Can South African men make a difference?

South Africa has the largest HIV/AIDS population in the world and one of the fastest growing epidemics, with one in four women between the ages of 20 and 29 already infected with the virus. However, for the first time there are signs that HIV incidence ‘€“ the annual number of new infections – may have stabilised in parts of sub-Saharan Africa. JO STEIN reports.

Men are a central focus in the UNAIDS Report 2000 which was released this week stating that South Africa has more people living with HIV/AIDS than any other country in the world.

The UNAIDS report states that if the AIDS epidemic is to be curbed, then prevailing concepts of masculinity will have to change. Cultural beliefs around masculinity heighten both men and women’€™s vulnerability to HIV/AIDS to such an extent that these beliefs are, in themselves, a driving force of the HIV/AIDS epidemic.

The fact that unequal power relations between men and women place women at risk of HIV infection is already known. What is not recognised, says the report, is that prevailing concepts of masculinity also increases men’€™s own vulnerability to HIV infection.

Because men are expected to be strong, daring and virile, their sexual behaviour places them at great risk of HIV infection. All over the world, states the UNAIDS report, men have more sexual partners than women and are more inclined towards sexual risk-taking and unsafe sex.

The same conception of masculinity is at the root of male violence towards women, especially sexual violence and rape, which also fuels the HIV/AIDS epidemic.

A study by the South African Medical Research Council study shows that the high incidence of women being forced to have sex with men has made such behaviour appear “normal” so that it is seldom even viewed as rape.

Until recently, HIV/AIDS prevention activities in South Africa, as elsewhere, have focussed largely on women and youth. But Dr Nono Simelela, Chief Director of HIV/AIDS and STDs in the National Department of Health, agrees that programmes to empower women must now be accompanied by parallel efforts directed at men.

“We are trying to open dialogue between men and women on issues of HIV/AIDS’€¦. All the strategies we have put in place which seek to empower women are useless if men are not part of the game,” says Simelela.

Another reason why perceptions of “masculinity” put both men and women at risk of HIV infection is that men are less likely to seek health care than women, because “real men don’€™t get sick,” says the UNAIDS report.

Someone with an untreated STD is at least six times more likely to be infected with HIV during sex. But many men with sexually transmitted diseases (STD) like herpes and gonorrhoea, which are easily cured, go untreated.

According to the UNAIDS report men in prisons are at particularly high risk of contracting HIV.

In South Africa, according to Gideon Morris of the Judicial Inspectorate’€™s Office, a prison sentence is tantamount to a death sentence by HIV/AIDS. Morris estimated that between 70% and 80% of suspects held in South African jails are raped by fellow prisoners before they are even officially charged.

Men living in all-male environments such as the military and men who migrate for work are also at particularly high risk of contracting HIV. A survey conducted by the Medical Research Council found that 56% of truck drivers in KwaZulu-Natal are HIV infected.

This year’€™s World AIDS Day Campaign theme “Men make a Difference” is the culmination of a year-long international campaign by UNAIDS to focus on the potentially constructive role men can play in combating the AIDS epidemic.

The positive focus is in line with the thinking of the South African Department of Health’s AIDS Directorate. “We don’€™t want to create a scenario of blaming men for the infection,” says Simelela.

“We want to bring them in, as partners, fathers, role models, leaders, employers and employees, to get them to start thinking about what they need to do to mitigate the impact of HIV/AIDS ‘€¦ As a father, to start talking to their children, as employers to start being cognisant of the need for workplace HIV/AIDS programmes, as partners to start interrogating their own sexuality, says Simelela.

When World AIDS Day is over, it will remain to be seen whether South African men will develop a more constructive conception of masculinity and assert their power, not over women, but over HIV/AIDS.

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