Building on Successes: Integrating Systems
It was emphasised that while great strides have been made in certain areas, such as PMTCT, treatment, medical male circumcision and testing, our response to the epidemic needs to be continually strengthened. This was the finding of the 6th South African AIDS conference, which took place from 18-21 June 2013 at the Durban ICC.
The conference chair and head of the Medical Microbiology Department at UKZN, Professor Koleka Mlisana, stressed the need to be cognisant of the successes achieved thus far, while guarding against complacency and ensuring that the systems we have developed are integrated into health policies and operations. She also highlighted the need for further research into behaviour, especially with regards to adherence to treatment and prevention.
Dr Aaron Motsoaledi, the Minister of Health, during his address in the opening ceremony of the conference, drew attention to the low numbers of men accessing testing and treatment services in South Africa and asked why there seemed to be no sessions at the conference focusing on this issue. He then encouraged women to ‘grab men and get them to test’. He was later gently rebuked by SANAC Deputy Chairperson Steve Letsike for this comment, as it may have communicated the message that women should take responsibility for men’s health, rather than men taking responsibility for their own health. The minister went on to commend the Brothers For Life programme for their important work in this area.
Dr Olive Shisana underlined the issue of men’s poor health seeking behaviour, while also acknowledging the increased likelihood of women accessing testing services due to PMTCT programmes. She also noted that in terms HIV positive people on treatment, women are double the number of men.
The Health Minister also took the opportunity to discuss the schools’ health programmes, which is currently in the implementation phase. He emphasised the holistic approach of this programme, involving vaccinations, basic testing of hearing and sight etc, but also HIV testing and a sexual and reproductive health and rights (SRHR) curriculum. Pretending that the youth are not engaging in sex is no longer an option, making it imperative emphasize the dual protection approach, consisting of both condoms and contraception.
Notwithstanding the Minister of Health’s comments regarding a dearth of focus on low numbers of men accessing testing and treatment services, a number of sessions addressed gender issues more generally. These included the satellite session on ‘Gender-based violence against women living with HIV: Implications for policy, legislation and programming’. During this session Dr Nono Simelela drew attention to the new national strategic plan to end gender-based violence currently being developed by the Gender Based Violence council, which she described as ‘finding its feet’. She commented that the process is currently struggling as the justice cluster is not delivering.
Referring to GBV levels in South Africa, Dr Simelela touched on the proliferation of young men attacking women in groups, urging the plenary to consider what steps can be taken to address young men’s behaviour and to explore the underlying drivers. She highlighted the need for services to be provided to men who need somewhere to turn to when they feel angry, noting that she has heard men comment in dialogues, ‘I know I get angry, I know I can be violent. I’ve got nowhere to go when I feel angry. My friends will just urge me on’. She concluded that men are looking to talk and that a space in which men can grapple with these issues is needed.
Dr Simelela highlighted Brothers For Life as the only campaign she is aware of that targets men and asserted the need for a broader movement that positions men as part of the solution; and allows men the opportunity to begin to address their relationship with anger and violence; explore alternative means of expressing themselves; and dealing with their emotions, challenges, vulnerabilities and frustrations in a healthy and non-violent way.
Ann Strode of Her Rights Initiative and AIDS Legal Network and UKZN echoed this by drawing attention to how little we discuss the challenges surrounding disclosure, ‘we encourage people to disclose but women often experience a range of negative effects’. Due to men’s low uptake of testing services, it is feasible that women are often forced to disclose their status first, having been tested first. Ms Strode said that women are thus often perceived as bringing HIV into the family, which we are not discussing or addressing. Similarly, we are not looking at men’s levels of disclosure, how men disclose or men’s roles in women’s disclosure.
Similar messages were highlighted by Rachel Jewkes of the Medical Research Council during a session on ‘Gender-based Violence and HIV’. She drew attention to the high levels of intimate partner violence in South Africa, adding that it was found the more sexual partners a man has, the more likely it is that he will be violent. She suggested that multi-level interventions are needed, in terms of society, the community, within relationships and on an individual level. For example, she said that interventions should include building relationship skills, as well as aiming to change constructions of masculinity and female acquiescence. She stressed that these are not isolated cases of individual behaviour but are patterns of behaviour, driven by gender norms that suggest how we ‘should’ behave and how we see ourselves in relation to the opposite sex. She emphasised that we need to concentrate our efforts where they will be most effective and we need to understand how processes such as biomedical interventions will not be effective if the context in which they are used is not addressed. She urged us to look at ourselves and assess the ways in which adults perpetuate social norms that influence young people. She concluded that we have to change social norms and the environment in order to enable people to make healthy choices.
During a session on ‘Behavioural Change Communication’ Jacqui Pienaar from an organisation in Howick called S’khokho Community Health shared interesting findings from a project they are running aimed at supplying condoms to communities in convenient locations, such as along pathways. They found this strategy to be highly effective, but female condoms were not popular and neither were the government provided Choice condoms. She reported that one woman said the visibility of the ‘condom trees’ made it easier for women to raise the topic of safe sex with their partner. In three months the project distributed 31 000 condoms. They also use the cans to advertise services such as medical circumcision. This discussion raised interesting questions around people’s perceptions and attitudes towards condom use and how little research has been conducted into what strategies would be most effective in terms of normalising condom usage.
In a satellite session on ‘Gender Issues’ a presentation on ‘Estimating the effectiveness of HIV communication on shifting social norms regarding women’s ability to negotiate safer sex’, Soul City’s regional One Love campaign, which was rolled out in eight countries in Southern Africa, reached the conclusion that further work targeting men is critical to bring about sustainable change.
SONKE had a poster display that captured the findings of an analysis of South Africa’s National Strategic Plans on HIV, comparing the 2007-2011 NSP with the current 2012-2016 NSP. The analysis of the former NSP underpinned Sonke’s submissions to SANAC during the development of the 2012-2016 NSP. The poster documented the progress made between 2006 and 2011 in terms of the level to which the NSPs engage with men and highlighted areas that can be strengthened further.
The conference was a great success and very well organised. As it closed, the atmosphere was one of positivity and enthusiasm. Prof. Mlisana called for increased efforts to achieve more, while acknowledging the need to CELEBRATE successes to date.