Group Education Manual - Peace Corps Wiki

Engaging Men and Boys inGender Norm TransformationPEPFAR Gender Norms Initaitive to reduce thespread and impact of HIV and AIDSACQUIRE/EngenderHealth/Instituto PromundoTraining Manual Developed byEngenderHealth and Instituto Promundo forPeace Corps Staff Training of Trainers16-20 June 2008Maputo, Mozambique1

© 2008 The ACQUIRE Project/EngenderHealth and Promundo. All rights reserved.The ACQUIRE ProjectInstituto Promundoc/o EngenderHealth Rua México, 31/1502440 Ninth Avenue Rio De Janeiro - RJNew York, NY 10001 U.S.A. 20031-144Telephone: 212-561-8000BrazilFax: 212-561-8067 Phone/Fax: +55 (21) 2544-3114e-mail: info@acquireproject.orge-mail: promundo@promundo.org.brwww.acquireproject.orgwww.promundo.org.brThis publication was made possible by the generous support of the American people through the Office of Population andReproductive Health, U.S. Agency for International Development (USAID), under the terms of cooperative agreement GPO-A-00-03-00006-00. The contents are the responsibility of the ACQUIRE Project and do not necessarily reflect the views ofUSAID or the United States Government.2

Table of ContentsI. Introduction 31. Gender and Power1.1. Looking at our Attitudes 111.2. Learning about Gender 131.3. Act Like a Man 171.4. Persons and Things 212. Sexuality2.1. Understanding Sexuality 232.2. Want…Don’t Want…Want…Don’t Want 293. Men and Health3.1. Caring for Oneself: Men, Gender, and Health 334. Substance Use4.1. The Risks of Alcohol Abuse and HIV 374.2. Decision Making and Substance Use 425. Healthy Relationships5.1. Sexual Consent 446. STI and HIV Prevention6.1. Positive or Negative 466.2 Levels of HIV Risk 496.2. Taking Risks/Facing Risks 526.4 Multiple Sexual Partners, Cross-Generational Sex, and Transactional Sex 557. Living with HIV7.1. Positive Life 577.2. Men, Women, and Caregiving 618. Violence8.1. What is Violence? 668.2. Sexual Violence in the Daily Routine 719. Making Change, Taking Action9.1. Men’s Role in Health Promotion 739.2. New Kinds of Courage 759.3. Don’t Stand By, Take Action 779.4. Men Holding Men Accountable 8110. Introductory Activities – Community Engagement10.1. Why Work with Men, HIV, and AIDS? 8310.2. What does Community Engagement Mean to You 8511. Activities to Motivate Communities for Action3

11.1. Working with Theater Practitioners 8811.2. Working with Visual Artists 9211.3. Media Campaigns and Social Marketing 9411.4 Health Fairs on Gender and HIV 10411.5. Group Discussions 10611.6. Talk Shows 10811.7. Marches/Rallies Linked to Gender and HIV 11211.8. Reaching Men Through Sports 11411.9. Door Campaigns 11611.10. One-on-One Discussions/Peer Outreach 11711.11 Action Planning12. Engaging Men at the Service Delivery Level12.1. A Framework for Working with Men 12112.2. Getting Tested for HIV 126AcknowledgementsA number of individuals contributed to the creation of this manual. EngendeHealth staff members KentKlindera, Andrew Levack, and Manisha Mehta and Promundo staff members Christine Ricardo and FabioVerani wrote the manual. Many sections and activities were taken or adapted from the Program H WorkingWith Young Men Series produced by Promundo, ECOS, PAPAI, and Salud y Genero and the Men AsPartners: A Program for Supplementing the Training of Life Skill Educators, 2 nd Edition curriculumproduced by EngenderHealth.We would like to acknowledge Megan McKenna and Dulcy Israel, who edited the manual, and LimeBlue inSouth Africa for designing the manual.We also appreciate the assistance of Laura Skolnik, Sara Wilhemsen, and Patricia McDonald, who providedfeedback on the manual. Finally, we would like to thank all the participants who attended the group educationworkshops in Namibia and Ethiopia, where we pretested this manual.The U.S. President's Emergency Plan for AIDS Relief through the interagency Gender Technical WorkingGroup’s Male Norms Initiative led to the development of this package.For more information, contact:Manisha MehtaChristine RicardoTeam Leader, Gender InitiativeCoordinator, Gender and Health ProgramEngenderHealthPromundo440 Ninth Avenue Rua México, 31/1502New York, NY, 10001 U.S.A Rio De Janeiro – RJ, 20031-144212-561-8394 +55 (21) 2544-3114Email: mmehta@engenderhealth.orgc.ricardo@promundo.org.br4

contribute to, and benefit from, all spheres of society (economic, political, social, cultural). In this way, genderequity leads to gender equality. For example, an affirmative action policy that promotes increased support tofemale-owned businesses can be considered gender equitable because it leads to ensuring equal rightsbetween men and women.(2) Gender Specificity: Looking at the specific needs that men have in terms of their health and developmentbecause of the way they are socialized. This means, for example, engaging men in discussions aboutsubstance use or risky behavior and helping them understand why they may feel pressured to behave in thoseways.This manual attempts to incorporate these two perspectives. 4Men and HIV/AIDSWorldwide, the behavior of many adult and adolescent men puts them and their partners at risk for HIV. Onaverage, men have more sexual partners than women. HIV is more easily transmitted sexually from man towoman than from woman to man. An HIV-infected man is likely to infect more persons than an HIVinfectedwoman. Engaging men more extensively in HIV prevention has a tremendous potential to reducewomen’s risk for HIV.In many other parts of the world, it is young and adult men who largely control when and under whatcircumstances sex will take place and whether a contraceptive method will be used. For many men worldwide,sexual experience is frequently associated with initiation into manhood. 5 Men may experience peer pressure tobe sexually active and have multiple partners in order to prove that they are manly, which increases their riskof exposure to HIV. Recent data indicate that new HIV infections in high-prevalence countries often occuras a result of concurrent or overlapping sexual partnerships. 6 Research has shown that in both urban andrural areas, young men who choose to abstain may suffer ridicule from their peers. 7,8 Accordingly, low levelsof consistent condom use among sexually active men are associated with a variety of factors, including lowself-risk perception, lack of, or limited access to, condoms, and the belief that unprotected sex is morepleasurable and that pregnancy is proof of masculinity and fertility.It is also important to address men’s use of violence and coercion in sexual relationships and its associationwith gender norms and risk behaviors. Research has shown that some men may consider the use of violenceagainst women to be an extension of male authority in the private realm and an acceptable means of controlor discipline, particularly in married and long-term relationships. 9,10 Moreover, research has shown that manymen may hold narrow views of what can be defined as “forced sex.” That is, they may believe that onlycoerced intercourse would be categorized as forced sex, and that it is acceptable to use physical violence orgifts to “persuade” partners to have sex. 11 All forms of violence and coercion, however, reinforce unequal4 In this manual, for the sake of brevity, when referring to work with men, we are including all work with boys, young men, and adultmen.5 Wight, D., et al. 2005. Contradictory sexual norms and expectations for young people in rural Northern Tanzania. Social Science &Medicine 62: 987–997.6 Hayes, R. et H. Weiss. 2006. Understanding HIV epidemic trends in Africa. Science Feb3:311(5761):620-17.7 Ijumba, A., et al. 2006. Developing community-based behavior change communications (BCC) interventions for youth: a participatory assessment inIringa region, Tanzania. Arlington, VA: Family Health International.8 Wight, D., et al. 2005. Contradictory sexual norms and expectations for young people in rural Northern Tanzania. Social Science &Medicine 62:987-97.9 Heidi, L., et al. 2004. Exploring the association between HIV and violence: young people’s experiences with infidelity, violence andforced sex in Dar es Salaam, Tanzania. International Family Planning Perspectives 30(4):200–206.10 Barker, G. and Ricardo, C. 2005. Young men and the construction of masculinity in Sub-Saharan Africa: implications for HIV/AIDS, conflict andviolence. Washington, DC: World Bank.11 Heidi, L., et al. 2004. Exploring the association between HIV and violence: young people’s experiences with infidelity, violence, andforced sex in Dar es Salaam, Tanzania. International Family Planning Perspectives 30(4):200–206.6

