Men's relationships with women vary tremendously within and between countries, but it is undeniable that male violence against women drives the spread of HIV and adds to the vulnerability of women and girls in a number of direct and indirect ways:

VIOLENCE IN THE HOME

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 poor position to question their husbands about their extramarital encounters, negotiate condom use or refuse to have sex. 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.

SEXUAL ABUSE OF WOMEN AND CHILDREN

Violence against women outside the home is also depressingly common. It runs the gamut from overtly violent rape to the coercive exploitation of female sexuality.

RAPE IN WAR

Rape is often used to humiliate and control the behaviour of civilian populations and/or to weaken an enemy by destroying the bonds of family and society. Women raped by military personnel are exposed to a far higher risk of HIV and other sexually transmitted infections than they would be through other unprotected sex, not just because rape can result in torn tissue and hence create an easy entry-point for HIV, but because their rapist has a higher risk of being infected. In most countries combined STD and HIV infection rates among the military are two to five times greater than those in civilian populations.

The 21st Special Session of the UN General Assembly held in 1999 drew attention to the role of gender equality and equity as a key determinant of success in the struggle against AIDS. Urgent steps need to be taken to enhance women's ability and knowledge, and to empower them to take informed action.

But men too must be encouraged to take responsibility for their sexual and reproductive health, and that of their partners. All over the world, women find themselves at risk of HIV because of their lack of power to determine when, where or even whether sex takes place. What is perhaps less often recognized is that cultural beliefs and expectations can also heighten men's vulnerability.

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

The Use of Condoms

Male condoms are the primary prevention technology available to protect against HIV transmission during sexual intercourse. While they are very effective when used consistently and correctly, there are many gender-related barriers that limit their use. In cultures where condoms are associated with illicit sex and STDs, women who attempt to introduce them into a relationship encounter problems such as being perceived as unfaithful or "over prepared". Condom use may conflict with their own, or their partner's desire, to conceive. Among both women and men, barriers to condoms also include perceptions that reduce pleasure and intimacy, and the fear that suggesting them would insult their partners.

Men Make a Difference

"You can't have a program for women unless you also work to change the behaviour of the other half"
Wendy Githens-Benazerga, AIDSCAP PVO

Men need to be encouraged to adopt positive behaviours and to play a much greater part in caring for their partners and families. 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.

In March 2000 UNAIDS launched a two-year campaign 'Men Make a Difference' focusing on the role of men in the HIV/AIDS epidemic. The campaign's objectives include motivating men and women to talk openly about sex, drug use and HIV/AIDS, and encouraging men to take care of themselves, their partners and their families.

The Campaign has three broad goals:

Raise awareness of the relationship between men's behaviour and HIV.
Encourage men and adolescent boys to make a strong commitment to preventing the spread of HIV and caring for those affected.
Promote programmes that respond to the needs of both men and women.

By focusing on men, the campaign aims to complement prevention programmes for women and girls.

"Engaging men as partners in fighting AIDS is thus the surest way to change the course of the epidemic."

Can Men Change?

Yes and no, suggests research by Care International in Vietnam. When men are equipped with the right kind of knowledge and skills they will improve their behaviour. However, the deep-rooted gender inequalities that shape sexual encounters are more difficult to transform.

'Men In The Know', a Care International project in Vietnam, developed sexuality training for men to promote safer sex within relationships, and trialed the training package with 2000 men.

A participatory workshop focussed on two broad areas:

a) imparting knowledge on the physiology of sex and
b) challenging socio-cultural factors that shape sexual encounters.

A pilot component was also directed at men who visit sex workers. It tested the effectiveness of a new approach, 'social marketing', in bringing about behavioural change through the communication techniques commonly used in commercial marketing.

The men responded very positively, pleased that they could now make responsible decisions. Partners were equally enthusiastic. However, men still decided when and where sex would happen. Although as a result of the workshop, men were perhaps more considerate towards their partners.

A Spirit of Mutual Respect

"Women face extra challenges in protecting themselves and their children from HIV infection. But this social vulnerabillity is hard for women to challenge as individuals, or though female solidarity alone. It will take an alliance of men and women working together in a spirit of mutual respect."

Michael Merson, former Executive Director
WHO Global Programme on AIDS

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Women, Gender and HIV/AIDS in East and Southeast Asia

Men's Role in the Fight Against HIV/AIDS