1. Concepts, evidence and good practice: GBV
The role of men and boys in
challenging gender in the
context of HIV and other STIs
Klas Hyllander
Men for Gender Equality Sweden & MenEngage
Regional meeting on HIV and GBV, Bratislava, Slovakia –
November 6-8, 2012

2. 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.

3. 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.

4. 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)

5. Digital storytelling – reaching people

6. Concepts, evidence and good practice: GBV
The role of men and boys in
challenging gender in the
context of HIV and other STIs
Klas Hyllander
Men for Gender Equality Sweden & MenEngage

7. The Global HIV/AIDS Epidemic
and 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

8. 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

9. Social norms and masculinities
In numerous sample survey studies, gender-related attitudes are
correlated 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 use
In 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.....

10. Social norms drive the behavior of men and boys: GBV and
norms about manhood – household sample data from Rio
de 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

11. Gender, Power and HIV/STIs
Gender norms and the gender-based power
differentials 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 vulnerability
to HIV/STIs.

12. 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.

13. 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

14. Prevalence of rape reported by adult men
30
25
20
South Africa
15 India
Croatia
10
5
0
All rape SIPV Gang rape

15. 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+

16. 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

17. The International Mandate for Gender
Equality and Engaging Men and Boys
CSW 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

18. Strategies for Engaging Men
and Boys

19. Growing evidence base that interventions with
men and boys work: WHO & Promundo 2008
Type of Intervention n Effective Promisin Unclear
g
Group Education 20 - 11 9
Services-Based 8 2 4 2
Community 8 6 2 -
Outreach/Mobilization
Integrated (includes 21 6 5 10
more than 1 of the above)
TOTAL 57 14 22 21
(24.5%) (38.5%) (36.8%)

20. 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)

21. Group Education
• Participatory
reflection on male
socialisation and
costs for men and
women.
• Focus on moving
from reflection to
internalisation to
sustained action

22. 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

23. Evidence
• Solid evidence that interventions can bring about positive gender,
SRH and HIV related changes amongst men and boys
Examples
• 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.

24. Mass Media: Brothers For Life
http://www.brothersforlife.org/video/original.html

25. Community Media: Radio, CTV, Murals,
Digital Storytelling

26. 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

27. The experience so far suggests the need
for programmes that ....
 Enable/empower men/boys to
question harmful and traditional
norms about manhood
Find and promote what’s in it
for men to change
Take into account other issues
– particularly poverty,
employment, urban/rural
differences, etc.
Are integrated across health
and social development issues
and with multiple intervention
levels

29. 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