HIV prevention: “Where are the men?”

Catholic Church-inspired organisations discuss lack of involvement among men in the prevention of mother-to-child HIV transmission

Members of a HIV parish support group in the Southern Highlands in Papua New Guinea. The volunteers go into communities to explain the importance of testing and offer counselling to couples. Credit: Patrick Nicholson/Caritas 2012

By Msgr. Robert J. Vitillo, Caritas Internationalis Special Advisor on HIV/AIDS and Francesca Matera, Geneva delegation volunteer

In many countries, pregnant women must seek permission from their husbands before accessing a simple HIV test that could be the determining factor for future health, illness or even death, both for themselves and their babies. Some women do not return for their test results because they fear the negative, or even violent, reactions of their husbands should the test be positive for HIV. And some HIV-positive women refuse to avail themselves of prevention of mother to child transmission (PMTCT) programmes, again out of fear of male reactions and rejection from the extended family.

PMTCT treatment programmes, which include HIV testing, follow up appointments, administration and adherence to antiretroviral (ARV) medications, are at the core of strategies being promoted by national governments and international agencies in order to reduce vertical (mother-to-child transmission of HIV which still accounts for approximately 90% of new infections in children.

The medications are provided to the pregnant woman as soon as HIV infection is diagnosed and to the baby soon after birth and, whenever possible, until the child has finished with breastfeeding.

Such regimens are widely used in high-income countries and thus have led to a virtual “elimination” of vertical transmission of HIV in those countries. In many low- and middle-income countries, uptake of PMTCT is still severely limited. This may be responsible for the vast majority of some 370,000 new HIV infections among children during 2011.

During a meeting in Geneva, on 17-19 October 2012, the members of the Catholic HIV/AIDS Network, for which Caritas Internationalis serves as secretariat, discussed these urgent issues.  The participants examined some interesting programmes designed to increase male involvement in PMTCT efforts and thus to facilitate greater uptake of these programmes by HIV-infected, pregnant women.

In the course of the discussions, it was recognised that, whether directly or indirectly, men have a substantial impact on the success of PMTCT programmes in developing countries, particularly in the sub-Saharan region of Africa. Since faith-based organisations (FBOs) play a major part in the cultural and spiritual welfare of society, CHAN members considered it a duty to reflect upon their role to promote stronger engagement men as family and community leaders.

Presenters focused on different approaches aimed at  achieving the same goal: to ensure that men are better engaged in the antenatal care of their wives by creating positive role models of masculinity for the community.

Dr. Dorothy Brewster-Lee,  of Catholic Relief Services (CRS is a Caritas member based in the USA), said that promotion of ‘male involvement’ represents a component of her agency’s reliance on the principles of Integral Human Development and Catholic Social Teaching. These principles put people at the centre of development and insist that women and men, boys and girls should have equal opportunities, resources, rights, access to goods and services and should be able to interact in mutual partnership..

An initiative which mirrors the nature of the Church’s mission to the community was presented by  Rev. Richard Bauer a Maryknoll Father working in Namibia, and was entitled ‘Men of the Bible as models for Male Involvement’. Fr. Bauer maintains that the best role models, those to whom  men-of-faith could easily relate,  can and must be the found in sacred scripture. His educational project also examines negative stereotypes of masculinity with a view of eliminating them.

Fr. Bauer based his programme on the hope that men and boys in rural villages would find inspiration in some of the best-known Bible passages – a book that, to use Rev. Bauer’s own words, “people are rather familiar with”  –  and would look to the Bible for positive models of masculinity.

In the New Testament, Jesus showed respect for women as mothers and sisters, care for the poor, compassion for the woman caught in adultery and even a strong emotional reaction to the death of his friend Lazarus. “What kind of man was Jesus? Was he really different from our concept of masculinity?” Fr. Bauer also points out to the male participants in his discussions that  Abraham was a listener and, as for honour, Joseph did not act when given the chance for revenge.

Another approach discussed during the CHAN meeting was that of encouraging men to support one another by joining discussion groups. Such groups represent an excellent opportunity to address common fears, confront prejudice and stand together create a new social norm where love is predominant. In a similar way, Sr. Tarcisia Hunhoff, Director of the Catholic HIV/AIDS office in Papua New Guinea reported good success in attracting men to seek HIV testing by establishing “male clinics” in several Catholic hospitals and care centres. She claimed that, too often, HIV testing is based in maternal and child health programmes, which can cause men to feel “out of place”.

Catholic Relief Services also introduced its “Faithful House Programme”, a three-day HIV prevention initiative designed to strengthen the relationship within the couple.  Participants in the course reported increased involvement by men in accompanying their wives pre-natal care. Furthermore, some 79 percent of husbands from the intervention group felt the need to show more concern and responsibility for their wives and children with some of the men deciding to write a will to ensure the future security for the household.


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