Prevention · Education · Support · Referrals

Serving the mountain communities of Banff, Canmore, Kananaskis
Lake Louise, Exshaw and Morley

Free
condoms
are
available
at the
following
locations:

AIDS Bow
Valley

The
Living
Room

The
Banff
YWCA

The Banff
Centre

Lube and
dental dams
are also
available at the
AIDS Bow Valley
office
302 Buffalo St.

GENDER

The different role that men and women play in a society and the rights and responsibilities associated with those is a powerful force. Gender roles and gender norms are culturally specific and thus vary tremendously around the world everywhere, however, men and women differ substantially from each other in power, status, and freedom. In virtually all societies, men have more power than women. Although their position of power in the world confers many benefits, it can also endanger their health.

The myth of masculinity leads to expectations of men to be physically strong, emotionally robust, and daring these expectations translate into attitudes and behaviors that have become unhelpful or frankly lethal. Others, on the contrary, represent valuable potential that can be tapped by HIV/AIDS programs. 

WHY SHOULD MEN BECOME MORE FULLY INVOLVED IN THE FIGHT AGAINST HIV/AIDS?

The number of special circumstances place men at particularly high risk of contracting HIV:

Worldwide, men tend to have more sex partners than women, including extramarital partners, thereby increasing their partners risk of HIV. Studies confirm that boys and men across the world report sex with other boys and men may have discreet relationships with other men so long as they also marry and have children. This places both the male and female partners at risk. Secrecy and stigma stifle discussion about HIV between couples.

Men are often less likely than women to seek health care - this may be associated with delays in treatment of STDs and health concerns. Untreated STD's have been associated with a five-fold increase of HIV transmission.

Men who migrate for work and live away from their families may pay for sex and use substances including alcohol to cope with the stress and loneliness of living far from home. This can further contribute to the spread of HIV, when they return to their communities and their primary partners.

Men in all-male environments, such as the military, may be strongly influenced by a culture that reinforces risk. Security Council has recently approved a program with will attempt to prevent and treat HIV/AIDS within the UN peacekeeping forces. The UN has acknowledged that UN peacekeepers may contribute to the spread of HIV. This may  involve extensive education for troops before deployment, access to confidential testing and treatment and each person being issued on condom per day.

Men make up 80% of the estimated 7 million injection drug users in the world. Studies indicate that although men take HIV preventive measures while using drugs, they fail to do so while having sex. For many individuals, the difference between IDU and the sexual spread of HIV is not clear.

Male violence further drives the spread of HIV through wars and the migration they cause, as well as though for acts of violence. Millions of men a year are sexually violent towards women and girls, sometimes with their own families.

Male sex work is common in many countries although it is often hidden and denied since most male, sex trade workers men who have sex with other men The stigma associated with this area of work makes it difficult to reach men and their customers. Specialized outreach programs are important ways to reach this population.

MEN AND PREVENTION

The HIVAIDS epidemic has put men’s sexual behavior in the spotlight. Prevention is the only solution.

Most approaches to prevention have looked at the link between knowledge of risk and behavior change. Most have managed to increase knowledge and awareness of HIV via prevention and awareness campaigns. The major studies show that there has been the failure to achieve behavior change.

Research has shown that there are a number of barriers to the adoption of risk-reduction strategies. Many of them form and are reinforced by gender roles and socioeconomic inequalities.

One of these barriers to behavior change is the concept of masculinity and machismo. This refers to the ideas of what it is to be a man. Male sexuality is often portrayed as unrestrained and unrestrainable.

This conception of male sexuality may be damaging to men. Efforts to increase consistent condom use may be made futile by stereotypes about male sexual response. In one study, men in South America expressed that they know and believed that condom use was important but were hesitant to refuse sex without a condom, as this might mean there were unmanly.

Many cultures consider the initiation of sex to be the man’s responsibility. These gender-role expectations destroy negotiations. While lack of knowledge and sexual inexperience remain highly valued for young women, men may be stigmatized if they cannot demonstrate having had a wide sexual experience.

Acceptance about social norms about “regular” or steady partners may also impede the use of condoms. Notions such as trust and romance make it difficult to introduce a discussion of condom use without bringing up issues of infidelity and mistrust.

Another barrier is assumptions about women’s sexual history. Men professed to make judgments about the “cleanliness" of  women. Women who wore too much make-up and “failed” to resist their advances were considered suspect and condoms were often used. On the other hand, women who dressed sedately and refused sex on an initial encounter were  deemed sage and condoms were not often used. This is consistent with findings that condoms were often used with sex workers but rarely with regular partners.

Other barriers to condom use include beliefs that condoms compromise the pleasures of sex, are unnatural, and  spoil spontaneity. Embarrassment about purchasing condoms has been found to be an issue for young people and for cultures where sexual discussions are taboo.

REACHING MEN

Men are a divers group of individuals. They reflect the spectrum of humanity, from kind and caring to abusive. While some men spread STD’s to their partners or act in other harmful ways, most men do not. It is important that programs abandon stereotypes of men and learn more about their concerns and needs, especially when designing different groups of men.

