All over the world, women find themselves at special risk of HIV infection because of their lack of power to determine where, when and how sex takes place. What is less recognized, however, is that the cultural beliefs and expectations that make this the case also heighten men's own vulnerability. HIV infections and AIDS deaths in men outnumber those in women on every continent except sub-Saharan Africa. Young men are more at risk than older ones: about one in four people with HIV is a young man under the age of 25.
Part of the effort to curb the AIDS epidemic must include challenging harmful concepts of masculinity and changing many commonly held attitudes and behaviours, including the way men view risk and how boys are socialized to become men. Broadly speaking, men are expected to be physically strong, emotionally robust, daring and virile. Some of these expectations translate into ways of thinking and behaving that endanger the health and well-being of men and their sex partners. Other behaviours and attitudes, on the contrary, represent valuable potential that can be tapped by AIDS programmes.
Focusing the Campaign on men also acknowledges the fact that men are often less likely to seek health care than women. Except in a handful of countries, men have a lower life expectancy at birth and higher death rates during adulthood than women. But boys who are brought up to believe that "real men don't get sick" often see themselves as invulnerable to illness or risk. This is reflected in the under-use of health services by men. Greater attention must be given to the health needs of men, including those living with HIV and AIDS.
There are sound reasons why men should become more fully involved in the fight against AIDS. All over the world, men tend to have more sex partners than women, including more extramarital partners, thereby increasing their own and their primary partners' risk of contracting HIV. Over 70% of HIV infections worldwide occur through sex between men and women, and a further 10% through sex between men. Another 5% or so take place among people who inject drugs, four-fifths of whom are men. Secrecy, stigma and shame surrounding HIV compound the effects of all these risk behaviours. The stigma surrounding HIV may prevent many men and women from acknowledging that they have become infected.
A number of special circumstances place men at particularly high risk of contracting HIV. Men, who migrate for work and live away from their families may pay for sex and use substances, particularly alcohol, as a way to cope with the stress and loneliness of living away from home. Men in all-male environments such as the military may be strongly influenced by a culture that reinforces risk-taking including unsafe sex. And in some all-male institutions including prisons, men who normally prefer women as sex partners may have unsafe sex with other men.
Male violence further drives the spread of HIV -- through wars and the migration they cause, as well as through forced sex. Millions of men a year are sexually violent towards women, girls, and other men sometimes in their own family or household. UNICEF released a report in 2000 stating that worldwide at least one in three women has been beaten, coerced into sex or otherwise abused in her lifetime.
Part of our task is to convince leaders to speak out as a friend, parent and concerned world citizen. The World AIDS Campaign focusing on men offers an opportunity for world leaders to renew their commitment to HIV/AIDS. It provides a platform to voice concerns on the rapid spread of the epidemic and the need for unified action. It also gives world leaders the opportunity not just to speak in their official capacity but also to use their personal equity and reputation to support HIV prevention and care for those infected.
At the same time, a balance needs to be struck between recognizing how men's behaviour contributes to the epidemic and recognizing their potential to make a difference. As politicians, as front-line workers, as fathers, as sons, as brothers and friends, men have much to give. Men need to be encouraged to adopt positive behaviours, and to play a much greater part in caring for their partners and families. Studies worldwide show that men generally participate less than women in caring for their children. In terms of the AIDS epidemic, which has left over 13 million children orphaned, there is an urgency for both men and women to provide the love and practical needs such as food, housing, clothing and education for children who have lost their parents.
All this does not mean an end to prevention programmes for women and girls. Rather, the Campaign aims to complement such programmes. Work that enhances gender awareness and sensitivity should focus on the needs of both sexes. The Campaign is designed to provide material for national and local organizations to create their own campaign based on "I care . . . Do you?" while responding to local priorities.
For more information on the World AIDS Campaign, please contact: Andrew Doupe, World AIDS Campaign Coordinator, UNAIDS, Geneva; tel. (+41 22) 791-4765; email: firstname.lastname@example.org.