AIDS - In the Hands of Men

	Produced by IPS with support from PAHO and UNAIDS

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In the Hands of Men

By Martin Foreman

LONDON - In the last two decades we learned a few lessons about AIDS prevention. One is that this global epidemic is driven by men.

HIV is primarily transmitted through sex between men and women. But men have more sexual partners than women, and men tend to control the frequency and form of intercourse, while women are physiologically more susceptible to the virus. For these reasons, it is men's behaviour that determines how quickly, and to whom the virus is transmitted.

Men's behaviour is strongly influenced by perceptions of masculinity. Most cultures expect men to be sexually active, often with more than one partner. Attitudes towards risk-taking lead many men to reject condoms as "unmasculine" or consider sexually transmitted infections as no more than an inconvenience. The same attitudes lead some to experiment with and become addicted to intravenous drugs.

Worldwide, concepts of masculinity are changing. Nevertheless, men are generally expected to be strong, to be the primary provider for the household and to defend themselves, their families and their societies from aggressors. Traditionally it is men, not women, who take risks, whether fighting battles, climbing mountains, racing cars - or injecting drugs.

Ideas vary of "what makes a man." In some societies, a man might be effeminate in Western eyes but he is considered a man if he has fulfilled his community duties by marrying and having sons. In contrast a single man in the same society, even if extremely masculine in a Western sense, is defined as "not-yet-a-man".

Credit: Fabricio Vanden Boeck/México

In some cultures, as in much of Latin America, a man who is the dominant partner in sex with other men is still seen as virile. For a man to be penetrated, however, almost always stigmatises him as effeminate, except in a few societies such as the Keraki of New Guinea, where boys "become men" through receptive anal intercourse.

Men who have sex with men are at particular risk. Discrimination and hostility in many societies make many men reluctant to admit to their own sexual behaviour. And although sex between men occurs in every society, many governments ignore the need to protect men who have sex with men - and their women partners.

Not every man is liable to contract or transmit HIV. Worldwide, perhaps one in four men endangers himself and his female or male partners. That number represents hundreds of millions of men who, it appears, regularly risk their own lives and, therefore, the lives of millions of others.

Such behaviour does not mean that men are to blame for the AIDS epidemic. Men are also potential victims since they cannot transmit the virus to others unless they contract it first themselves. While a few knowingly act irresponsibly, social and physical circumstances prevent many others from protecting themselves. Some men, including adolescent boys, transsexuals and transvestites, as well as men who are younger, poorer or physically or psychologically weaker, are particularly vulnerable and can be forced into situations in which they contract the virus from other men.

Women have become the target of many HIV/AIDS prevention programmes. While these efforts have played a major role in raising awareness of the disease, they are not sufficient: women cannot protect themselves unless men also do so.

The question now is whether men can be persuaded to change and whether widely held notions of masculinity will allow men to be responsible and protective. It may be that deeper changes in society are needed before the AIDS pandemic can be contained.

Many men assume that the solution to HIV prevention can be found within existing social structures and values. That may be true, but the continued escalation of the epidemic suggests that the dramatic progress needed to combat HIV will depend on radical changes to those structures and values, particularly in relation to the roles of men and women.

* Martin Foreman is director of the Panos AIDS Programme.