Global HIV/AIDS Politics, Policy, and Activism

Chapter 9 – Mobilizing Men and Boys in HIV Prevention and Treatment: The Sonke Gender Justice Experience in South Africa

Efforts to understand men’s health-seeking behaviour are poorly understood in the AIDS epidemic, and encouraging men to get tested and into treatment is a major challenge, but one that is poorly recognized. Addressing these issues effectively means moving beyond laying blame, and starting to develop interventions to encourage uptake of prevention, testing, and treatment for men — for everyone’s sake. While there has been an expectation of gender inequality that favors men, the evidence indicates that we are doing a disproportionately poor job of providing them with the medical assistance they need.

There is mounting evidence that men are at a distinct disadvantage in the roll-out of ART in sub-Saharan Africa. Disproportionately fewer men than women are accessing ART across Africa. Men are starting ART with more advanced HIV disease, men are more likely than women to die on ART, to interrupt treatment and to be lost to follow-up on ART. Despite this evidence of gender inequity in access to ART, most international and national ART-related policies and programmes in Africa are still blind to men.

Based in South Africa but working across Africa, Sonke has developed an innovative model to build government, civil society, and citizen capacity to effectively engage men for HIV prevention, treatment, and care—and to mobilize men as AIDS activists. The authors present this model and suggest that it is imperative to engage with men and engage systemically if advances are to be made in gender equality, HIV prevention, and the delivery of antiretroviral treatment.