Feature story

Men, boys and AIDS: reframing the conversation

09 December 2015

If the Fast-Track approach to end the AIDS epidemic is to be successful, the rights, roles and responsibilities of men in the AIDS response need to be placed firmly on the global agenda.

It has long been noted that the Fast-Track Strategy cannot be achieved without action on gender equality and human rights. The vulnerability of young women and girls has been an important focus of many programmes and has been debated many times, but more recognition is needed that harmful norms also drive the epidemic among men. Health systems are falling short of addressing the needs of men, which is having a negative impact on the health of both men and women.

“Men play a critical role. When we engage men for their own health and to change harmful gender norms, we improve both men’s and women’s health. This is an essential element of the UNAIDS Fast-Track approach to ending the AIDS epidemic,” said Michel Sidibé, UNAIDS Executive Director.

Reaching men with HIV-related prevention, treatment, care and support services is vital. Men and adolescent boys make up nearly 49% of the global population of 34.3 million adults living with HIV and account for 52% of all new adult HIV infections. Around 60% of the 1.2 million people who died of AIDS-related illness in 2014 were male.

According to UNAIDS, there is a lack of services for men who are at higher risk of HIV infection. Diversity among men, including age, risk behaviour and sexual orientation, needs to be taken into account when planning programmes.

Women under the age of 25 are often vulnerable to HIV, and gender inequality and the structures of society often prevent them from accessing the HIV information and services that can protect them. Men, on the other hand, are affected later in life and are more empowered to access services, but, for many reasons, they don’t.

Men’s access to HIV services is important for their own health but it is also an important way to reduce vulnerability among women. Engaging men in health services for their own health can also provide an entry point for programmes that can also transform harmful gender norms.

UNAIDS calls for more work to be done to explore exactly how harmful gender norms and notions of masculinity may increase men’s vulnerability. For example, stereotypes of male “strength” and invincibility can lead to men not using condoms and avoiding health services, such as HIV testing. It has been shown by research in 12 low- and middle-income countries that men with less equitable attitudes to women are less likely to be tested for HIV.

In addition, studies have reported that men are more likely not to seek out—and stick to—antiretroviral therapy.

UNAIDS contends that health professionals themselves often assume that men do not need, or are not willing to use, HIV-related services. There is a need for such preconceptions to change, with the development of comprehensive policies and programmes that promote men’s access to programmes and address their specific needs. This means changing the perceptions of men in the response to HIV, as they are often referred to as “transmitters” or “vectors”, stereotypes that blame them for infection, stigmatize them and isolate them further from accessing services.

There is a call for a global shift in the discussion on HIV and gender—that it should become more inclusive of men and encourage their greater positive engagement in all aspects of the AIDS response and in advancing gender equality. Sexual and reproductive health is not the responsibility of women alone. Focused, integrated sexual and reproductive health services must be made available to men and adolescent boys. Although much more research needs to be done, there is already a body of data that lays the groundwork for developing and implementing more comprehensive policies and programmes.

To reflect the seriousness of this issue and the need to chart the way forward, a global high-level meeting on men, adolescent boys and AIDS is being held in Geneva on 10 and 11 December. It is co-convened by UNAIDS, Sonke Gender Justice and the International Planned Parenthood Federation. The main objectives are, broadly, 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.