power dynamics in relationships and limit the likelihood that a couple will negotiate preventive behaviors,such as abstinence or condom use.In many settings, only a small number of men participate in HIV services (voluntary, counseling and testing,anti-retroviral treatment or preventing mother to child transmission). This is due to a variety of reasons,including limited access to health services and the common perceptions among men that clinics are “female”spaces and that “real men” do not get sick or do not participate in health care. Gender norms also place adisproportionate burden of HIV and AIDS-related care on women. Men generally do not participate as fullyas women do in caring for children or for family members with AIDS. A review of studies worldwideconcludes that fathers contribute about one-third as much time as mothers in direct child care. 12 Studies fromthe Dominican Republic and Mexico find that married women with HIV often return to their parents’ homebecause they are unlikely to receive adequate care from their husbands. 13Men and Reproductive HealthIn the socialization of men, reproduction is not considered as important as sexuality. A good example is theimportance attached to menarche, the initiation of menstruation, versus semenarche—the first maleejaculation. Generally speaking, there is a lack of communication between mothers and daughters about thetransformation of girls´ bodies and their fertility. The silence, however, is often even greater between fathersand their sons on the subject of semenarche. A few studies have shown that boys react to the semenarcheexperience with surprise, confusion, curiosity, and pleasure. Some boys are unaware of what seminal liquid isand think it is urine. It is important, therefore, that boys receive guidance during puberty, so that they can feelmore secure in dealing with body changes, and understand their bodies as being reproductive. Even aftersemenarche, most young and adult men deal with their sexuality as if fertility did not exist. In many settings,contraception is considered to be a “woman’s concern,” and although condoms are often the best choice formale contraceptives, serving both to protect against STIs and as contraception, many men feel insecure usinga condom, fearing they will lose their erection. With increasing awareness of HIV/AIDS, malecondom useamong men has increased in many settings, but continues to be inconsistent. The female condom, anotheroption for HIV prevention and pregnancy prevention, has also been introduced to a limited extent in manysettings and has been tested and adopted in various countries.Increasingly, health educators are focusing on dual protection,that is, emphasizing that condoms are suitablefor avoiding unintended pregnancy and for preventing STIs. Furthermore, most sex education programshave also seen the importance of promoting condom use within sexual games, as part of foreplay, andgenerally presenting condoms as an erotic and seductive stimulus in the sexual relationship. While the frankdiscussion of condom use has been hindered in some countries, increased condom use has been key incountries that have been able to reduce rates of HIV transmission. Promoting increased use of contraceptionby men is essential, but not enough. To become more involved in contraceptive use, men should also besensitized to their role as procreative or reproductive individuals, who, along with the partner, should decideif, when, and how to have children.Moving Into ActionThis manual highlights the importance of linking education activities to action. It introduces the EcologicalModel. 14 This model allows participants to take the knowledge and skills gained in a workshop session andput it into action by examining the various levels where change take place.. It is important to start withindivudals, but too often when indivudals leave a workshop transformed, they are thrown right back into their‘gender box’ when they return home to their family or community.The Ecological Model12 Bruce, J., et al. 1995. Families in focus: new perspectives on mothers, fathers and children. New York: Population Council.13 Rivers, K. & Aggleton, P. 1998. Men and the HIV epidemic, gender and the HIV epidemic. New York: UNDP HIV and DevelopmentProgram.7

Introduction tothe EcologicalModelThe Ecological Model provides a conceptual framework for a more comprehensiveapproach to working with men.not clear on definition—conceptual framework is alittle vague The model emphasizes that to change individual behavior, programsneed to not only work with individuals, but to also address the systems and groups—peers, families, communities, media, policies—that influence individuals. Thismodel encourages men and mixed-gender groups to think about the:• Changes that are needed across all sectors of society• Range of different strategies across different levels of action that will berequired to bring about these change• Roles of different social actors during such changesThe Ecological Model underlines the different levels of action that are required tomake changes in sexual and reproductive health, gender equality, and violence.These levels are:The Levels of 1. StrengtheningModel 14 Knowledge and Skillsthe Ecological Individual2. Creating SupportivePeer and FamilyStructures3. Educating HealthService Providers4. MobilizingCommunityMembers5. ChangingOrganizationalPractices6. Influencing PolicyLegislation at theSocietal LevelHelping men to understand how gender and socialnorms can put them, their partners, and families atrisk and how to promote alternate, healthierbehaviorsEducating peers and family members about healthrisks and ways they can support individuals to takeactions that promote health and safetyEducating providers about male involvement so theycan transmit skills and knowledge to others.Teaching providers to encourage and support (forconsistency—since there are no full sentenceselsewhere here) men to seek healthcare and supporttheir partners’ access to health information andservices.Educating community members and groups abouthealth risks and ways they can support individuals totake actions that promote health and safety.Mobilizing groups and individuals to developcoherent strategies for promoting constructive maleinvolvementAdopting policies, procedures, and organizationalpractices that support efforts to increase men’sinvolvementDeveloping strategies to change laws and policies toinfluence outcomesWorking acrosslevelsWhen using the Ecological Model, it is important to pay attention to the linksbetween the different levels. In other words, no level should be seen as independentof another. In this way, it becomes clear that policy work affects, and is affected by,14 These have been adapted for work related to engaging men in sexual and reproductive health, HIV prevention, care and support,and violence prevention.8

