Concepts, evidence and good practice: GBV

The role of men and boys in challenging gender in the

context of HIV and other STIs

Klas HyllanderMen for Gender Equality Sweden & MenEngage

Regional meeting on HIV and GBV, Bratislava, Slovakia – November 6-8, 2012

Overview

• Gender norms and gender-based power differentials between men and women are key drivers of men’s and women’s vulnerability to HIV/STIs

• Understanding/analysis of men and boys as gendered creates opportunities for prevention

• Social gender norms/notions of manhood drive the behaviors of men and boys.

• Link HIV-GBV: multi-country studies have found intimate partner violence to be significantly associated with women’s risk for STIs, including HIV.

Overview cont’d

• A 2006 WHO multi-country study: women who reported physical or sexual violence by a partner ranged from 15 percent to 71 percent, with the majority of settings falling between 29 percent and 62 percent

• 10-20% of women say their first sexual experience was coerced

• Prevention of violence against women and GBV requires changing gender-inequitable norms

• Growing consensus on need to focus on primary prevention: stopping violence before it begins by changing violence-supporting norms and behaviors, primarily perpetrated by men.

Overview cont’d

• There is a growing evidence-base that primary prevention programming with men and boys works

• Gender-transformative programming most efficient• Types of programming:

– Service-Based– Group Education– Community mobilisation (Media campaigns, Community media: Digital

storytelling)– Integrated

• Multi-level approaches most efficient (e.g. policy, media campaigns, group education, service-based programs)

Digital storytelling – reaching people

Concepts, evidence and good practice: GBV

The role of men and boys in challenging gender in the

context of HIV and other STIs

Klas HyllanderMen for Gender Equality Sweden & MenEngage

The Global HIV/AIDS Epidemic and Men• In generalized or concentrated epidemics, sexual

behavior of men key• Epidemic leveling off in some countries mostly

when large groups of men change behaviors – e.g. Thailand, Brazil, Uganda

• Young women 50% more likely to contract HIV than young men

• HIV higher in conflict zones, in armed forces, prisons and in cases of gender-based violence and transactional sex

• Men less likely than women in some settings to seek Voluntary Counseling and Testing and to disclose status

Men and Boys: Gendered• The concept of gender is

often perceived to refer primarily to women and girls

• But gender norms shape socially acceptable notions of masculinity as well as femininity

• Gender norms help define what it means to be a man as well as a woman

• Understanding masculinity norms creates prevention opportunities

Self-reported physical violence toward female partners Self-reported acts of delinquency Number of sexual partners Rates of self-reported STI symptoms Condom use Substance/alcohol use

In sum, how and to what extent boys and men internalize prevailing inequitable social definitions of manhood and gender-related norms affects their health and well-being and that of their partners and their use of violence against women.....

Social norms and masculinitiesIn numerous sample survey studies, gender-related attitudes are correlated with men’s and boys’ ....

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High Equitable Medium Equitable Low Equitable

Social norms drive the behavior of men and boys: GBV and norms about manhood – household sample data from Rio de Janeiro

Gender, Power and HIV/STIs

Gender norms and the gender-based power differentials between men and women(and amongst different groups of men, and amongst different groups of women)

are key drivers of men’s and women’s vulnerability to HIV/STIs.

Masculinities, SRH and HIV• Ideas of manhood that equate ‘being a man’ with sexual

risk-taking, and being in control, are associated with more negative attitudes towards condoms and less use, more sexually transmitted infections, more partners, including more casual partners, more frequent sex, more abuse of alcohol and more transactional sex.

• A significant proportion of men with STIs do not inform their sexual partners.

• Men all too often prevent women’s from determining whether or how sex takes place.

Links GBV - HIV• A complex combination of biological and social factors links violence

against women with increased risk of HIV. • Violence and threats of violence or coercion may limit women’s

ability to negotiate safe sexual behaviors, particularly use of condoms during sex.

