The 21^st 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.

Why Focus on Men? There are five main reasons for focusing the World AIDS Campaign on men. Men's health is important but receives inadequate attention. In most settings, men are less likely to seek needed health care than women, and more likely to engage in behaviour -- such as drinking, using illegal substances or driving recklessly -- that puts their health at risk. In stressful situations, such as living with AIDS, men often cope less effectively than women. Men's behaviour puts them at risk of HIV. While HIV transmission among women is growing, men -- including adolescent boys -- continue to represent the majority of people living worldwide with HIV or AIDS. In some settings, men are less likely to pay attention to their sexual health and safety than are women. Men are more likely than women to use alcohol and other substances that lead to unsafe sex and increase the risk of HIV transmission, and men are more likely to inject drugs, risking infection from needles and syringes contaminated with HIV. Men's behaviour puts women at risk of HIV. On average, men have more sex partners than women. HIV is more easily transmitted sexually from men to women than vice versa. In addition, HIV-positive drug users -- who are mostly male -- can transmit the virus to both their drug partners and sex partners. A man with HIV is therefore likely to infect more people over a lifetime than an HIV-positive woman. Unprotected sex between men endangers both men and women. Most sex between men is hidden. According to surveys from across the world up to a sixth of all men report having had sex with another man. Many men who have sex with men also have sex with women -- their wives or regular or occasional girlfriends. Hostility and misconceptions about sex between men have resulted in inadequate HIV prevention measures in many countries. Men need to give greater consideration to AIDS as it affects the family. Fathers and future fathers should be encouraged to consider the potential impact of their sexual behaviour on their partners and children, including leaving children behind as AIDS orphans and introducing HIV into the family. Men also need to take a greater role in caring for family members with HIV or AIDS.