How should we fast-track the HIV response among men and boys?

Slide shown during the meeting

On 10-11th December IPPF, UNAIDS and Sonke Gender Justice hosted a high-level meeting entitled “Rights, Roles and Responsibilities of men in fast tracking the end of AIDS”. The meeting brought together leaders, governments, researchers and practitioners who were experts in the field of HIV and gender programming to build consensus on what the evidence is saying about men and adolescent boys in the HIV response, and what role they have to play in ending the AIDS epidemic.

Having listened to the many expert voices in the room – here are some take home messages about what needs to be done to more positively and effectively engage men in the HIV-response:

1. We need to collect and analyse data more smartly and stop ‘generalising’.

HIV-related data needs to be disaggregated by age, sex and location and existing data needs to be analysed with a gender dimension in mind – particularly the bringing together of both qualitative and quantitative data for a richer analysis. For example, the organisers of the meeting had to specially commission data analysis of HIV prevalence among key groups of men generally seen as most vulnerable to HIV – e.g. men who have sex with men, truck drivers, clients of sex workers and fishermen etc. This analysis showed that apart from men who have sex with men, there was no consistency between countries in the groups at highest risk. Therefore we need to stop generalising and instead develop a more nuanced, country specific understanding of the HIV epidemic among men.

2. A holistic gender lens needs to be applied to the HIV response.

A clear output from the meeting was that gender matters and an HIV response that focusing on biomedical interventions and ignores the role of gender is going to fail. Equally, however, it was clear that any gendered HIV response will only succeed if working with women and men, girls and boys. Where HIV is primarily sexually transmitted and most new infections occur through heterosexual sex (e.g. sub-Saharan Africa) there is a cycle of transmission taking place which was presented by CAPRISA (see slide above).

3. A community approach needs to be scaled up to address gender inequality.

Gender is about power, and harmful gender norms lead to greater vulnerability to HIV for both men and women. The evidence is strong that HIV can be reduced when power dynamics in sexual relationships are changed and this requires interventions at the community level which foster dialogue with both men and women. There are many proven tools such as Stepping Stones, SASA! and One Man Can – what is now needed is to find ways to effectively scale these programmes up.

4. We need to flip the discourse from “why men don’t” to “why men do”.

Whilst the evidence shows that men are less likely to test for HIV, less like to be on treatment if living with HIV and less likely to adhere when they are on treatment, there are millions on men who are bucking this trend. The discussions and examples at the meeting focused on how health systems are not well set up to meet the HIV and other health needs of many men – or many women for that matter. By there was very little discussion of what lead to millions of men to get tested for HIV or begin treatment or what is helping them adhere to their treatment. We need to place more emphasis on learning directly from the experiences of men living with HIV who are (and aren’t) currently engaging in the health system and then for these lessons to be shared and the programmes that work to be scaled up.

5. We need stronger, more inclusive and more integrated health systems.

Sexual and reproductive health and HIV are not the responsibility of women alone and it is clear from the discussions that health systems need to be recalibrated to better meet the needs of men and adolescent boys. This includes the policy level where policies are gender transformative; it includes training service providers on the specific SRH needs of men; and it includes looking at innovative forms of service delivery beyond the clinic. However, most importantly, whilst these changes are taking place, there needs to be careful planning and coordination to ensure that there are no unintended adverse impacts on services for women and adolescent girls.

What next?

This high-level meeting is not the beginning of this work, and neither is it the end, but it is a step along the way. The Platform for Action from the meeting – which will be released in the coming months – will outline what some of these next steps should be. During his closing remarks, Tewodros Melesse, the IPPF Director General also gave a commitment for some steps IPPF will take over the next seven year (see below).

It is clear that the foundations of these next steps need to be rooted in gender justice. This was summed up nicely by Mark Dybul – Executive Director of the Global Fund. He said “We’ll achieve none of the sustainable development goals, none, if we don’t’ have a gender equal world”.

IPPF Commitment on #MenAndHIV:

IPPF is committed to working with all partners to build on what works and promote a synchronised approach to programming that is gender transformative. Working together as a global Federation, between 2016 and 2022 we will:

  • continue to provide technical support on mobilising men to transform harmful gender norms;
  • advocate for an enabling policy environment that ensures men’s access to services and reduces gender based violence;
  • contribute to the evidence base about what works in gender transformative programming; and
  • meet the diverse SRH and HIV needs of tens of millions of men and adolescent boys in over 150 countries.