Objective Three:
To promote programmes which respond to the needs of men and women

• Objective 3.1: Devise messages, activities and interventions that address the needs of men and women

• Objective 3.2: Provide support and care for boys and men living with, affected by, or orphaned by, HIV/AIDS

• Objective 3.3: Provide employment opportunities and vocational training to reduce the vulnerability of unemployed and disempowered men

• Objective 3.4: Provide male-friendly health services, including reproductive health and prevention of mother-to-child transmission of HIV
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• Objective 3.5: Advocate for social, economic and legislative changes to protect the rights of men and women and to challenge the social norms that increase the risk for women of HIV infection through men's behaviour

Objective 3.1: Devise messages, activities and interventions that address the needs of men and women

AIDS prevention and care programmes are widespread but often promote broad messages that are not rooted within the context of men's and women's lives. While abstinence and mutual fidelity are effective ways of preventing HIV infection, not every one can, or wants to adopt these options. Even the consistent use of condoms is difficult for many men and women.

To be successful, prevention programmes must respond to the realities of individual lives. This means not only addressing men and women differently, but tailoring messages and activities to the audience--whether male or female, young or old, urban or rural, well or poorly educated, wealthy or impoverished -- and taking into account sexual preferences and drug use.

Impoverished unmarried young men in rural areas, who have limited access to television or few other forms of entertainment, may view sex as one of the few pleasures available to them. Condoms may not be available, or may be too expensive or too large for adolescent boys. Strategies to reduce the risk of HIV infection for such men and boys need to be formulated, as these groups are unlikely to heed advice not to have sex if they cannot use a condom. Masturbation and mutual masturbation, for example, can be promoted as a means of achieving pleasure at no risk.

In some societies many women are sexually active from an early age because the money or gifts offered to them in exchange for sex allow them to buy clothing, attend school or appease their hunger. Young girls need to be taught skills to help them reject sexual advances from men or at least to negotiate the use of condoms, while their partners, who are often much older, need to be educated about the consequences of their behaviour.

Sometimes men's desire to have sex conflicts with women's wish to protect themselves. Programmes that explore the reasons behind why some men act the way they do, are likely to have a much greater impact than the programmes that restrict themselves to advising abstinence, mutual fidelity and consistent condom use.

In general, men's power over the sex lives of women is drawn from the social system in which they live. In most societies, the legal and economic benefits that most men enjoy are not available to a majority of women. Only when society as a whole takes steps to support the rights of women to autonomy and equality, will larger numbers of women have the chance to protect themselves from HIV. Community leaders and national policy-makers (who are mostly men) need the courage to confront practices in their society that confer greater privileges on men, but which also facilitate the spread of HIV.

Violence against women, young girls and some men, and particularly sexual violence, places them at greater risk of HIV infection. While such practices may have deep historical and cultural roots, the social and health consequences of gender-based violence are severe and quite unacceptable.

Ideas for Actions

• Promote the benefits of abstinence and fidelity. For example, evidence from Lusaka, Zambia, shows that the percentage of pregnant girls aged 15-19 infected with HIV, dropped on average by almost half from 1993-98; this corresponded with fewer women having sex before marriage in 1996 than in 1990. Similar changes in men's behaviour occurred from 1998 onwards.
• Organize and provide educational forms of entertainment for groups of young men.
• Openly acknowledge and respond to the difficulties that many men and women face in using condoms.
• Produce and distribute condoms that are of an appropriate size for boys and young men.
• Urge the removal of any taxes on condoms.
• Make condoms available in discreet but easy-to-access places such as toilets, bars, restaurants, schools, supermarkets, petrol stations, etc.
• Promote income-generating activities for young women.
• Promote educational tools such as street theatre and comic books that examine the attitudes of men and women towards sex and HIV/AIDS.
• Train journalists to report sensitively and accurately on relationships between men and women, on how such relationships affect the spread of HIV and on men's role in caring for those affected by the disease.
• Incorporate men and HIV/AIDS issues into ongoing campaigns such as the 'stop violence against women' and human rights campaigns.
• Initiate debates in national and local forums that examine the role of men in HIV/AIDS transmission; propose prevention programmes directed at men; and initiate or implement legislation that protects women.
• Educate women and men, particularly young people, with a view to promoting equal relationships between women and men and stress the unacceptability of sexual violence.
• Encourage men to respect women and accept their responsibilities in matters relating to HIV transmission and respect for women.