A number of researchers and community groups have recognized the importance of involving men in programs to prevent HIV infection, as well as to address the broader inequalities which pose a risk to sexual health. One of the important gaps in research is the absence of clear information about men’s attitudes towards sex and sexuality. We know more about men’s perspectives and interests if we are to engage them productively.

Women have reported that men are reluctant to use condoms but little is known about men’s reasons. For example,  South Africa reported that men could become violent or coercive if condom use was requested. A pilot project analyzed their reaction to requests for condom use. Their responses indicated that they were not against condom use, but more about the importance of timing the request. They unanimously agreed that if the request to use a condom was made before sex occurred there were much more likely to respond favourably. This is important information, which can benefit women.

STRATAGIES TO INCREASE MEN’S PARTICIPATION

Reach out to young and unmarried men.

Worldwide, one in four people with HIV is a young man under the age 25. Men are more likely to maintain safer sex practices and they initiate them at an early age. To meet the needs of young men, programs must learn about men’s perception and responsibilities as sex partners.

Programs must also assess what young men actually know about sexual health and start at their level. Many programs make the assumption that young men understand the basics around sexual intercourse but this man not be the case. Machismo may make it difficult for young men to acknowledge that they are actually lacking information about it. Another strategy which has been suggested is the training of young men to work as peer health educators.

Allowing men to talk about their problems in a safe environment is an important first step to reaching men with the messages. To this end, some clinics have started offering men-only nights, while other clinics are offering serving in conjunction with sports events, military facilities and juvenile justice centers.

BIOLOGICAL FACTORS

If is estimated that between 75-85% of HIV cases worldwide have been contracted via sexual contact. Globally, HIV have been spread via heterosexual contact.

CIRCUMCISION

There is a growing body of epidemiological evidence which shows that uncircumcised men are at a much greater rate becoming infected with HIV that circumcised men.

Why are uncircumcised men at risk?
Uncircumcised men are susceptible to STD’s via the following mechanism: The frenulum, the thin band connecting the foreskin to the glands is made up of highly vascularised (containing many blood vessels) tissue. This makes it susceptible to trauma during intercourse and lesions produced by other sexually transmitted diseases.

This fragile are contains Langerhan’s cells which have HIV receptors. This area is likely to be the reason that uncircumcised men are at greater risk of HIV and other STD’s.

Circumcision has also been shown to protect against other sexually transmitted infections. The presence of another STD can  increase the risk of HIC transmission by up to 5 times. In uncircumcised men infection may occur directly through the foreskin of the uncircumcised penis, which has limited mucosal immunity. Washing under the foreskin before and after wearing a condom during high-risk activities reduces risk.

Although condoms must remain the first choice for preventing the transmission if sexually transmitted infections and HIV, they are often not used correctly of consistently and there may be strong cultural objections to using them.  As well, religious attitudes towards male circumcision are even more deeply held but in light of the evidence that circumcision offers some protection against HIV, circumcising males seems highly desirable, especially in countries with high levels of infection.

MEN WHO HAVE SEX WITH MEN (MSM)

Data from provincial resting reports indicates MSM are less likely to contract HIV in 1999 than in earlier years (Alberta Health and Wellness, 1999). From 1985 to 1994, 74.6% of new HIV diagnoses were among MSM, but by 1999 that number had dropped significantly to 25.7%. In Alberta, MSM account for 11% of all new HIV diagnoses (Health Canada, 1999) there continue to be causes for concern for MSM, particularly in rural areas. Same-sex encounters are often kept quiet and thus are not discussed with health professionals who could counsel them in methods of protection. Men may be from rural areas to take part in sexual activities in large cities where they are most likely to encounter HIV positive men (DeCarlo, 1997). Rural rates of HIV have the potential to skyrocket, as seen in the rural south of the United States, 44% of HIV positive men had engaged in unprotected sex with a same partner (Centers for Disease Control & Prevention, 1998).

HETEROSEXUAL POPULATIONS

HIV or AIDS cases are often reported as stemming from unknown risk factors. In many cases, the risk factor is determined to be unprotected heterosexual sex. Between 1985 and 1994, heterosexual contact accounted for only a few reported positive HIV test reports, but in the first six months of 1999 that number has risen to 18.3% of test reported (Health Canada, 1999). This suggests that individuals may not be aware of the risk posed by their partners and/or that health professionals are not recognizing this risk.

Data indicates that a significant proportion of couples do not use condoms regularly. In 1997, a survey showed that those who reported having one or more non-regular partners in the previous, 27.7% of men and 28.1 of women used a condom the last time they has sexual intercourse (Health Canada, 1999). In the rural context, a 1998  study indicated that in the rural United States, 69% of HIV positive men and 98% of HIV positive women had engaged in unprotected sex with an opposite-sex partner (Centers for Disease Control and Prevention, 1998).