By Frederick Womakuyu

THE United Nations Women’s Fund (UNIFEM), estimates that of the 38.6 million adults living with HIV/AIDS by the end of 2002, 19.2 million (nearly 50%) were women. It adds that the rate of new infections among women is increasing faster than those among men.

This indicates a rise in incidence or prevalence among women due to biological, social and economic factors. It is not surprising when some people think that putting the HIV/AIDS prevention agenda into practice should be the women’s responsibility.

The time has come for men to also take responsibility in HIV/AIDS prevention.
The effect of HIV on women increases the burden of care that women carry. That burden is heavier than it should be due to lack of education, economic advantages and adequate health care for women in many societies.

According to UNIFEM, there are limited opportunities, especially for young women, to fully participate in HIV/AIDS prevention, when it is known that they are affected by HIV/AIDS.

Correcting this gender imbalance that contributes to and is exacerbated by the HIV/AIDS pandemic, will depend on increasing men’s responsibility for HIV/AIDS prevention and care.

Dr. John Tumusiime of Medecins San Frontiers, Uganda, says the majority of risk-reduction interventions target prenatal women and prostitutes and fails to take into account the socialisation process that influences women’s risk of HIV infection.

“In particular, it ignores the adverse effects sexual relationships between men and women have on women’s ability to adopt and maintain HIV/AIDS preventive behaviour,” Dr. Tumusiime says.

Domestic violence and sexual abuse of women and children
Experts say it is undeniable that violence against women drives the spread of HIV and adds to the vulnerability of women and girls directly and indirectly.
Dr. Helen Namutebi of Nsambya Hospital, says domestic violence reduces women’s control over their exposure to HIV.

In settings where violence is regarded as a man’s right, women are in a disadvantaged position to question their husbands about their extramarital encounters, negotiate condom use or refuse to have sex,” says Dr. Namutebi.

According to studies carried out worldwide, between a third to half of married women say they have been beaten or otherwise physically assaulted by their partners.

“My husband has threatened my life a couple of times. He intentionally infected me and accused me of infecting him. Yet he knew I was faithful to him. Fortunately, my two children are safe, but they judge my HIV status as my inability to take care of them,” says Anne Mugerwa, a resident of Ntinda.
Dr. Namutebi says violence against women outside the home is also depressingly common and it ranges from violent rape to the coercive exploitation of female sexuality.

Sexual abuse (during war)
Dr. Namutebi explains that rape is often used to humiliate and control the behaviour of civilian populations and to weaken an enemy by destroying the bonds of family and society.

She says women raped by military personnel are at a higher risk of HIV and other sexually transmitted infections than they would be through other unprotected sex.

“In most countries, combined sexually transmitted diseases (STDs) and HIV infection rates among the military are two to five times greater than those in civilian populations,” she says.

Dr. Halima Ahmed of Ahamadya Hospital, Mbale, says the 21st Special Session of the UN General Assembly in 1999 drew attention to the role of gender equality and equity as a key determinant of success in the struggle against AIDS.

“Men must be encouraged to take responsibility for HIV/AIDS prevention. All over the world, women find themselves at risk of HIV because of lack of power to determine when, where or even whether sex takes place.

“What is less often recognised is that cultural beliefs and expectations can heighten men’s vulnerability,” says Dr. Ahmed.

Use of Condoms
Dr. Ahmed says male condoms are the primary prevention against HIV transmission during sexual intercourse. However, in cultures where condoms are associated with illicit sex and STDs, women who attempt to introduce them into a relationship are perceived as unfaithful or “over-prepared”.

Condom use may conflict with their own, or their partner’s desire to conceive. Some women and men believe condoms reduces pleasure and a suggestion to start using them is an insult to their partners.

Men Make a Difference
“You can’t have a programme for women unless you also work to change the behaviour of men,” says Dr. Boson Katusiime of Mulago Hospital.

Numerous studies worldwide show that men generally participate less than women in caring for their children. This has a direct bearing on the AIDS epidemic, which has left over 11 million children orphaned.

Dr. Anne Marie of Care-Uganda, says in March 2000, UNAIDS launched a two-year campaign ‘Men Make a Difference’, which had three broad goals:
l Raise awareness of the relationship between men’s behaviour and HIV.

Encourage men and adolescent boys to make a strong commitment to prevent the spread of HIV and care for those affected.

Promote programmes that respond to the needs of both men and women.
“Encouraging men to be partners in preventing HIV is the surest way to change the course of the epidemic,” says Dr. Marie.

Can Men Change?
‘Men in the Know’, a Care Uganda project in Lira, developed sexuality training for men to promote safer sex within relationships. They carried out trials in 2,000 men on two broad areas:
l Imparting knowledge on the physiology of sex and
l Challenging socio-cultural factors that shape sexual encounters.

A pilot component directed at men who visit sex workers tested the effectiveness of ‘social marketing’, in bringing about behavioural change through communication techniques commonly used in commercial marketing.
The men were pleased that they could make responsible decisions.

However, men still decided when and where sex would happen, although they were more considerate towards their partners.

“I openly discuss issues of sex and HIV with my wife and children. This has helped us share safe sex methods like use of condoms, faithfulness and caring for each other,” says Peter Musoke, a resident of Naguru.

“It will take an alliance of men and women in a spirit of mutual respect,” says Michael Merson, the former executive director of the Care Global Programme on AIDS.

Men’s likely behaviour
Men are less likely than women to:
Seek health care
Pay attention to their sexual health
Men are more likely than women to:
Inject drugs, risking infection from needles and syringes contaminated with HIV

Compiled by Dr. Halima Ahmed