Objective 3.2: Provide support and care for boys and men living with, affected by, or orphaned by, HIV/AIDS

The vast majority of the more than 34 million people living with HIV do not know that they are infected. A major reason is that in many places, especially in rural areas, HIV tests are not available.

However, even for those with access to testing, there are many disincentives to taking the HIV test. There is still much ignorance about HIV and many people still view a diagnosis of HIV-positive as a death sentence. Many HIV-positive people are deeply ashamed of their diagnosis and are stigmatized by their spouse, family and/or community. In the worst instances, people who have publically declared their HIV status have been brutally assaulted or killed.

Some people refuse to be the silent 'victims' of HIV and are open about their status, thereby giving the epidemic a human face, but they belong to a small minority. And in countries with high HIV prevalence rates, the small numbers of those who are openly HIV-positive are not sufficient to make people aware of how widespread the epidemic is, nor how severe will be its future effects on the business, economic, and social sectors and on communities and households.

In their everyday life, many HIV-positive people suffer from discrimination at the workplace, and in the provision of housing, insurance and health services. Most governments have not provided HIV-positive people sufficient legal protection from discrimination, and, in many instances, governments themselves discriminate against HIV-positive people.

Even when they test HIV-positive men are less likely than women are to seek help because they are expected to be self-reliant. However, except in countries where sex between men is the primary route of transmission, there is a general lack of support for both women and men who are HIV-positive. This can lead to further HIV transmission because good-quality care, support and counselling has been shown to help people with HIV protect their partners.

Many women who test positive for HIV face the twin prospects of coping with their diagnosis and finding a way of informing their husband or male partner. In such situations, men and other family members may accuse the woman of bringing HIV into the household -- even though it is much more likely that the man is responsible. In extreme cases, women with HIV may be ejected from their home by their husband or by their husband's family after his death.

To reduce the fear and stigma associated with HIV, governments need to work together with people with HIV, and provide them with care and support. Experience has shown that as the climate of fear around HIV changes, people are encouraged to access voluntary testing and counselling services, if these are provided. Over time, the HIV test may become commonplace and widely accepted, and further strengthen community support for those infected with HIV.

Ideas for Actions

• Establish self-help groups for boys and men living with, affected by or orphaned as a result of HIV/AIDS. For example, Straight arrows, Support and Services for HIV+ Straight men and their families, Victoria, Australia. http://www.users.bigpond.com/StraightArrows/.
• Establish services that encourage men to access voluntary counselling and testing, and support those who test HIV-positive.
• Work with community leaders to promote the acceptance of people living with HIV/AIDS.
• Promote planning for the care of HIV orphans as part of national AIDS strategies.
• Include people living with HIV in television and radio programme story lines.
• Educate people to distinguish clearly between the person and the virus, and to support, not condemn, people living with HIV.
• Support the production of books and exhibitions by HIV-affected communities which tell the lives of HIV-positive people in words and images.
• Through public campaigns explain how HIV is transmitted within the country, both within specific populations and at large.
• Facilitate community discussion on the sanctity of marriage and the high rate of HIV infection within marriage.
• Promote voluntary pre-nuptial testing and counselling for couples.
• Train employers on the rights of men and women with HIV, and the need to counter discrimination in the work setting.
• Promote law reform to protect the marital rights of both men and women, including inheritance.

Objective 3.3: Provide employment opportunities and vocational training to reduce the vulnerability of unemployed and disempowered men

Poverty can render entire communities especially vulnerable to HIV. Both men and women may be forced to leave their homes in search of work; prostitution may become a survival strategy for young men, women and children; and lack of hope or future may lead to the apparent solace of drugs.

While both women and men should have full and equal access to education, vocational training and employment, men are traditionally seen as the providers in most societies. Therefore, when such opportunities are available, men generally access them, since such privileges are often seen as the prerogative of men.

Hence, it is perhaps not surprising that many men react negatively if they cannot find work or if they are unable to provide for their family. Their sense of anger or disempowerment may lead to alcohol or drug abuse, or violent behaviour. Men may also seek comfort in casual sex. Due to their overall unstable situation many men are less likely to practise safer sex.

Employment opportunities for men may, in some cases,restore their self-esteem and reduce their tendency towards unsafe sex. However, these very opportunities for employment often mean that many couples live apart, since men must migrate for work. Due to loneliness, and the availability of money and opportunity, many men have unprotected sex with other women, sometimes prostitutes, and become HIV-infected. When they return to the village, they may infect their spouse.

