Perceptions of positive parenting

By Jon Hopkins, HIV Officer (IPPF Central Office)

“If I was an HIV negative father, my worries on my own self or on my life and my medicines would have been less. It can happen with any disease, but the stigma attached with HIV deepens the impact and stresses you out. The worry for the future of your children increases multi-fold. It increases one’s responsibilities multi-fold too” Father living with HIV, India 

In 2011, IPPF supported qualitative research in nine countries to document the perspectives and experiences of young people living with HIV accessing standalone or integrated sexual and reproductive health (SRH) and HIV services. Young people living with HIV were interviewed in each country including young men and women under the age of 30 some of whom were men who have sex with men (MSM), sex workers, transgender people and migrant workers.

Further analysis has been done on the results of the survey in Sudan, Mexico and India. Interesting gender differences can be seen in the perceptions of parenthood among young people living with HIV, with a greater concern that HIV status affected parenting choices more for men than women. In all three countries, a majority of respondents felt that being HIV-positive affected a man’s role as a father. The reasons given were that men had a greater sense of responsibility towards their children as their primary role was providing social and financial security and this was affected by being HIV-positive (see figure 1).

The importance of male involvement can be clearly seen in these findings. Young men and young women living with HIV see the importance of male involvement when considering their own parenting choices. This shows that attention, support and services need to focus not only on the sexual and reproductive health and choices of young women, but also on men and their dreams and desires of fatherhood. 

Download the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys

Masculinity as a barrier to SRH and HIV services

By Hayley Thomson, Research and Policy Officer (Sonke Gender Justice Network, South Africa)

As HIV testing and treatment services become more widely available across the world, it is becoming apparent that fewer men than women are accessing them. For example, in South Africa, according to 2010-2011 data, men represented only 30 per cent of those who tested during a national, and widely publicized, HIV counselling and testing campaign. Despite this, very few efforts are made to specifically target men to increase their uptake of testing and treatment services. Some policymakers and service providers may feel that the only barrier to men accessing services is men themselves, and that it is more important to focus energy on providing services to women. While it is obviously necessary to ensure services are available to women, it is unhelpful to assume that there is nothing that can be done to encourage men to access testing and treatment services. We should also not overlook the fact that men’s access to HIV and SRH services benefits women. 

Men are shown from a young age that clinics and hospitals are female spaces – staffed by women and attended by women. From the onset of menstruation women are encouraged to prioritize their health, attend annual check-ups, go for pap smears, and so on. It is acceptable for girls and women to discuss such female health issues with their mothers and other female relatives and friends.  What do we do to encourage men and boys to prioritize their health?

To be considered a man, men are also taught from a young age that they need to be strong and in control. As South African President Jacob Zuma recently expressed in an interview when discussing his childhood, "You could not afford to be a coward or they would tell you that you have to cook like a girl, instead of eating the food that is cooked by the girls". Any behaviour that does not conform to this hegemonic notion of masculinity runs the risk of being labelled as unmanly, feminine, or even ‘gay’. Within our social hierarchy men have more power than women, but heterosexual men have more power than homosexual men, therefore in order to be accepted as a ‘real’ man, boys are conditioned to realize that any behaviour that could elicit the label of being ‘gay’ should be avoided. Going for medical check-ups, getting tested or seeking treatment, just doesn’t fit in with this masculine ideal – it seems weak, it involves asking for help, making oneself vulnerable, and therefore could be viewed as womanly. It is clear that men’s uptake of HIV and SRH services are a far more complex issue than a question of individual choice.

There is much that needs to, and can, be done to enable and encourage men to access SRH and HIV services. Interventions focussing on these issues have been shown to effectively increase men’s support for their partner’s SRH and improve the health of men, women and children. Sonke Gender Justice Network, along with their partners and other CSOs, worked hard to ensure that South Africa’s National Strategic Plan on HIV, STIs and TB 2012-2016 acknowledged the need to address men’s health-seeking behaviour and masculine gender norms [Available here]. Sonke, along with their MenEngage partners, also conduct policy advocacy work to address this issue throughout the region.

Download the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys

HIV Update: Engaging men & boys

By Kevin Osborne (IPPF)

Men have their own specific sexual and reproductive health needs, and these needs are as diverse as men are. Addressing gender inequities in health, promoting sexual and reproductive health and rights, and preventing HIV and gender-based violence is not possible without efforts to directly engage all men and boys.

HIV has highlighted that ‘getting to zero’ is not possible without reaching and involving men and boys in HIV and sexual and reproductive health (SRH) programmes. Men are often poorly served by existing SRH and HIV services and are reluctant to use them, which has direct implications for their well-being and that of their partners and children. Some men feel that they must live up to gender stereotypes by proving their masculinity, which can contribute to an unwillingness to seek help, information or treatment.

Service providers have often focused on reaching women and girls, and clinics and services are often perceived as ‘female-only’ spaces. It is important to develop services that meet men’s specific SRH needs and that are more appealing and accessible to them. Encouraging men to attend as partners and integrating services are some ways to achieve this.

It is vital that all service providers have a good understanding of the SRH issues of different men, as not all men are the same! Younger men, older men, men living with HIV, men who have sex with men, married men, and others, all have additional or slightly different SRH needs. A wide range of SRH-related services should be offered to address issues from HIV and other sexually transmitted infections - to positive prevention, non-communicable conditions (such as male-specific cancers), sexual dysfunctions, family planning, and parenting choices. Service providers should also be able to refer clients to related services, such as harm reduction, mental health and/or other social services.

Men and boys are already changing their attitudes and practices towards sex, relationships, their own health, and their dreams and desires of fatherhood. Men can be fathers, brothers, partners, and friends. For all men we need to ensure our efforts continue to value, support and better serve them in all of these different roles.

Download the full issue of the IPPF HIV Update newsletter: http://www.ippf.org/resource/HIV-Update-Engaging-men-and-boys