight times less likely to report STIs and 2.4 times as likely to use condoms.• Men As Partners and PMTCT in Ethiopia: 46% increase in men testing with their partners and 87.6% increase in the number of men joining their partners for PMTCT visits.• One Man Can Workshop: 27% tested for HIV soon after the workshop and 2/3rds increased use of condoms.
Mass Media: Brothers For Lifehttp://www.brothersforlife.org/video/original.html
Community Media: Radio, CTV, Murals, Digital Storytelling
Key Elements in Effective Campaigns to Engage Boys and Men Clear and positive messages Formative research + extensive testing of messages Engage local boys/men in constructing the messages Promoting a gender-equitable lifestyle or alternative male identity High quality media At least 4-6 months in duration
The experience so far suggests the needfor programmes that .... Enable/empower men/boys toquestion harmful and traditionalnorms about manhoodFind and promote what’s in itfor men to changeTake into account other issues– particularly poverty,employment, urban/ruraldifferences, etc.Are integrated across healthand social development issuesand with multiple interventionlevels
Resources• Men, Masculinities and HIV/AIDS: Strategies for Action (International Center for Research on Women, Instituto Promundo, MenEngage Alliance, Sonke Gender Justice Network)• WHO – Engaging men and boys in changing gender-based inequity in health: Evidence from programme interventions – Policy approaches to engaging men and boys in achieving gender equality and health equity• UN Women: ”Virtual Knowledge Center on Ending Violence Against Women” www.endvawnow.org/ (section on Men and Boys)• UNFPA ”Engaging Men and Boys in Gender Equality and Health: A global toolkit for action.”• MenCare www.men-care.org