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IRIN PlusNews HIV/AIDS News and information service | Southern Africa | SOUTH AFRICA: Men falling through the cracks | Care Treatment, Prevention Research, Stigma Human rights | Focus
Sunday 18 December 2005
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SOUTH AFRICA: Men falling through the cracks

[This report does not necessarily reflect the views of the United Nations]


Imbizo Men's Health Project provides VCT in an all-male environment

JOHANNESBURG, 25 July (PLUSNEWS) - Most women can testify to the old adage that a good man is hard to find. But finding men who are willing to undergo voluntary HIV counselling and testing (VCT), and support their HIV-positive pregnant partners in the prevention of mother-to-child transmission, is even harder.

According to researchers, men account for only 21 percent of all clients receiving VCT in South Africa.

In the old Nurses Home building at Chris Hani Baragwanath Hospital in the country's largest township, Soweto, near Johannesburg, most of the patients at the Perinatal HIV Research Unit (PHRU) or its psychosocial support services, HIVSA, are women.

As Dr Francois Venter of the Reproductive Health Research Unit (RHRU) put it, it was "bloody easy to find women": they were more likely to access health care services and get tested, particularly during pregnancy; or clinics, especially antenatal clinics, where most of the HIV testing takes place, because these healthcare facilities were perceived as unfriendly to men.

It was difficult enough to find men who would agree to be tested, but getting hold of a supportive man to accompany his partner on her antenatal visits during pregnancy or agree to be tested as a couple, was almost impossible.

A community-based survey conducted in Soweto by the Population Council found that although 62 percent of males interviewed had encouraged their partners to go to antenatal clinics during their last pregnancy, only 37 percent accompanied them during these visits. "An even lower proportion of men" accessed VCT with their partner as a couple, the Population Council's Prudence Ditlopo pointed out.

When men do play a role in VCT, both parties benefit: HIV-positive women are more likely to receive Nevirapine during follow-up visits, avoid breastfeeding their infant, and use condoms; men are more likely to access antiretroviral treatment sooner.

So why aren't they doing it? In trying to come to grips with men's low use of VCT and participation in preventing mother-to-child transmission of the virus, the University of Washington's Andrew Levack spent time in Soweto interviewing men and women for his research.

Fear of disclosure and stigma remain the biggest barriers, Levack found. In Soweto, VCT has become associated with death, as many people do not take the test until they show the symptoms of AIDS and are very ill, but men were more scared of AIDS than of dying, he noted.

"Because we fight the wars, I wouldn't say we are afraid to die - I would say we are scared to die slow; we prefer to die fast," said one male respondent.

Men were even more reluctant to be tested when they had multiple sexual partners or indulged in high-risk sexual behaviour. "Those who need it most are not getting tested," Levack warned.

Another common reason was that they just did not see any value in knowing their status, which was often seen as a burden: they would have make lifestyle changes, stop having sex, drinking and smoking.

Making free ARVs available was often not enough motivation for men to get tested, as most people knew that the life-prolonging medication was not a cure for HIV/AIDS.

About 6.5 million people are living with the virus in South Africa and it was surprising that some of the men who participated in the study did not feel vulnerable to HIV infection, Levack commented.

"The thing is, I do not believe it could happen to me - the other day I was listening to the radio; every time they talk about AIDS I would get bored and change the channel ... I just don't believe it could happen to me," remarked a participant from Mdeni, an area in Soweto.

The most surprising finding was that men were "proxy testing" by using their partner's HIV status as an indicator of their own; women reinforced this idea, believing that they should be the first to test, for their partner.

Levack recommended the launch of communitywide campaigns targeting men with messages such as, "my status is not my partner's status".

According to study respondents, the role of men in society was another factor: men were not socialised to take care of their health and seek services from clinics, which are traditionally seen as the woman's domain.

Participants also observed that South African men had been taught to hide their emotions and not ask for help, making it hard for them to get social support when living with HIV.

But Levack stressed that men were being tested, usually because they had been influenced by partners and friends, were religious, or knew someone living with HIV; in some cases, they got tested simply for "peace of mind".

He called for the expansion of the number of male-specific VCT service sites to encourage more men to come forward.

Nevertheless, Bernard Nhlapo, VCT Coordinator of the Imbizo Men's Health Project, run by HIVSA, cautioned that male-specific clinics would not solve the problem.

Imbizo's two 'drop-in' centres in Kliptown and Diepkloof offered advice on health matters, HIV testing and counselling and other services in an all-male milieu, but stigma was still turning men away. When the first two centres opened this year, "it was so depressing sitting there for the whole day with no-one coming", and although the clinics were slowly gaining clients, "the going is still slow".

Dean Peacock, programme manager of the Men as Partners (MAP) Programme in South Africa, suggested that healthcare workers "work outside the four walls of the clinic", and noted, "We are not calling for the rearranging of the health system ... just low-cost things like messages, pamphlets, posters, targeted at men."


Recent SOUTH AFRICA Reports
National survey finds young women most at risk of HIV/AIDS,  1/Dec/05
AIDS activists take government to court again,  29/Nov/05
Poor governance blamed for US $10 million unspent in HIV/AIDS budget,  1/Nov/05
NAPWA partners with controversial Rath Foundation,  20/Oct/05
Trials test efficacy of diaphragms in preventing HIV/AIDS,  26/Sep/05
Le portail d'informations générales de la Côte d’Ivoire
The Global Fund to fight AIDS, Tuberculosis & Malaria
Mothers and HIV/AIDS

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