I care . . . Do you?"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.
- Men are influenced by cultural norms regarding manhood, some of which are very negative in the context of HIV.
- For social, cultural and economic reasons, men are often in a stronger position in their relationships with women. This gives them more control in deciding when and where to have sex, as well as whether or not to use condoms. Because of their position, men can be good advocates for behavioral change and social responsibility.
- "Macho" attitudes that encourage multiple sexual partners and risk-taking put men -- and their partners -- at risk of HIV infection.
- Discrimination against, or hostility towards, men who have sex with men can promote HIV transmission because safer-sex messages can be difficult to communicate to the community.
- Talking about sex and revealing one's HIV status is often difficult for men and women.
- Community leaders have a critical role to play in HIV/AIDS prevention and care.
- Attitudes, traditions and values in every culture affect boys' and men's sexual behavior.
- In most cultures, boys and men have more sexual partners than do girls and women.
- Certain sexual practices, such as sex between men, are taboo in many cultures; this can seriously hinder the promotion of safer sexual practices and the use and distribution of condoms among vulnerable groups.
- Some traditions can result in increased risk of HIV infection. They include the following:
- Polygamy, if one or more of the wives or the husband is infected;
- "Inheritance rights" whereby brothers or other male adult relations are compelled to marry the wife of a male relative who has died of AIDS. Often the wife is already HIV-infected;
- Circumcision and excision, if the instruments used are not properly disinfected;
- Scarring and tattooing, if the instruments used are not properly disinfected;
- Brotherhood rites, as a result of possible blood exchange;
- Ritual deflowering and sexual violence by men against women, girls and children; and
- Dry sex practices used to increase sexual pleasure.
- Men often find it difficult to seek help when diagnosed with HIV. Many men withhold information on their HIV status, because they are afraid of being stigmatized and rejected by their community or because of cultural taboos.
Socially constructed images of masculinity can encourage high-risk behavior such as violence, sexual risk-taking, excessive drinking or drug use. These "macho" attitudes, which are encouraged in many cultures and make women more vulnerable to HIV infection because of the imbalances in decision-making power, mean that many women cannot negotiate condom use and are often forced to have unwanted sexual relations. These attitudes also make men vulnerable to HIV infection since they often emphasize sexual prowess, encourage men to have multiple sexual partners and prompt them to exercise their authority over women.
For many men and women, it is often difficult to talk about sex and to reveal one's HIV status. Advocating abstinence, faithfulness or condom use can be difficult for many couples. In the community, openly discussing sexually transmitted infections can often mean breaking local taboos, resulting in a loss of prestige. Many men are afraid of revealing a HIV-positive diagnosis because they fear losing their jobs and being rejected by their social group, or because they feel guilty towards their regular partner.
Community leaders -- including traditional healers or medicine men -- have a critical role to play in HIV/AIDS prevention and care because they are often highly respected medical, social and psychological advisers in their community. Their position enables them to either promote or hinder behavioral change as well as HIV prevention and care in general. Therefore, their involvement in a community's response to HIV is vital.
Many cultures and religions give more freedom to men than to women. For example, in many cultures it is considered normal -- and sometimes encouraged -- for young men to experiment sexually before marriage. Also, in many cultures, it is considered acceptable for men -- even married men -- to have sex with sex workers. These cultural attitudes towards sex are leading to HIV infections in both men and women -- often the men's wives.
Because men are traditionally seen as the providers, and they believe that they must fulfill this role, many of them react negatively if they cannot find work or if they are unable to provide for their family. Men's sense of anger or disempowerment may lead to alcohol or drug abuse, or violent behavior, increasing both their own and their partner's risk of HIV infection. Employment opportunities for men may restore self-esteem and reduce their tendency to engage in such risky behavior. However, employment may also mean that couples have to live apart, since men must sometimes migrate or be mobile for work, as is the case for long-distance truck drivers. Due to loneliness and the availability of money, these men may have unprotected sex with other women or men and become HIV-infected. These HIV-positive men may, in turn, infect their wives and other sexual partners.
Some beliefs can result in increased risk of HIV infection. One especially dangerous myth, which is found in some cultures around the world, is that having sex with a virgin will cure HIV. While this is obviously untrue, increasing numbers of young girls are infected as a result of this practice.
In many societies, there are very negative attitudes towards men who have sex with other men. Nonetheless, in every society, no matter how strong the taboos, some men have sex with other men. They do so for many reasons -- for pleasure, for economic reasons, under compulsion, due to a lack of availability of women, or for a combination of the above reasons. Many men who have sex with men also have sex with women -- for pleasure, out of a sense of duty, due to self-denial or in order to hide their desires from others. Therefore, it is important to encourage broader discussion of male-to-male sex, since it is one of the ways in which HIV is transmitted.
Ideas for Action
- Personal questioning:
- Do attitudes regarding male/female relations in your culture influence the spread of HIV?
- Should men challenge practices that are traditional in their culture but facilitate HIV transmission?
- What are the norms that guide your sexual practices?
- Are power, struggle and violence inherent in sexual relations in your culture?
- Make the family the place where boys first learn to respect women and to speak about their sexuality.
- Encourage local leaders to teach men how to honor their masculinity by actively caring for their partner's and their children's health.
- Train healers to act as cultural intermediaries between traditional and modern health care systems.
- Encourage male religious leaders to use their influence to inspire social responsibility among boys and men.
- Identify and promote positive images of masculinity and male behavior for promoting HIV prevention: men as fathers caring for their family, and men with a sense of responsibility and reliability towards themselves and their partners.