The plan has ambitious goals, including the reduction of new HIV infections by at least 50% using combination prevention approaches; and getting at least 80% of eligible patients on antiretroviral treatment (ART), with 70% alive and on treatment five years after initiation.
At Sonke we work to engage men and boys in achieving gender equality and addressing the gender dimensions of HIV and AIDS. For us, the new NSP represents a breakthrough: it recognizes that greater efforts need to be made to engage men in HIV services and it makes clear that doing so is in the interests of women, men and the public health system.
In South Africa, and in fact across the world, men are chronically underrepresented in HIV services, as they are in health services more generally. Results from South Africa’s recent national HIV testing campaign reveal that men made up only 30% of the nearly 13 million people who got tested. Men also access HIV treatment later than women and often eventually access services with severely compromised immune systems. In South Africa, about 55% of those living with HIV are women but more than two-thirds of patients receiving public sector ART are female. Once on treatment men are more likely than women to interrupt treatment, to be lost to follow-up, and to die while on treatment.
This is bad for men, women and health systems in general. When men fail to access health services it often means that women have to care for them while they are ill. When men do access clinic and hospital services, it is often with advanced AIDS related illnesses and very low CD4 counts. This makes it difficult and expensive to treat them’and people who start treatment with low CD4 counts have worse outcomes, including higher mortality levels. This affects women in a more direct way, they grieve for the unnecessary deaths of the men they cared about and loved: their husbands, partners, brothers, fathers, sons, friends and co-workers.
The lack of attention to men’s low utilization of HIV services needs to change. Exciting new research findings show that if people access treatment early, it improves their long-term health outcomes and radically decreases the likelihood that they will pass on the virus. However, ‘treatment as prevention’, as it is now being called, will only be effective on a population level if far larger numbers of men know their status and get on treatment earlier than is currently the case.
An article in prestigious journal The Lancet titled Expanding HIV care in Africa: making men matter’ concludes ‘encouraging men to get tested and into treatment is a major challenge, but one that is poorly recognised’¦ Addressing these issues effectively means moving beyond laying blame, and starting to develop interventions to encourage uptake of prevention, testing, and treatment for men’for everyone’s sake’.
In order to affect men’s uptake of testing and treatment services we need to address men’s poor health seeking behaviour, which is in part caused by the gender norms which equate illness with weakness, and weakness with emasculation. However, it’s not just the attitudes held be men; health systems are not set up to engage men. Getting men involved in HIV services requires changing men’s health seeking practices and improving the supply of health services to men. In other words, it requires addressing both supply and demand issues.
Sonke has been working to raise this issue. Nationally we’ve worked with, and through, SANAC to ensure that language which engages with men is included within the NSP. We’re glad that the following language addressing the problem has been incorporated within the 2012-2016 final NSP document:
· ‘Efforts must be made to increase men’s health-seeking behaviour’.
· ‘Challenge the gender roles, norms and inequalities that increase women’s vulnerability to HIV and compromise men’s and women’s health’…
· ‘address the position of women in society, particularly their economic standing; and engage with men on changing socialisation practices’.
We congratulate SANAC and the Department of Health for their work on the NSP. Managing the many competing demands of nearly 20 SANAC sectors could not have been easy and we commend the writing team for their hard work.
Our work is not over however, and the real work, as such, begins now, in earnest, as the NSP is launched on 1 December, World AIDS Day. The plan then needs to be translated into an Operational Plan by March 24th, alongside nine Provincial Strategic Plans and then ultimately many more District Strategic Plans. One of the failings of our last NSP was that it was not sufficiently engaged with at the provincial and district level; very few of the Provincial or Local AIDS Councils ever really functioned for very long. This will need to change.
As civil society we will work with national, provincial and local government to support the roll-out of the NSP at each of these three levels, as well as assisting as far as we can with the development of the Men’s Sector Operational Plan, the PSPs and DSPs. When necessary we will engage in advocacy to hold the government to its commitments.
As Sonke, we will pay particular attention to three key issues: 1) whether implementation engages men to promote women’s rights and to address the gender inequalities driving the HIV epidemic, 2) whether campaigns are rolled out to address gender norms and notions of manhood that put pressure on men to engage in risky practices in order to demonstrate their masculinity, such as drinking, having multiple sexual partners and dominating women, and 3) whether implementation enables and supports men to improve their use of critical HIV services, especially testing; early uptake of, and adherence to, treatment; and medical male circumcision.
The National Department of Health’s long-term HIV and AIDS vision is to ensure that within 20 years there are Zero new HIV and TB infections, Zero deaths associated with HIV and TB and Zero discrimination related to HIV and TB. What we achieve in the next five years will determine whether we can achieve that.
Story by: by Dean Peacock, Hayley Thomson, Desmond Lesejane and Mbulelo Dyasi from Sonke Gender Justice Network.