Information tobe recordedExamplecommunity education. This, in turn, affects and impacts the ways individuals in agiven community regard a particular issue.For each level, the model can help participants to identify:• WHAT actions to take• WHO should take this action• HOW the success of this action should be assessed. This final column isused to keep a record of group suggestions for indicators of success.These indicators answer the question: How will we know if actions are successful?If you want to use the Ecological Model in action planning, create the followingflipchart (see example below) or create a handout of the Model and pass it out toparticipants. Remember that you will probably need more than one sheet orhandout during a workshop. If a particular training activity helps participants thinkabout ways that they can engage men more in the work they do, ask them to use theEcological Model to jot down those ideas. They can write them down in the chartaccording to the different levels of the Ecological Model. This will be useful forthem as they develop their action plans after the training.The Ecological Model1. StrengtheningIndividualKnowledge andSkills2. CreatingSupportive Peerand FamilyStructures3. EducatingHealth ServiceProviders4. MobilizingCommunityMembers5. ChangingOrganizationalPractices6. InfluencingPolicyLegislation atthe SocietalLevelWHATActionWHOPerson or organizationGuiding Principals9

EngenderHealth is an international reproductive health organization based in New York City. Through itsMen As Partners (MAP) Program, it has integrated male involvement approaches and engaged men since1996. Its groundbreaking program works with men to play constructive roles in promoting gender equity andhealth in their families and communities. EngenderHealth works with individuals, communities, health careproviders, and national health systems to enhance men’s awareness and support for their partners’reproductive health choices; increase men’s access to comprehensive reproductive health services; andmobilize men to actively take a stand for gender equity and against gender-based violence. To date,EngenderHealth has developed Men As Partners programs in over 15 countries in Africa, Asia, and LatinAmerica, and in the United States.Promundo is a Brazilian non-governmental organization based in Rio de Janeiro. Since 2000, Promundo hasled a global network of NGO and UN partners in developing, testing, implementing, and evaluating a set ofinterventions to promote gender equality—first focusing on young men (Program H – H for hombres andhomens, the words for men in Spanish and Portuguese) and subsequently, incorporating work with youngwomen (Program M - M for mujeres and mulheres, the words for women in Spanish and Portuguese). TheProgram H initiative, which consists of group educational activities to engage young men and adult men ingender equality, community campaigns, staff training, and an impact evaluation model, is now beingimplemented in more than 20 countries in Latin America, Asia, and sub-Saharan Africa.Promundo and EngenderHealth’s work with men recognizes that current gender roles often give men theability to influence or determine reproductive health choices made by women. Current gender roles alsocompromise men’s health by encouraging them to equate a range of risky behaviors with being “manly,”while encouraging them to view health-seeking behavior as a sign of weakness.However, we take a positive approach in working with men because we believe that men have a personalinvestment in challenging the current order, and can be allies in the improvement of their own health, and thehealth of the women and children who are so often placed at risk by these gender roles. We recognize thatmen, even those who are sometimes violent or do not show respect toward their partners, have the potentialto be respectful and caring partners, to negotiate in their relationships with dialogue and respect, to shareresponsibilities for reproductive health, HIV prevention and care, and to interact and live in peace andcoexistence instead of with violence.10

Chapter 1 - Gender and PowerObjectives1.1 Looking At Our Attitudes1. To explore attitudes about gender differences, roles, and inequalitiesAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Any level; Resources:Low45 minutesMaterials • Four signs (“Strongly Agree,” “Strongly Disagree,” “Agree,” and “Disagree”)• MarkersAdvancedpreparation• TapeBefore the activity begins, place the four signs around the room. Leave enough spacebetween them to allow a group of participants to stand near each one. Review thestatements provided below. Choose five or six that you think will help the discussionmost.Statements• It is easier to be a man than a woman.• When a woman is pregnant, preventing HIV to her child is her responsibilitysince she carries the child• A man is more of a “man” if he has many sexual partners.• Sex is more important to men than to women.• It is okay for a man to have sex outside of relationship, if his partner doesnot know about it.• A woman who carries a condom in her purse is “easy.”• Men are more intelligent than women.• Women who wear revealing clothing are asking to be raped.• Homosexuality is natural and normal.Facilitator’snotesIf all the participants agree about any of the statements, play the role of “devil’sadvocate” by walking over to the opposite side of the room and asking, “Why wouldsomeone be standing on this side of the room?” (i.e., what values would they havethat would put them here?).Some participants may say that they don’t know whether they agree or disagree anddon’t want to stand beside any of the four signs. If this happens, ask theseparticipants to say more about their reactions to the statement. Then encourage themto choose a sign to stand beside. If they still don’t want to, let these participants standin the middle of the room as a “don’t know” group.Steps 1. Explain to the participants that this activity is designed to give thema general understanding of their own and each other’s values and attitudesabout gender. It is designed to challenge some of their current thinking aboutgender issues and help them clarify how they feel about certain issues.Remind the participants that everyone has a right to his or her own opinion,and everyone’s opinions should be respected.11

Objectives1.2 Learning About Gender1. To understand the difference between the terms “sex” and “gender.”2. To understand the terms “gender equity” and “gender equality.”Audience Age : Youth or adults; Sex : Men or mixed groups; Literacy : Low; Resources :MediumTime45 to 60 minutesMaterials • Flipchart• Marker• Tape• Enough copies of Handout 1: The Gender Game for all participants• Resource Sheet 1: Answers to the Gender GameSteps 1. Explain that this session will help clarify some of the terminology that we will beusing in the workshop. It will also help us understand what these terms mean inour own lives.2. Ask participants if they can explain the difference between “sex” and “gender.”After getting feedback from the group, provide the following definitions:• Sex refers to physiological attributes that identify a person as male orfemale• Gender refers to widely shared ideas and expectations concerningwomen and men. These include ideas about typically feminine/female andmasculine/male characteristics and abilities, and commonly sharedexpectations about how women and men should behave in various situations.3. Distribute the handout and ask the participants to indicate if the statements arereferring to “sex” or “gender.” After giving the participants a chance to read andanswer the statements on their own, discuss each of the answers with the entiregroup.4. Explain that there are several terms related to the word “gender” that also need tobe explained. Ask the group if they have ever heard the term “gender equality.”Ask them what they think it means. Allow plenty of time for discussion.5. After getting their feedback provide the following definition:• Gender Equality means that men and women enjoy the same status.They share the same opportunities for realizing their human rights andpotential to contribute and benefit from all spheres of society (economic,political, social, cultural).6. Ask the group if the definition makes sense. Allow them to ask questions aboutit.7. Ask the group to discuss whether or not gender equality actually exists in their13

