The 21st Special Session of the UN General Assembly (ICPD+5) held in 1999 drew attention to the role of gender equality and equity as a key determinant of success in the struggle against AIDS. Steps need urgently to be taken to enhance women's ability and knowledge and to empower them to take informed actions. Men too must be encouraged to take responsibility for their own sexual and reproductive health and that of their partners.
Worldwide, HIV infections and AIDS deaths in men outnumber those in women on every continent except sub-Saharan Africa. Even here, the cost to men is enormous: by the end of 1999, ten million African men were living with HIV, as compared with seven and a half million infected men in the rest of the world combined. Young men are at particular risk compared to men who are older: about one in four people with HIV is a young man under age twenty-five.
Men's vulnerability in the AIDS epidemic is part of a bigger picture. While being a boy and then a man generally brings privileges, it carries high health costs. Except in a handful of countries, men have a shorter life expectancy at birth than women. Older men frequently delay seeking health care for illnesses that could be prevented or cured. Young men die more often than young women, mainly from traffic accidents and violence -- both related to ideas of "manhood" that encourage boys to take risks or use violence. Similar ideas of manliness encourage sexual and drug-related risk-taking.
While biological factors contribute to the behavioural differences between men and women, in every society, men's conduct is determined at least in part by expectations as to how men should act -- expectations often shared by women as much as men. Ideas about "manhood" evolve over time. They differ from culture to culture and within cultures. Education, age, upbringing, income all influence the role that men are expected to play.
Men are a highly diverse group, and generalizations about their behaviour must be attempted with caution. Studies from around the world, however, show that men on average have more sex partners than women. This means that a man with HIV is likely to pass the virus on to a greater number of people than a woman (see box), especially since for biological reasons HIV is twice as easily transmitted sexually from a man to a woman as vice versa.
Many if not most men do not put themselves or their partners at risk through their sexual or drug-taking practices. Without men, however, HIV would have little opportunity to spread. Over 70% of HIV infections worldwide are estimated to occur through sex between men and women. A further 10% can be traced to sexual transmission between men. In addition, over 5% of infections are estimated to result from the sharing of needles and syringes by people who inject drugs, four-fifths of whom are men.
Beliefs about what it is to be a man (and a woman) undoubtedly underpin these statistics. Together with cultural expectations about gender roles and behaviours, they influence how people act and the risks they take. Working with and persuading men to change some of their attitudes and behaviours has enormous potential to change the course of the HIV epidemic and to improve the lives of their families and their partners.
This article was provided by UNAIDS. It is a part of the publication Men and AIDS -- A Gendered Approach, 2000 World AIDS Campaign. Visit UNAIDS' website to find out more about their activities, publications and services.