Panos | January 2009

By Kristin Palitza

Durban, South Africa (2010 Features): "When I was growing up, I understood manhood to mean that the woman has no say in the relationship, no matter if this regards day-to-day decisions or decisions around sexuality," says Zithulele Dlakavu.

Dlakavu grew up in a South Africa where the man is King. Where culture dictates and supports men having multiple sexual relationships and refusing to practice safer sex.

But that is now in the past –- at least for Dlakavu.

"My perception of manhood has changed a lot in the past years. A while ago, I wanted my woman to do what I want. Now I am giving her the freedom to express herself," says Dlakavu.

His relationship with his girlfriend has shifted greatly after he learnt about perceptions of manhood and what they mean for HIV prevention.

Dlakavu says he is a changed man since he took part in the One Man Can project run by Cape Town-based NGO Sonke Gender Justice that supports men and boys in taking action to end domestic and sexual violence and promote healthy, equitable relationships. He now sees his girlfriend as his equal partner and is acutely aware that this is one of the key elements of a healthy relationship, both in the medical and a psychological sense of the word.

"My relationship has much improved since I learnt about the importance of communication and giving support to each other," he explains. "I also changed my circle of friends to be with people who give me credit when I'm doing the right thing, like being faithful, not with those who put pressure on me to have lots of partners."

Today, Dlakavu works as one of the facilitators of Sonke's One Man Can campaign and teaches other men about constructions of masculinity, gender roles and how these intersect with HIV, health and human rights.

Involve Men In HIV Response

Involving men in HIV prevention is key in a country like South Africa, where one in four men have participated in sexual violence, according to a 2006 survey by the South African Medical Research Council (MRC). Of the total respondents interviewed, 16.3 per cent have raped a non-partner or have participated in gang rape, while 8.4 per cent have been sexually violent towards an intimate partner. MRC also found that, in South Africa, a woman is killed by an intimate partner every six hours.

Other studies have shown that the first sexual experience for many South African women is unwanted. Researchers at the University of the Witwatersrand in Johannesburg say that almost one third of women report that their first sexual encounter was not consensual. Experts also note that women with violent or abusive male partners are more vulnerable to HIV infection.

"Domestic and sexual violence is endemic in South Africa, so we simply have to ask ourselves what role men play," says Sonke Gender Justice co-director Dean Peacock. To address this issue, the One Man Can campaign has a proactive, activist orientation that helps turn men into more responsible citizens who know, for example, how important it is to know one's HIV status.

In South Africa the AIDS epidemic is significantly driven by gender-related attitudes, in other words men, explains Peacock. One of the main reasons for this are power inequalities between men and women, cultural pressures and the high rate of crime, domestic and sexual violence. "Advancing gender equality means reducing abuse, domestic violence and HIV transmission," he adds.

Another driver of the epidemic is the fact that men are not accessing health services in South Africa.

"Men are accessing health services at far lower rates than women, and men are significantly less likely than women to use VCT [voluntary counselling and testing] services," says Peacock. "If men don't know their status, they are much more likely to show risk behaviour, which in turn places women at higher risk [of contracting HIV]."

Gender Stereotypes

Because of gender stereotypes of the strong, tough male, South African men are socialised to disregard their own health and consequently women's health and rights.

"We need to encourage men to redefine masculinity to mean that men take care of themselves, their health and their partners," suggests Peacock.

Robert Morrell, researcher in the faculty of education at the University of KwaZulu-Natal in Durban agrees: "It is well established that constructions of masculinity give South African men little inclination to look after their personal health. If that doesn't change, we won't see an uptake in men accessing VCT, antiretroviral treatment and other HIV-related health services."

Such change in male attitudes and behaviour is sought by Men as Partners, a programme developed by Johannesburg-based NGO Engender Health and the Planned Parenthood Association of South Africa. The programme engages men in reducing gender-based violence and promoting men's constructive role in sexual and reproductive health, including HIV and AIDS.

"The missing link between men and HIV prevention is effecting behavioural change," says Engender Health advocacy and communications manager Dumisani Rebombo. "Distributing condoms is not effective if we don't manage to shift attitudes at the same time."

The Men as Partners project focuses on creating safe, reflective spaces in which men can think about and act out different forms of masculinity.

"Because we believe that socialisation, how men are raised, are at the core of gender-based violence, we find that a personalised approach to men works much better than national mass campaigns," says Rebombo. "Men should play an active role in finding solutions to negative gender norms and HIV prevention that they can implement in their daily lives."

After working with men individually, EngenderHealth and programme participants then extend lessons learnt to their families -- involving wives, children, relatives -– and later at the community level. "Ultimately, societal change needs everybody," explains Rebombo.

Too Late To Change?

But, teaching men about prevention is almost starting the process too late, some experts say. Programmes on HIV and gender need to start much earlier to be effective -– when men are still boys and their socialisation is still in process.

"We need to start to educate early because there are no quick fixes. We're talking about long-term change here," says Morrell.

South African schools should, for example, integrate gender-aware health modules into their obligatory life orientation classes, Morrell suggests, which have been slotted into the country's curriculum to teach pupils practical, constructive skills for their day-to-day lives.

As a result, South Africans might have to be patient while waiting for change to come, reckons Morrell: "I don't think [fully integrating men in HIV prevention] is something that we can sort out in this generation."

According to the South African health department's "National HIV and Syphilis Sero-prevalence Survey" 2006/2007, women are disproportionately affected by HIV. More than 29 per cent of pregnant women and 13.3 per cent of women are living with HIV in South Africa, while male HIV prevalence is much lower, at 8.2 per cent.

Due to the generally high HIV prevalence, South Africa will struggle to gain Universal Access by 2010. The national Department of Health has committed itself in its UNGASS 2008 country report, however, to make HIV prevention a key priority over the next few years -- the department aims to halve the rate of new HIV infections by 2011. To achieve this the department needs to focus on changing the attitude of men. /2010 Features