country. As the group discusses this, write down any statements that explain whywomen do not share equal status with men in all spheres of society. Be sure toinclude some of the following points if they are not mentioned by the group:• Women in many countries are more likely than men to experiencesexual and domestic violence.• Men are paid more than women for the same work (in most cases).• Men are in more positions of power within the business sector.• Women bear the brunt of the AIDS epidemic, both in terms of totalinfections and in care and support for those living with HIV.8. Ask the group if they have ever heard the term “gender equity.” Ask them whatthey think it means and how it is different from gender equality. Allow plenty oftime for discussion. After getting their feedback provide the following definition:9. Gender Equity is the process of being fair to men and women. Gender equityleads to gender equality. For example, an affirmative action policy that promotesincreased support to female-owned businesses may be gender equitable because itleads to ensuring equal rights among men and women. After clarifying thedefinitions of gender equality and gender equity, ask the group the followingquestions:? Why should men work towards achieving gender equality?? What benefits does gender equality bring to men’s lives?? How does gender inequity contribute to HIV infection?? How can gender equity contribute to preventing HIV?Closing10. Ask the group to identify gender-equitable actions that men can take to helpcreate gender equality.A major goal of a ME program is to encourage communities to be moregender sensitive, so that men and women can live healthier and happier lives, andto prevent HIV infection. To achieve this, we must encourage gender-equitablebehaviors such as men and women making joint decisions about their health, menrespecting a woman’s right to say no to sex, men and women settling differenceswithout violence, and men and women sharing responsibility for parenting andcare for others.14

Handout 1A: The Gender GameThe Gender Game:Identify if the statement refers to gender or sexGenderSex1. Women give birth to babies, men don’t.2. Girls should be gentle, boys should be tough.3. Globally, women or girls are the primary caregivers for those sick withAIDS-related illnesses in more than two-thirds of households.4. Women can breastfeed babies, men can bottle feed babies.5. Many women do not make decisions with freedom, especiallyregarding sexuality and couple relationships.6. The number of women with HIV (human immunodeficiency virus)infection and AIDS (acquired immunodeficiency syndrome) hasincreased steadily worldwide.7. Four-fifths of all the world’s injecting drug users are men.8. Women get paid less than men for doing the same work.15

Resource Sheet : Answers to the Gender GameThe Gender Game:1. Sex2. Gender3. Gender4. Sex5. Gender6. Sex and Gender7. Gender8. Gender16

1.3 Act Like a ManObjectives 1. To identity the differences between rules of behavior for men and for women2. To understand how these gender rules affect the lives of women and menAudienceTimeAge: Youth or adults; Sex: Mixed groups; Literacy: Any level; Resources: Low45 to 60 minutesMaterials • Flipchart• Markers• Tape• Resource Sheet 2: Example of Flipcharts for Act Like a Man/Act Like aFacilitator’snotesWomanThis activity is a good way to understand perceptions of gender norms. Rememberthat these perceptions may also be affected by class, race, ethnicity, and otherdifferences.It is also important to remember that gender norms are changing in many countries.It is getting easier, in some places, for men and women to step outside of their“boxes.” If there is time, discuss with the group what makes it easier in some placesfor women and men to step outside of the box.Steps 1. Ask the male participants if they have ever been told to “act like a man.” Askthem to share some experiences of someone saying this or something similar tothem. Ask: “Why do you think they said this?” “How did it make you feel?”2. Now ask the female participants if they have ever been told to “act like awoman.” Ask them to share some experiences of someone saying this orsomething similar. Ask: “Why do you think they said this?” “How did it makeyou feel?”3. Tell the participants that you want to look more closely at these two phrases.Explain that by looking at them, we can begin to see how society creates verydifferent rules for how men and women are supposed to behave. Explain thatthese rules are sometimes called “gender norms” because they define what is“normal” for men and womeb to think, feel, and act. Explain that these rulesrestrict the lives of both women and men by keeping men in their “act like aman” box and women in their “act like a woman” box.4. In large letters, print on one sheet of flipchart paper the phrase “Act Like a Man.”Ask participants what men are told in their community about how they shouldbehave. Write these on the sheet. Check the (what examples?) examples to seethe kinds of messages that are often listed and introduce them into the discussionif they have not been mentioned.5. When the group has no more to add to the list, ask the discussion questions listedbelow.17

? Which of these messages can be potentially harmful? Why? (Place a star next toeach message and discuss one by one.)? How does living in the box impact a man’s health and the health of others,especially in relation to HIV/AIDS?? How does living in the box limit men’s lives and the lives of those around them?? What happens to men who try not to follow the gender rules (e.g. “living outsidethe box”)? What do people say about them? How are they treated?? How can “living outside the box” help men to positively address HIV and AIDS?6. Print on another sheet of flipchart paper the phrase “Act Like a Woman.” Askparticipants what women are told in their community about how they shouldbehave. Write these messages on the sheet.• Check the examples to see the kinds of messages that are often listed. Feedthese in to the discussion if they have not been mentioned.7. When the group has no more to add to the list, ask the discussion questions listedbelow.? Which of these messages can be potentially harmful? Why? (Place a star next toeach message and discuss one by one)? How does living in the box impact a woman’s health and the health of others,including in relation to HIV/AIDS?? How does living in the box limit women’s lives and the lives of those aroundthem?? What happens to women who try not to follow the gender rules? What do peoplesay about them? How are they treated?? How can “living outside the box” help women to positively address HIV andAIDS?8. Next, draw another table that has both a column for men and women. Label it“Transformed Men/Women.” Ask the participants to list characteristics of menwho are “living outside the box.” Record their answers. Once you get seven orso responses, ask the same about women who are “living outside the box.” Helpthe participants recognize that, in the end, characteristics of gender equitable menand women are actually similar.9. Ask participants the following questions:Closing? Are your perceptions about the roles of men and women affected by what yourfamily and friends think? How?? Does the media have an effect on gender norms? If so, in what way(s)? How doesthe media portray women? How does the media portray men?? How can you, in your own lives, challenge some of the nonequitable ways menare expected to act? How can you challenge some of the nonequitable ways thatwomen are expected to act?Throughout their lives, men and women receive messages from family, media,18

TrainingOptionsand society about how they should act as men and how they should relate towomen and to other men. As we have seen, many of these differences areconstructed by society and are not part of our nature or biological make-up.Many of these expectations are completely fine, and help us enjoy ouridentities as either a man or a woman. However, we all have the ability toidentify unhealthy messages as well as the right to keep them from limitingour full potential as human beings. As we become more aware of how somegender stereotypes can negatively impact our lives and communities, we canthink constructively about how to challenge them and promote more positivegender roles and relations in our lives and communities. Therefore, we are allfree to create our own gender boxes and how we choose to live our lives asmen and women.The following additions can be added to the session, but will require more time.• Role play to begin session:Divide the participants into three small groups and ask them to develop a short skit(one or two minutes) that portrays someone telling another person to “act like a man”or “act like a woman.”19

