Men, HIV/AIDS, and Human Rights

"Simplistic portrayals of men as probably violent, inevitably sexually irresponsible, callous, and uncaring impede rather than support efforts to change the gendered dimensions of vulnerability to HIV and AIDS. They undermine efforts to mobilize men around the solidarity they feel for women in their lives whom many men care deeply about. To be effective, work with men to achieve gender equality and improve both men's and women's health will need to recognize and support the efforts of growing numbers of men who want a more equitable world."

Published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS - 51 Suppl 3: S119-25), this article critiques approaches to HIV and AIDS that rely on simplistic portrayal of men as advantaged holders of power and privilege - and even as violent oppressors. Such messages are problematic, from the perspective of these authors, because they:

• may not resonate with those who are disadvantaged by intersecting forms of discrimination (race, ethnicity, nationality, class, sexuality, disability, and so on);
• miss the many men who may in fact be committed to challenging rigid gender roles that negatively impact men and women; and
• reinforce regressive norms.
  

To provide context for this argument, the authors explore the history of initiatives focused strategically on engaging men to achieve gender equality. They explain that this growing trend is often traced to the Program of Action that emerged from the 1994 International Conference on Population and Development (ICPD) held in Cairo, Egypt. Programmes that emerged from ICPD work in 3 sometimes-overlapping ways: they serve men as clients, involve men in improving women's health, and/or work directly with men and boys to promote a positive shift away from regressive gender attitudes and behaviours. They provide several concrete examples to illustrate the claim that, "[s]ince ICPD, work with men for gender equality has gained widespread legitimacy and is increasingly seen as an indispensable means for achieving it." The authors point to a rapidly expanding evidence base demonstrating that rigorously implemented initiatives that reach out to men can change social practices that affect the health of both sexes, particularly in the context of HIV and AIDS. For example, "[r]esearch conducted to determine the impact of Sonke Gender Justice's One Man Can Campaign in 3 rural communities in South Africa showed that amongst participants in community education activities and campaigns, 25% subsequently tested for HIV, nearly two-thirds increased their use of condoms, about 80% talked with friends or family about HIV and AIDS, gender equality, and human rights, and about half indicated that they responded to acts of gender-based violence they witnessed..."

Next, the authors examine international mandates for working with men, which they find problematic due to reliance on "the instrumentalist approach", which they characterise as one that only includes men and boys in the context of their responsibility to change to improve women's access to health and rights. To show why this is the case, they excerpt from several international instruments that outline the mandate for male inclusion - italicising examples of phrases indicative of the instrumentalist approach in order to problematise it. One criticism: "Governments' refusal to explicitly articulate the rights of men who have sex with men in the context of HIV/AIDS is discriminatory and dangerous. Silence in the HIV/AIDS instruments about the real vulnerabilities that some men face also risks embedding notions of men's invincibility."

Using other language that includes men's needs is, in the authors' estimation, an important first step to gender equality work that moves beyond the instrumentalist-only perspective. "To give an example of such a framing, one might assert that men have the right to comprehensive sexuality education that challenges traditional notions of men as sexual risk takers. Such an approach might posit that men have the right to HIV/AIDS services that cater to their needs, the right to gender-transformative public health campaigns that challenge dominant alcohol industry advertisements and instead emphasize healthy alcohol use, or the right to be free of sexual violence when in the custody of the state." In addition to the push for equality in its own right, the authors explain, there is a growing recognition that dominant norms about manhood harm both women's and men's health. "Studies repeatedly show that men who adhere to rigid notions of manhood, who equate masculinity with risk taking, dominance, and sexual conquest, and who view health-seeking behaviors as a sign of weakness experience a range of poor health outcomes." Further exploration of men's multiple anxieties, struggles, and fears may, as outlined here, reveal empowerment strategies that would help men overturn societal pressures to be "real men" - to the ultimate benefit of both sexes.

The article makes recommendations which move beyond treating men as a monolithic group - simply as "the problem" - and instead lays a foundation for engaging men both as agents of change and holders of rights to the ultimate benefit of women and men.

• Engage men as proponents of gender equality and health: "Significantly, [the World Health Organization, or] WHO's analysis of 57 programs showed that the most effective campaigns and outreach programs used positive, affirmative messages showing what men and boys could do to change, affirming that they could change and showing men changing or acting in positive ways..."
• Avoid simplistic gender stereotyping: "Recent feminist interventions have critiqued essentializing portrayals of women as victims and men as perpetrators as bad for both women and men....Messages that most men are aggressors and never victims promote harmful perceptions about the one way in which to be a man. They may inadvertently serve to justify violent behavior as a normal manifestation of maleness, promoting a sense of inevitability about its continuation....Worst-case scenario narratives about men's probable violence in response to their partners' diagnosis may actually discourage women from disclosing to or seeking support from a potentially compassionate male partner....Similarly, advocacy that suggests that men will not play a role in the care economy inadvertently reinforces gender stereotypes and leaves women with the burden of care and support - especially in the context of HIV and AIDS....Making men's caregiving more visible has the potential to shift social norms about men's role in the care economy and increase men's involvement further."
• Recognise that men are not monolithic and have unequal access to health care and human rights: "Although gender roles certainly shape women's and men's health outcomes, the impact is both mitigated and exacerbated by other intersecting local and global social inequalities."
• Use policy approaches to take gender transformative work with men and boys to scale: "Across the world, there are millions of community outreach workers, community health workers, and adult literacy practitioners, amongst many others, who could reach hundreds of millions of men and boys. Governments should mobilize them in the service of gender justice." The authors add that, although a growing number of governments have made domestic and international commitments to address gender equality and health equity, many frequently fail to act on these commitments. A number of organisations working with men have begun to develop initiatives aimed at holding government accountable for their obligations..."