Empowerment of women and protecting both women and men from HIV requires that both women's and men's needs be taken into account. In some cases, employment of men may increase women's economic dependence on their male partners. Policy-makers and aid organizations need to explore ways of increasing employment opportunities for both men and women.

Employment opportunities may mean that couples live apart. Policy-makers and aid organizations need to explore better employment practices that do not require the man to move away from the family or that the family moves as a unit.

Ideas for Actions

• Increase opportunities for on-the-job apprenticeships for young men.
• Link private companies to youth organizations to create newtraining opportunities.
• Promote awareness of violence and other forms of abuse within the family, recognizing that it is often a result of men's inability to cope with circumstances beyond their control.
• Educate children that a man's sense of self-worth is not based on his income, but includes broader responsibility for the family, partners and the home.
• Link HIV/AIDS prevention to projects that develop or increase micro-credit schemes or low-interest loans for income-generating activities.

Objective 3.4: Provide male-friendly health services, including reproductive health and prevention of mother-to-child transmission of HIV

Many people have little or no access to reproductive health services, such as diagnosis and treatment of sexually transmitted infections, antenatal and obstetric care or contraception. Where such services do exist, they often appear more friendly to women, particularly married women, than men.

Are parallel health services available for men and boys? When these health services exist, how can men be encouraged to use them and seek support when they need it? When asked what they want from health centres, men often mention the same things as women: high-quality service at an accessible price; privacy; confidentiality; staff who are sensitive to their needs of men, including those of men who have sex with men; and clinic hours that are compatible with work schedules. Some men also prefer male doctors and nurses.

Reproductive health services that cater to the specific needs of boys and men have a special role to play in encouraging men to protect themselves and their partners against sexually transmitted infections. In such settings, staff can also address other health issues of concern to young men, such as male-to-male violence and the dangers of behaviours such as drug use.

Ideas for Actions

• Encourage governments to decentralize health care services and allocate more funds for health care.
• Establish health services specially designed for men and boys.
• Promote links between schools and clinics to provide appropriate health services for boys and girls, young men and young women.
• Train health care professionals to provide confidential care and support to boys and young men.
• Encourage health centres to adopt working hours that are convenient to boys and young men.

Objective 3.5: Advocate for social, economic and legislative changes to protect the rights of men and women and to challenge the social norms that increase the risk for women of HIV infection through men's behaviour

All sectors of society, including government ministries, religious bodies, nongovernmental organizations, the media, the commercial sector and village councils need to be engaged in the task of raising awareness of men's role in the HIV/AIDS epidemic and encouraging men to adopt safer sexual behaviours.

Policy-makers, religious and community leaders, most of whom are men, may face challenges in recommending policies which may seemingly destabalize their own authority. However, convincing leaders that the interests of their communities and nations can be better served by promoting safer behavioural norms among men, remains a priority.

National policies on HIV/AIDS need to be formulated jointly by women and men and include strategies that recognize men's position in sexual decision-making and the right of both women and men to protection. Such policies should include the rights of men and women to education, health care services, voluntary counselling and testing, and protection from HIV-related stigma and discrimination.

Ideas for Actions

• Hold meetings with leaders at the national, district and municipal level to brief them on Men Make a Difference and how to work with men and women.
• Organize meetings with representatives from the trade unions, religious groups, people living with HIV/AIDS organizations, the UN Theme Group and the National AIDS Programme and including men and women, to discuss Men Make a Difference, determine local priorities and develop a new and enhanced programmatic response.
• Develop interactive programmes with small groups of community leaders to help them understand the need to promote safer sex including behaviour change among men.
• Advocate for the rights and responsibilities of men and women, boys and girls living with, affected or orphaned by HIV/AIDS.
• Work with religious bodies to develop responses to the epidemic that acknowledge the reality of men's, and women's lives and the difficulties that both men and women have in adhering to ideal standards of behaviour.
• Review national policies on HIV/AIDS to ensure that they address inequities between men and women. Examine policies across all sectors to see whether they reinforce women's dependence on men and, consequently, women's risk of contracting HIV.
• Advocate for stricter legislative frameworks that address violence against young boys, young girls, and women, and monitor their legal enforcement.
• Promote more research and data collection on HIV/STI and risk behaviour in younger and narrower age brackets (i.e. less than 14, 15 -- 19, 20 -- 24), or by a single age.
• Ensure that research is male or female specific to better understand the different circumstances and times at which girls and boys, women and men become infected.