Resource Sheet: Example of Flipcharts for Act Like a Man/WomanExample FlipchartsAct Like a ManAct Like a Woman• Be tough• Do not cry• Be the breadwinner• Stay in control and do not back down• Have sex when you want it• Have sex with many partners• Get sexual pleasure from women• Produce children• Get married• Take risks• Don’t ask for help• Use violence to resolve conflicts• Drink• Smoke• Ignore pain• Don’t talk about problems• Be brave• Be courageous• Make decisions for othersTransformed Men• Be loving• Act caring• Be an assertive communicator• Express emotions constructively andwhen appropriate• Remain faithful to one partner• Get tested for HIV regularly• Use condoms regularly• Delay sexual activities until bothpartners are ready• Speak out in favor of gender equality• Challenge others to recognize theirharmful gender norms and changethemselves• Be passive and quiet• Be the caretaker and homemaker• Act sexy, but not too sexy• Be smart, but not too smart• Follow men’s lead• Keep your man, provide him with sexualpleasure• Don’t complain• Don’t discuss sex• Get married• Produce children• Be pretty• Be seen, not heardTransformed Women• Be loving• Act caring• Be an assertive communicator• Express emotions constructively andwhen appropriate• Remain faithful to one partner• Get tested for HIV regularly• Use condoms regularly• Delay sexual activities until both partnersare ready• Speak out in favor of gender equality• Challenge others to recognize theirharmful gender norms and changethemselves20

ObjectivesAudience1.4 Persons and ThingsTimeMaterialsFacilitator’snotesSteps1. To increase awareness about the existence of power in relationships and itsimpact on individuals and relationshipsAge: Youth or adults; Sex: Men or mixed groups; Literacy: Any level;Resources: Low45 to 60 minutesNoneSome of the participants might not feel comfortable with the role play in thisactivity. It is important to be sensitive to how participants react to being assignedthe role of “persons” or “things” and to be prepared to make the necessaryaccommodations. For example, rather than have the participants actually carryout the role play, the facilitator might invite the participants to discuss in pairshow “persons” might treat “things” and the feelings that this might generate forthe “persons” and “things.” The facilitator should also be prepared to makereferrals to counseling or other services for those participants who might beespecially affected by the activity.1. Divide the participants into three groups. Each group should have the samenumber of participants. (Note: If the number of participants does not allowfor an even distribution, assign the “extra” participants to the third groupwhich, as described below, will be the observers.)2. Tell the participants that the name of this activity is: Persons and Things.Choose, at random, one group to be the “things,” another to be “persons,”and a third to be “observers.”3. Read the following directions to the group:a) THINGS: You cannot think, feel, or make decisions. You have to do whatthe “persons” tell you to do. If you want to move or do something, you haveto ask the person for permission.b) PERSONS: You can think, feel, and make decisions. Furthermore, youcan tell the objects what to do.c) OBSERVERS: You just observe everything that happens in silence.4. Assign each “person” a “thing” and tell them that they can do what they wantwith them (within the space of the room).5. Give the group five minutes for the “people” and “things” to carry out theirdesignated roles.6. After five minutes, tell the persons and things that they will switch and thatnow the “persons” will be “things” and “things” will be ”persons.” Give themanother five minutes to carry out the new roles.7. Finally, ask the groups to go back to their places in the room and use thequestions below to facilitate a discussion.? How did your “persons” treat you? What did you feel? Did you feelpowerless? Why or why not?? How did you treat your “things”? How did it feel to treat someone this way?Did it make you feel powerful? Why or why not?? Why did the “things” obey the instructions given by the “persons”?? Were there “things” or “persons” who resisted the exercise?21

Closing? In your daily lives, do others treat you like “things”? Who? Why?? In your daily lives, do you treat others like “things”? Who? Why?? For the “observers”: How did you feel not doing anything? Did you feel likeinterfering with what was happening? If yes, what do you think you couldhave done?? In our daily lives, are we “observers” of situations in which some peopletreat others like things? Do we interfere? Why or why not?? If you had been given a chance to choose between the three groups, whichwould you have chosen to be in and why?? Why do people treat each other like this?? What are the consequences of a relationship where one person might treatanother person like a “thing?”? How would being treated like a “thing” impact a person’s vulnerability toHIV?? In your communities, do men most often belong to one of these threegroups? Which group? Do women most often belong to one of these threegroups? Which group? Why do you think this is?? How does society/culture perpetuate or support these kinds ofrelationships?? What can we do to make sure that different groups such as men and womenlive in an equitable world where they can enjoy the same opportunities, equaltreatment, and equal rights?There are many types of relationships in which one person might have morepower over another. As you will discuss throughout many of the activities in thismanual, the unequal power balances between men and women in intimaterelationships can have serious repercussions for the risk for STIs, HIV/AIDS,and unplanned pregnancy. For example, a woman often does not have the powerto say if, when, and how sex takes place, including whether a condom is used,because of longstanding beliefs that men should be active in sexual matters andwomen should be passive (or that women “owe” sex to men). In other cases, awoman who is dependent on a male partner for financial support might feel thatshe does not have the power to say no to sex. In cases of cross-generational sex,the age and class differences between men and women can further create unequalpower relations that can lead to risk situations. There are other examples ofpower relationships in ourlives and communities. Think of relationships betweenyouth and adults, students and teachers, employees and bosses. Sometimes thepower imbalances in these relationships can lead one person to treat anotherperson like an object. As you discuss gender and relationships between men andwomen, it is important to remember the connection between how you might feeloppressed, or treated like “objects,” in some of your relationships and how you,in turn, might treat others, including women, like “objects.” Thinking about theseconnections can help motivate you to construct more equitable relationships withwomen in your homes and communities.22

Chapter 2 - Sexuality2.1 Understanding SexualityObjectives1. To discuss human sexuality in a holistic and comprehensive way2. To provide a framework for further discussions on sexuality and HIVAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:Medium60 minutesMaterials • Flipchart• Markers• Tape• Enough copies of Handouts 2: Definitions and Questions for Small GroupDiscussions about Sexuality and Handout 3: Definitions for Circles ofSexuality for all participantsAdvancepreparation• Resource Sheet 3: The Circles of SexualityPrepare a flipchart with the circles of sexuality as illustrated in Resource Sheet 3: TheCircles of Sexuality.Steps 1. Explain that this session will explore the concept of “sexuality.” Askparticipants to share what they think sexuality means to them.2. Explain that there are many long and complicated definitions of sexuality, butthat they are often confusing. Tell them we like to simplify the definition , bythinking of sexuality as comprising several circles (see Resource Sheet 3: TheCircles of Sexuality).3. Draw the diagram by referring to Resource Sheet 3: The Circles of Sexuality.When drawing the circles, label each, but do not add the information shaded ingrey in Resource Sheet 3. Each circle represents one of the elements ofsexuality. When all of the circles are placed together, they encompass the totaldefinition of sexuality. Explain that one of the shapes is different and is notlinked to the others (Sexuality to Control Others) because it is a negativeelement of sexuality, even if it exists in many situations.4. Divide the participants into four groups. Explain that each will take on a circleof sexuality and explore what they think it means (the Sexual Identity circlewill be explained by the facilitator). Assign a circle to each group and ask themto describe what the circle entails using flipchart paper and markers. Pass outHandout 2: Definitions and Questions for Small Group Discussions aboutSexuality and tell them to refer to the guiding questions related to their circleto help them with this activity.23

