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