• Multi-country studies have found intimate partner violence to be significantly associated with women’s risk for STIs, including HIV.– Women who have experienced physical/sexual intimate partner violence are 54%

more likely to have HIV (Dunkle et al 2004).– Men who have perpetrated physical/sexual intimate partner violence are more

than twice likely to have HIV (Jewkes et al 2008)

• A 2006 WHO multi-country study: women who reported physical or sexual violence by a partner ranged from 15 percent to 71 percent, with the majority of settings falling between 29 percent and 62 percent

• 10-20% of women say their first sexual experience was coerced

0

5

10

15

20

25

30

All rape SIPV Gang rape

South Africa

India

Croatia

Prevalence of rape reported by adult men

0

10

20

30

40

50

60

70

1 2-3 4-5 6-10 11+

South Africa

India

Croatia

Distribution of victim numbers among men who have raped

Reforming masculinities• Prevention of violence against women and GBV requires changing

dominant gender norms• Growing consensus on need to focus on primary prevention:

stopping violence before it begins by changing violence-supporting norms and behaviors, primarily perpetrated by men.

• We start from the assumption that men and boys can change and are changing

• New generation of boys and men influenced by the gains of women’s rights movement

• New legislation in many countries – VAW, paternity leave, joint custody of children

• Many boys and young men who show a mixture of more gender-equitable views mixed with inequitable views about women

• The question is not if men can change, but how we can speed up the change

The International Mandate for Gender Equality and Engaging Men and Boys

CSW 48th Session (2004) called for: • Gender equitable education;• Engaging men as fathers in gender equitable socialization of

children and in care giving;• Institutionalizing the inclusion of men and boys in gender equality

and gender mainstreaming policies;• Public information campaigns and engaging the media, including

internet, in questioning inequitable and sexist views;• Engaging men and boys in HIV/AIDS treatment and prevention, and

in sexual and reproductive health; and

• Engaging men and boys to reduce gender-based violence

Strategies for Engaging Men and Boys

Growing evidence base that interventions with men and boys work: WHO & Promundo 2008

Type of Intervention n Effective Promising

Unclear

Group Education 20 - 11 9

Services-Based 8 2 4 2

Community Outreach/Mobilization

8 6 2 -

Integrated (includes more than 1 of the above)

21 6 5 10

TOTAL 57 14 (24.5%)

22 (38.5%)

21 (36.8%)

But Which Kinds of Programs Work Best in Engaging Men?

Gender neutral: No distinction between men and women; men just another target group

Gender sensitive: Recognize role of gender norms/structures but little attempt to transform them

Gender transformative: Seek to promote equitable relationships, somehow change gender relations

• (Adapted from: Rao Gupta, et al 2002)

Group Education• Participatory

reflection on male socialisation and costs for men and women.

• Focus on moving from reflection to internalisation to sustained action

Key Elements in Effective Group Education with Boys and Men

Information + Critical reflection about

masculinity Skills building/experiential

learning Creating a safe space 10-16 sessions

recommended More effective when

combined with campaigns

Evidence• Solid evidence that interventions can bring about positive gender,

SRH and HIV related changes amongst men and boys

Examples• Stepping Stones: after two years men reported fewer partners,

higher condom use, less transactional sex, less substance abuse and less perpetration of intimate partner violence

• Programme H: participants between four and eight times less likely to report STIs and 2.4 times as likely to use condoms.

• Men As Partners and PMTCT in Ethiopia: 46% increase in men testing with their partners and 87.6% increase in the number of men joining their partners for PMTCT visits.

• One Man Can Workshop: 27% tested for HIV soon after the workshop and 2/3rds increased use of condoms.

Mass Media: Brothers For Life

http://www.brothersforlife.org/video/original.html

Community Media: Radio, CTV, Murals, Digital Storytelling

Key Elements in Effective Campaigns to Engage Boys and Men

Clear and positive messages Formative research +

extensive testing of messages Engage local boys/men in

constructing the messages Promoting a gender-equitable

lifestyle or alternative male identity

High quality media At least 4-6 months in duration

Enable/empower men/boys to question harmful and traditional norms about manhood

Find and promote what’s in it for men to change

Take into account other issues – particularly poverty, employment, urban/rural differences, etc.

Are integrated across health and social development issues and with multiple intervention levels

The experience so far suggests the need for programmes that ....

Resources• Men, Masculinities and HIV/AIDS: Strategies for Action

(International Center for Research on Women, Instituto Promundo, MenEngage Alliance, Sonke Gender Justice Network)

• WHO– Engaging men and boys in changing

gender-based inequity in health: Evidence from programme interventions– Policy approaches to engaging men and boys in achieving gender equality and h

ealth equity

• UN Women: ”Virtual Knowledge Center on Ending Violence Against Women” www.endvawnow.org/ (section on Men and Boys)

• UNFPA ”Engaging Men and Boys in Gender Equality and Health: A global toolkit for action.”

• MenCare www.men-care.org