5. Ask each group to present their four circles then explain the Circle of SexualIdentity. Once this has been done, pass out Handout 3: Definitions for Circles ofSexuality. Make sure the key points of each circle are covered by referring toHandout 3.6. After all of the circles are presented, conclude the activity with the followingdiscussion questions:? Is it easy to talk about sexuality? Why or why not?? Are the challenges of talking about sexuality different for men and women? Why?What makes it hard for men to talk about this? What makes it hard for women?? What would make it easier for men and women to talk about sexuality?? Where is “sexual intercourse” included within the definition of sexuality? Doesthe term play a large or small role in the definition of sexuality?? What are some similarities in how men and women experience sexuality?? What are some differences? Why do you think these differences exist?? What have you learned from this exercise? How can you apply this in your ownlives and relationships?ClosingSexuality is an important component of human life and while the sexual act forreproduction is similar for nearly all living creatures, only humans attribute values,customs, and meanings to sexuality that go beyond procreation. Sexuality alsoincludes how we feel about our bodies, how we give and receive pleasure, and howwe express romantic feelings, among other things. Unfortunately, in many cultures,men and women receive different messages about sexuality. Men’s sexuality is seen asimpulsive and uncontrollable while women’s sexuality is seen as passive andcontrollable. These contrasting messages often have negative implications for howmen and women relate to each other in intimate and sexual relationships. It istherefore important that both men and women have opportunities to comfortablytalk about sexuality and develop skills to communicate about sexuality with partners.24

Handout 2A: Definitions and Questions for Small Group Discussions About SexualitySensuality – Sensuality is how our bodies get and give pleasure.• What senses do our bodies use to get and give pleasure?• What types of activities involve pleasure?Intimacy/relationships – Intimacy is the part of sexuality that deals with relationships.• What is needed for a healthy relationship?• Where do we learn how to love and care for a person?Sexual health – Sexual health involves our behavior related to producing children, enjoying sexualbehaviors, and maintaining our sexual and reproductive organs.• What sexual health issues do men and women face?Sexuality to control others – Unfortunately, many people use sexuality to violate someone else or to getsomething from another person.• How do people try to use sex to control other people?• How do the media try to use sex to control others?25

Handout 2B: The Five Circles of SexualitySensualityHow our bodies give andreceive pleasure.Involves all of the senses(touch, sight, smell, taste,sound).Explains our need to betouched. Includes our abilityto fantasize.Sexual Health Ourbehavior related toreproduction and our sexualorgans(e.g.., STIs, pregnancy)Relationships/IntimacyOur ability to love, trust, and carefor othersSexual IdentityIncludes fourelements1. Biological Sex: is based on ourphysical status of being either maleor female2. Gender Identity: How we feelabout being male or female3. Gender Roles: Society’sexpectations of us based on oursex4. Sexual Orientation: the sex towhich we are attracted to sexuallySexuality to ControlOthers Using sex toviolate someone’s rightsor get something fromanother(e.g.. advertisements,rape)26

Handout 2C: Definitions for Circles of SexualitySensuality – Sensuality is how our bodies derive pleasure. It is the part of our body that deals with thefive senses: touch, sight, hearing, smell, and taste. Any of these senses, when enjoyed, can be sensual. Askthe participants to provide examples of how a person might enjoy each of the five senses in a sensualmanner. The sexual response cycle is also part of our sensuality because it is the mechanism that enablesus to enjoy and respond to sexual pleasure.Our body image is part of our sensuality. Whether we feel attractive and proud of our bodies influencesmany aspects of our lives.Our need to be touched and held by others in loving and caring ways is called skin hunger. Adolescentstypically receive less touch from family members than do young children. Therefore, many teens satisfytheir skin hunger through close physical contact with a peer. Sexual intercourse may result from a teen’sneed to be held, rather than from sexual desire. Fantasy is part of sensuality. Our brain gives us thecapacity to fantasize about sexual behaviors and experiences, without having to act upon them.Intimacy/relationships – Intimacy is the part of sexuality that deals with relationships. Our ability tolove, trust, and care for others is based on our levels of intimacy. We learn about intimacy fromrelationships around us, particularly those within our families.Emotional risk-taking is part of intimacy. In order to experience true intimacy with others, a person mustopen up and share feelings and personal information. We take a risk when we do this, but intimacy is notpossible otherwise.Sexual identity – Every individual has his or her own personal sexual identity. This can be divided intofour main elements:Biological sex is based on our physical status of being either male or female.Gender identity is how we feel about being male or female. Gender identity starts to form at around agetwo, when a little boy or girl realizes that he or she is different from the opposite sex. If a person feels likehe or she identifies with the opposite biological sex, he or she often considers himself or herselftransgender. In the most extreme cases, a transgender person will have an operation to change his or herbiological sex (often called gender “re-assignment” surgery) so that it can correspond to his or her genderidentity.Gender roles are society’s expectations of us based on our biological sex. Ask the group to think about whatbehaviors we expect of men and what behaviors we expect of women. These expectations are genderroles.Sexual orientation is the final element of sexual identity. Sexual orientation refers to the biological sex thatwe are attracted to romantically. Our orientation can be heterosexual (attracted to the opposite sex),bisexual (attracted to both sexes), or homosexual (attracted to the same sex). People often confuse sexualorientation and gender roles. For example, if a man is feminine or a woman is masculine, people oftenassume that these individuals are homosexual. Actually, they are expressing different gender roles. Theirmasculine or feminine behavior has nothing to do with their sexual orientation. A gay man may befeminine, masculine, or neither. The same applies to heterosexual men. Also, a person may engage insame-sex behavior and not consider himself or herself homosexual. For example, men in prison mayhave sex with other men but may consider themselves heterosexual.Sexual health – Sexual health involves our behaviour related to producing children, enjoying sexualactivities, and maintaining our sexual and reproductive organs. Issues like sexual intercourse, pregnancy,27

and sexually transmitted infections (STIs) are part of our sexual health. Ask the group to identify as manyaspects of sexual health as possible.After discussing the four circles of sexuality, draw a fifth circle that is disconnected from the other four.This circle is a negative aspect of sexuality and can inhibit an individual from living a sexually healthy life.You can say that the circle can “cast a shadow” on the other four circles of sexuality. It is described asfollows:Sexuality to control others – This element is not a healthy one. Unfortunately, many people usesexuality to violate someone else or get something from another person. Rape is a clear example of sexbeing used to control somebody else. Sexual abuse and forced prostitution are others. Even advertisingoften sends messages of sex in order to get people to buy products.28

