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.
- In general, HIV infections are higher among men than women, except in sub-Saharan Africa.
- Young men put themselves and their partners at risk of HIV infection by:
- having unprotected sex with a man or woman; and
- sharing needles and syringe or drug solutions for drug injecting.
- Being able to talk about their problems, including concerns about sexuality, is an important first step for boys and young men in learning how to protect themselves from HIV infection.
- Boys and young men do have control over their health.
- Many young men are particularly vulnerable to HIV infection because, when they socialize, they often drink to the point of intoxication and experiment with sex.
- Drinking alcohol often leads to unsafe sex because it becomes more difficult to say no to sex, to use condoms and to practice safer sex.
- Approximately one-quarter of those living with HIV/AIDS are men under 25.
- More than 70% of HIV infections worldwide are estimated to result from sex between men and women. Ten percent can be traced to sexual transmission between men, and 5% of infections are due to needle-sharing by people who inject drugs. Four out of five injecting drug users are men.
- Research in many parts of the world suggests that men tend to have more sexual partners during their lifetime than women.
- Studies show that when young men lack sexual health education (which can provide them with an understanding of their own bodies, pregnancy and sexually transmitted infections), they have an increased risk of contracting HIV. Many young people get their sexual health information from unreliable sources. Studies from countries as diverse as Cameroon, Costa Rica, the Philippines and Zimbabwe reveal that, while parents often provide young girls with some sexual health education (usually relating to menstruation and pregnancy), boys rarely receive any.
- Most societies assign the role of breadwinner to men and confer special privileges upon both men and boys, compared to women and girls. These privileges often include the right to have sex outside of longer-term relationships or to engage in extra-marital relationships, which can increase the risk of HIV infection for both men and women.
- In many societies, boys and young men are conditioned not to express their emotions, to maintain formal relationships with their children, and to use violence to resolve conflicts and maintain their "honor." Within the context of HIV and AIDS, such conditioning is particularly worrying since it reinforces the view that men do not have a caregiving role, and can result in behavior that places themselves and others at risk of HIV infection.
- Generally, men tend not to look after their own health, and they take more risks, including exposure to HIV infection. With the exception of a handful of countries, this correlates with men having a lower life expectancy at birth than women.
- Boys and young men use health care systems less than women.
- For both boys and girls, the age at which they have their first sexual experience correlates with the age at which they have their first experience with alcohol and/or other mind-altering substances.
- Much drinking takes place in bars, at parties and in nightclubs where people are often searching for sexual partners. Research suggests that excessive alcohol and other drugs, including the so-called "party drugs," are often linked to unsafe sex, and drinking has been associated with people having more than one sexual partner. Research shows that those who combine alcohol and sex are seven times less likely than other people to use condoms during sex.
Giving Young Men and Boys Information and Education on Reproductive and Sexual Health
Boys and young men are often expected to know about sex and sexuality. This expectation stops many of them from seeking information about HIV/AIDS for fear of appearing ignorant about sexual matters. Information and education relating to HIV prevention can help boys and young men to make the necessary decisions for their healthy development and to become responsible adults. In addition, experience working with boys and men has highlighted the importance of acquiring skills to deal with common male health concerns, and to handle situations in which they would be at risk of coerced or unprotected sex.
Living with Male Stereotypes
General male stereotypes include dominance, physical strength and risk-taking. The pressure to live up to such stereotypes can sometimes prompt boys and young men to have unsafe sex or to impose their will on female or male sexual partners, sometimes leading to rape.
Boys and young men are often expected to pursue numerous sexual partners and be in control of sexual encounters. In many societies, sexual experience among boys and young men is encouraged by peers and seen as a matter of prestige. Also, it is commonly believed that young men and boys "need" many sexual partners and that "variety" is a natural part of the male make-up. In many countries, secondary school-age students believe that boys should have many girlfriends, while girls should "stick to one boy." If such behaviors involve unsafe sex, then all concerned are put at risk of HIV infection.
Providing Health Services for Young Boys and Men
Many boys and young men see themselves as somehow invulnerable to illness and, as a result, do not use health care services, or only go to them when faced with serious symptoms. Because of this, many health services are not oriented towards boys and young men. However, studies among boys and young men show that they would like to have access to confidential and affordable services, provided at a time and location convenient to them. Most importantly, they want health care providers to be sensitive to their needs.
Alcohol Use and HIV
Being drunk often provides the necessary excuse for inappropriate, unsociable or risky behavior, such as having unintended or unprotected sex or being sexually aggressive. Also, peers may put pressure on their intoxicated colleagues and convince them to have unsafe sex. Rape or other forms of sexual violence often result from excessive drinking. Communities may expect or accept such behavior in the circumstances, treating it as "normal" for someone who is drunk. However, this kind of behavior can cause the transmission of HIV or sexually transmitted infections (STIs).
Ideas for Action
- Provide boys and young men with information and life skills that will enable them to ensure their reproductive health, based on wise, responsible choices -- choices that include abstinence and delayed sexual activity, as well as safer sex.
- Train doctors and health workers to talk with their patients about sexual behavior, safer sex, and substance abuse, including injecting drug use and drinking.
- Display information about safer sex and HIV prevention, as well as providing easy access to condoms through vending machines in bars and nightclubs.
- Promote 100% condom use among boys and young men beginning their sexual lives, since it is easier to maintain behavioral patterns that are learned early in life.
- Promote the message that condoms provide more pleasure because there is less worry about HIV and other sexually transmitted infections, as well as pregnancy.
- Promote condom use as fashionable -- even "modern" -- as well as acceptable and responsible.
- Advocate the availability of condoms to young people who are sexually active.
- Provide facilities for men-only sessions in clinics dealing with family welfare, reproductive health, and sexually transmitted infections. Gain the support of local community leaders in encouraging young men to attend.
- Bring boys and young men together to talk about their concerns regarding care for their families, and help them develop the skills for talking with, and listening to, their partners and children.
- Target boys and young men with messages about alcohol and drug use, on telephone cards and matchbooks, as well as through the use of other creative outreach strategies such as theatre, art, sports, and in places where men gather.
- Within the community, foster the attitude that drunkenness is no excuse for unsociable behavior or unsafe sex.