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HIV & AIDS: What men can do

16th February 2011

By: In On Africa IOA

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This CAI paper discusses the need for HIV-positive women’s male partners to create a climate free of violence and stigmatisation and argues that such a climate will ultimately contribute significantly to a reduction in the spread of HIV & AIDS. The global increase in availability of antiretroviral therapy has resulted in an escalating trend to test all pregnant women for HIV (2) and women are arguably empowered in some ways by knowing their HIV status (3) they can be more careful with health-related issues, treat infections early, eat a balanced diet, invest better care to their infants, use family planning, and take advantage of advice on how to live with HIV.(4)

There are many HIV-positive women, however, who do not agree that knowledge of their HIV status will help them.(5) Being sick and dying worries them, and the knowledge that HIV & AIDS can not be cured only adds to that.(6) Women diagnosed with HIV during pregnancy are often too afraid to openly disclose their HIV status,(7) because they are often discriminated against by their partner’s families and by community members.(8) Women who openly admit their HIV status may face dramatic negative repercussions that impact their own and their children's wellbeing.(9) They experience fear of blame, physical assault, abandonment and/or abuse by both men and women, so in order to avoid the emotional and social stress that such knowledge may bring, many believe it is better not to know their status.(10)

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The Zingatia Maisha program in Kenya offers a practical example of how male partners can create a more supportive environment for women.(11) The initiative works toward eliminating AIDS-related shame and stigma by targeting the partners of women that visit clinics. By increasing male participation in the prevention of mother-to-child HIV transmission (PMTCT) programmes, the initiative creates more understanding and tolerance.(12) It also encourages men to visit exclusively male clinics and is fast gaining popularity in western Kenya.(13)

HIV positive: The social impact of test results

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Getting tested for HIV & AIDS during pregnancy in order to prevent transmission of HIV & AIDS to the fetus often has negative consequences for the women involved.(14,15,16,17) They may experience stigma simply because they got tested, but most often they if the test result is positive. Consequently, offering support services to protect women's rights and enable them to live healthily after an HIV-positive diagnosis is of great importance.(18) But changing the underlying social structures and beliefs has been a mammoth challenge. Against the background of risk of stigma and discrimination, many women report that they felt pressured to be tested for HIV during pregnancy, that they did not receive adequate pre-test counselling, and even that their consent to the test was ill-informed.(19) Most women who give informed consent do not actively request their results, less than one third inform their partner of the test and/or results, and violence against women after a positive test result is common.(20) In some pilot projects, the uptake of interventions to reduce mother-to-child-transmission (MTCT) of HIV was severely affected by women’s fear of being tested for HIV.(21) HIV-positive mothers often need to feed their babies formula instead of breast milk, but formula availability depends heavily on the male partner’s support.

Male partners’ attitudes are critical to the success of interventions and prevention initiatives and can therefore be a significant obstacle to reduction of the spread of HIV & AIDS in both urban and rural settings.(22,23) The President’s Emergency Plan for AIDS Relief (PEPFAR) in Rwanda has been involving men in prevention of mother-to-child HIV transmission (PMTCT) programs for several years – they call men their ‘secret ingredient’ to the success of their programs.(24)

The Zingatia Maisha program

Addressing the stigmatisation of HIV-positive women and the negative reactions leading to violence has long been underestimated. Research shows that male involvement in PMTCT is linked to greater uptake of HIV testing, antiretroviral treatment, condom use, and support for infant feeding choices.(25) The Zingatia Maisha program, developed by the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), was developed to get men more involved in PMTCT. It offers couple-counselling and partner involvement in MTCT prevention programmes and helps people living with HIV to cope with day-to-day life, offers support systems to HIV-positive individuals and aims to enhance effective treatment.(26) The Zingatia Maisha program encourages male participation by giving priority to women who attend with their male partners and to men who bring their children to clinics.(27) The concept is fast gaining popularity in western Kenya, and is increasing male participation in prevention of PMTCT programmes. There are currently many similar being programmes run all over the continent, including South Africa, Ethiopia, Nigeria, Zambia, Uganda, Mozambique, Namibia, Tanzania and Botswana.(28)

Concluding remarks

The consequences of positive status disclosure are severe enough to prevent women from getting tested, but the Zingatia Maisha programme and other similar programmes offer a solution to this problem. Through educating men on issues that are usually taboo and actively involving them as partners of women, stigma and discrimination can be reduced and even eliminated. Specially created male clinics where HIV-positive men form support groups and receive counselling on the importance of accompanying their partners for antenatal visits help create a better understanding amongst the men involved and among communities as a whole. The initiative is gaining popularity amongst involved African communities and reduces women’s negative HIV-related experiences. Best of all, it ultimately decreases the number of children born with HIV by encouraging testing and treatment.