2.2 Want…Don’t Want…Want…Don’t WantObjectives1. To discuss a variety of reasons why individuals choose to have or to not have sex2. To discuss the challenges and strategies related to negotiating abstinence or sex inintimate relationshipsAudienceTimeAge: Youth or adults; Sex: Men (with adaptation) or mixed groups; Literacy: AnyLevel; Resources: MediumOne hour and 30 minutesMaterials • Flipchart• MarkersFacilitator’snotes• Resource Sheet 4: Why Men and Women Want to Have SexDuring this activity, some men may be asked to role-play women. This is not alwayseasy for men, and it should be presented as optional (one alternative is to involve themen in a debate based on the scenarios presented, rather than in role-play.). It islikely some men will laugh during the role-playing exercise. It is important tounderstand that some of this laughter might be due to the awkwardness, ordiscomfort men may feel playing the role of women, or seeing other men play therole of women. The facilitator should be sensitive to these responses, and whenappropriate, remind the participants of earlier discussions about gender roles. Thefacilitator should also encourage the men to reflect on why they might respond incertain ways when they see men taking on traditional female roles or characteristics.If the facilitator feels it is more relevant, this activity can be adapted so that thegroup role-plays the negotiation of condom use in an intimate relationship (as aform of preventing STIs and HIV and/or as a form of birth control). Or anyremaining time can be used to role-play other issues, including condom use, planningthe number of children to have, or how to spend household income.Steps 1. Divide the participants into four groups and assign each group a topic ofdiscussion from the table below. Two groups will represent men (M1 and M2), andtwo groups will represent women (W1 and W2).GroupM1M2W1W2Topics of DiscussionReasons why men want to have sex in an intimate relationshipReasons why men do not want to have sex in an intimate relationshipReasons why women want to have sex in an intimate relationshipReasons why women do not want to have sex in an intimaterelationship2. Explain that the groups (or volunteers from each group) will be paired togetherto negotiate abstinence and sex. Allow the groups five to ten minutes to discussand prepare for the negotiations.3. The first negotiation:Group M1 (men who want to have sex) negotiates with Group W2 (women whodo not want to have sex). Ask the group to imagine that the context is an intimaterelationship in which the man wants to have sex, but the woman does not.29

4. The second negotiation:Group M2 (men who do not want to have sex) negotiates with Group W1(women who want to have sex). The role-play should be conducted in the sameway as above. After negotiating, ask the participants how they felt and what theylearned from the exercise.5. In both cases, the facilitators should write on flipchart paper the most importantarguments, both in favor and against.6. Open up the discussion to the larger group.? Were the role-plays realistic?? How are these negotiations similar to what happens in real life?? What positive communication strategies were used?? What negative communication strategies were used?? What are some other communication strategies that could have been used?? What makes it easier to negotiate abstinence with an intimate partner? Whatmakes it harder?? What happens if the negotiation happens in the heat of the moment, rather thanbefore? Does it become easier or more difficult?? What are the reasons why a woman would want to have sex? To not have sex?(See Resource Sheet 4: Reasons Why Men and Women Have Sex. )? What are the reasons why a man would want to have sex? To not have sex? (SeeResource Sheet 4: Reasons Why Men and Women Have Sex.)? How does a man react if a woman takes the initiative in asking for sex?? Can men ever say no to sex? Why or why not?? Can women ever say no to sex? Why or why not?? Is it fair to pressure someone to have sex? Why or why not?? How can men and women deal with pressure from peers and partners to havesex?? How can this pressure influence someone’s ability to be abstinent or to practicesafer sex? How does this influence the prevention of HIV?? Are certain individual’s rights less respected when it comes to sexual decisionmaking, in terms of gender, age, and class? Why do you think this is?? If the couple decides to have sex, what should they discuss before they have sex?? What have you learned from this exercise? How can you apply this to your ownrelationships?ClosingPeople make decisions about sexual activity throughout their lives. Manyfactors go into making the decision to have or abstain from sex. In the caseof women, the fear of losing their partner, societal expectations, or low selfesteemmight lead them to agree to sex. Among men, the decision to havesex might come from peer or social pressure to prove their manhood.Furthermore, communication styles, emotions, self-esteem, and unequalpower relations all play a role. It is important to be conscious of how thesefactors influence your own and your partner’s desires and decisions. It is alsoimportant to remember that negotiation does not mean winning at all costs,but seeking the best situation for both parties. All individuals have a right to30

make their own decisions about sex and decide if and when they want tobecome sexually active with their partner. Under no circumstances shouldthese rights be denied to an individual or should these decisions about sex bemade by others. It is important to note that discussing sex is important but itis also important to discuss condom use as well, especially as a form of birthcontrol in an intimate relationship and as a form of STI and HIV prevention.TrainingoptionsOptional Step: The facilitator might want to develop “Problem” and “Solution” treesto help participants understand the causes and results of both good and badcommunication about sexuality issues. Divide the participants into two groups. Eachgroup will be given an assignment to draw a tree. Group One will draw a “ProblemTree” and Group Two will draw a “Solution Tree.” Provide the following instructionsfor the groups:Group One: The “Problem Tree” group will be asked to draw a tree trunk in thecenter of a flipchart. Ask the group to brainstorm some of the causes of poorcommunication about sexuality. Each of the causes should be depicted as a root ofthe tree. After noting each cause, the group should consider what else can contributeto that cause. For example, if one reason is “embarrassment,” what causesembarrassment? One of the causes could be “social norms.” This would then bedepicted as a subroot of the original cause. The problem tree will also look at theoutcomes of poor communication. Those outcomes will be depicted as the branchesof the tree. As they did with the causes, the groups should brainstorm and identifythe primary and the secondary outcomes of poor communication.Group Two: The same process will be used for the “Solution Tree.” GroupTwo will be asked to draw a tree trunk in the center of aflipchart. Ask thegroup to brainstorm some of the causes of healthy communication aboutsexuality. Each of the causes should be depicted as a root of the tree. Afternoting each cause, the group should consider what else can contribute to thatcause. For example, if one reason is “sense of vulnerability,” what causesthat? Other causes might include “education” or “previous STIs.” Thesewould then be depicted as subroots of the original cause. The solution treewill also look at outcomes of healthy communication. These outcomes willbe depicted as the branches of the tree. As they did with the causes, thegroups should brainstorm and identify the primary and the secondary resultsof healthy communication.LinksThe discussion of negotiation in sexual relationships can be linked to the activity“Persons and Things” and to the unequal power relationships that often exist inmale/female relationships. It can also be linked to the activity “Talking About UsingCondoms,” which presents negotiations of condom use in a different format.31