NOTES:

(1) Contact Susanne Bakelaar through Consultancy Africa Intelligence's Gender Issues Unit (gender.issues@consultancyafrica.com).
(2) De Bruyn, M. & Paxton, S. 2005. HIV testing of pregnant women- what is needed to protect positive women’s needs and rights? Sexual Health, 2, pp. 143-151.
(3) Gaillard, P. 2002. Vulnerability of women in an African setting: Lessons for mother-to-child HIV transmission prevention programmes. AIDS, 16, pp. 937-939.
(4) Ibid.
(5) Temmerman, M., Ndinya-Achola, J., Ambani, J. & Piot, P. 1995. The right to not know HIV-status test results. Lancet, 345(8955), pp. 969-970.
(6) Gaillard, P. 2002. Vulnerability of women in an African setting: Lessons for mother-to-child HIV transmission prevention programmes. AIDS, 16, pp. 937-939.
(7) Ibid.
(8) De Bruyn, M. & Paxton, S. 2005. HIV testing of pregnant women ¬– what is needed to protect positive women’s needs and rights? Sexual Health, 2, pp. 143-151.
(9) Temmerman, M., Ndinya-Achola, J., Ambani, J. & Piot, P. 1995. The right to not know HIV-status test results. Lancet, 345(8955), pp. 969-970.
(10) Ibid.
(11) ‘Kenya: Male clinics boost participation in PMTCT’, IRIN Plus News, 9 November 2010, http://www.plusnews.org.
(12) Ibid.
(13) Ibid.
(14) Ibid.
(15) Temmerman, M., Ndinya-Achola, J., Ambani, J. & Piot, P. 1995. The right to not know HIV-status test results. Lancet, 345(8955), pp. 969-970.
(16) De Bruyn, M. & Paxton, S. 2005. HIV testing of pregnant women - What is needed to protect positive women’s needs and rights? Sexual Health, 2, pp. 143-151.
(17) Mboi, N. 1996. Women and AIDS in south and south-east Asia: The challenge and response. World Health Statistics Quarterly, 49, pp. 94- 105.
(18) De Bruyn, M. & Paxton, S. 2005. HIV testing of pregnant women - What is needed to protect positive women’s needs and rights? Sexual Health, 2, pp. 143-151.
(19) De Bruyn, M. & Paxton, S. 2005. HIV testing of pregnant women - What is needed to protect positive women’s needs and rights? Sexual Health, 2, pp. 143-151.
(20) Temmerman, M., Ndinya-Achola, J., Ambani, J. & Piot, P. 1995. The right to not know HIV-status test results. Lancet, 345(8955), pp. 969-970.
(21) Gaillard, P. 2002. Vulnerability of women in an African setting: Lessons for mother-to-child HIV transmission prevention programmes. AIDS, 16, pp. 937-939.
(22) Gielen, AC., O'Campo, P., Faden, RR & Eke, A. 1999. Women's disclosure of HIV status: experiences of mistreatment and violence in an urban setting. Women’s Health, 25(3):19-31.
(23) Naidoo, J. R., Uys, L. R., Greeff, M., Holzemer, W. L., Makoae, L., Dlamini, P., Phetlhu, R. D., Chirwa, M., & Kohi, T. 2007. Urban and rural differences in HIV/AIDS stigma in five African countries. African Journal of AIDS Research, 6(1),pp. 7-23.
(24) ‘Rwanda: Men are the “secret ingredient” in PMTCT program’, PEPFAR, April 2007, http://www.pepfar.gov.
(25) ‘Kenya: Male clinics boost participation in PMTCT’, IRIN Plus News, 9 November 2010, http://www.plusnews.org.
(26) ‘Kenya: Male clinics boost participation in PMTCT’, IRIN Plus News, 9 November 2010, http://www.plusnews.org.
(27) Ibid.
(28) For detailed information on each country, visit ‘A compendium of programs in Africa’, USAID, http://www.aidstar-one.com.


Written by Susanne Bakelaar (1)

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