Resource Sheet: Reasons Why Men and Women Have Sex 15REASONS WHY MEN AND WOMEN HAVE SEX⇒ Pressure from friends/partner⇒ To communicate loving feelings in a relationship⇒ To avoid loneliness⇒ To prove his/her manhood/womanhood⇒ For affection or to feel loved⇒ To receive pleasure⇒ The belief that everyone is doing it⇒ To hold onto a partner⇒ Not knowing how to say “no”⇒ To become pregnant or to become a parent⇒ To satisfy curiosity⇒ Nothing better to do⇒ To receive money or gifts⇒ Media messages make it seem glamorous⇒ The idea that it will cure them of HIV/AIDS⇒ Religious beliefs or personal/family values⇒ To avoid an unplanned pregnancy⇒ To avoid STIs and HIV infection⇒ To avoid hurting his or her reputation⇒ To avoid feeling guilty⇒ Fear that it will hurt⇒ To wait for the right partner⇒ Not ready⇒ To wait for marriageREASONS WHY MEN AND WOMENDO NOT HAVE SEX15 CEDPA. 1988. Choose a future:issues and options for adolescent boys. Washington, D.C.32

Chapter 3 - Men and Health3.1 Caring for Oneself: Men, Gender, and Health 16Objectives 1. To promote greater awareness of the links between how men are raised and thehealth risks they faceAudience Age: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:MediumTimeOne hourMaterials • Small pieces of paper or cards• Flipchart• Markers• Resource Sheet 5: Gender and Health Questions and Resource Sheet 6:Facilitator’snotesStepsAnswers to Gender and Health QuestionsGlobal statistics related to men and various health outcomes are provided inResource Sheet 6. It can be useful for the facilitator to complement these statisticswith local and/or national ones, which can help the participants better contextualizethe health risks men may face in their own communities.1. Prior to the session, write each of the questions from Resource Sheet 5 on a smallpiece of paper or card. For groups with reading difficulty, the facilitator can readthe questions aloud rather than distribute them.2. Divide the participants into two or three small groups, and distribute thequestions among them.3. Explain to each group that there are three possible answers to each question:man, woman, or both. Ask them to discuss each of the questions they havereceived and to try to come up with the answer as a group.4. Allow 20 minutes for the groups to discuss the questions.5. Write the questions on flipchart paper and then read each question aloud; askhow the groups replied, and mark the answers with an “X” on the flipchart.6. Explore the responses of the group, asking them to explain their answers.7. After the groups have presented all of their responses, explain that the correctanswer for each question is “Men.” Review each question, presenting some of thestatistics included in Resource Sheet 6 and using the following questions tofacilitate discussion:? Did you know that men are more at risk for this health problem?? Why do you think this is true?? Is it possible for men to avoid this health problem? How?16 Wilson, P and Johnson. J. 1995. Fatherhood development: a curriculum for young fathers. Philadelphia: Public/Private Ventures.33

(Note: Facilitator should encourage the participants to reflect on the behaviorsand lifestyles associated with the health problem and how they might be preventedor changed.Procedure Note: Although the answers to the questions are most often men, insome settings, the answer to some of the questions might be women or both. Ifthis is the case, the facilitator should focus the discussion on the fact that themajority of the questions had a response of men.8. After discussing each question, ask the questions below to wrap up the session.? Do you see these patterns among men in your community?? Are there other health problems that men are more at risk for than women?? During what age range are men most at risk for some of these problems?? Why do men face these health risks? What is the relationship between these risksand how men are socialized?? What can you do to reduce these risks in your own lives? In the lives of othermen?ClosingMost causes of death for men are associated with the self-destructive lifestyle manymen follow. Around the world, they are pressured to act in certain ways. For example,men often take more risks, have more partners, and are more aggressive or violent intheir interactions with others,_all of which put them and their partners at risk. Asmen, it is important to be critical about your lifestyles and the ways you putyourselves at risk. You might have been raised to be self-reliant, not to worry aboutyour health, and/or not to seek help when you feel stress. But being able to talkabout your problems and seeking support are important ways to protect yourselvesagainst various negative health outcomes such as substance use, unsafe sexualbehaviors, and involvement in violence. Through critical reflections of these norms,you can learn to appreciate how health is not merely a matter for women, but also aconcern for men, and learn how to take better care of yourselves.34

Resource Sheet 5: Gender and Health Questions*Respond to each of the following questions with: “Men,” “Women,” or “Both.”1) Who has a shorter lifespan?2) Who is more likely to die from homicide?3) Who is more likely to die in road accidents?4) Who is more likely to die from suicide?5) Who is more likely to consume alcohol and get drunk?6) Who is more likely to die from an overdose (excessive substance use)?7) Who is more likely to have sexually transmitted infections (STIs)?8) Who is more likely to have more sexual partners and more unprotected sex?9) Who is less likely to seek health services?* In rural settings, where certain questions might not be relevant, the facilitator should substitute anothermore applicable question and research correct answers.35

Resource Sheet 6: Gender and Health Answer SheetWho has a shorter lifespan?⇒ Globally, the life expectancy for men is 65 years and for women it is 69 years. 17Who dies more often from homicide?⇒ Globally, approximately eight out of every 100 deaths among men of all ages are due to homicide.Among women, two out of every 100 deaths are due to homicide. 18Who dies more often from road accidents?⇒ Globally, 28 of every 100,000 men and 11 of every 100,000 women die from road accidents. In otherwords, almost three times as many males as females die from road traffic injuries. 19Who dies more often from suicide?• Globally males commit suicide at 3.6 times the rate of women. 20Who consumes more alcohol and gets drunk more often?⇒ Globally, men are ranked higher than women in percentages of episodic and binge drinking. 21Who dies more often from overdoses (excessive substance abuse)?⇒ Globally, among young men ages 15 to 29, males are more likely than females to die from alcohol usedisorders. 22Who has more STIs?⇒ Globally, men represent a higher number of cases of gonorrhea and syphilis and women represent ahigher number of cases of trichomonas and chlamydia. 23Who has more sexual partners and more unprotected sex?Globally, men report more multiple partners than women, except in some industrialized nations. 24Who is less likely to seek health services?⇒ Globally, men are less likely than women to seek health services . 2517 Population Reference Bureau. 2006. World Population Datasheet. Washington D.C.18 World Health Organization. 2002. World Report on Violence and Health. Geneva, Switzerland.19Ibid.20Bertolote,JM and Fleischmann, A. 2002. A global perspective in the epidemiology of suicide. Suicidologi, Arg. 7, No 2.21 World Health Organization. 2004. Global status report on alcohol. Geneva, Switzerland.22 Ibid.23 World Health Organization. 2001. Global prevalence and incidence of selected curable sexually transmitted infections. Geneva, Switzerland.24 Wellings, K., et al. 2006. Sexual behavior in context: a global perspective.The Lancet 368 (9548):1706-1728.25 Addis, M and Mahalik, J. 2003. Men, masculinity, and the contexts of help seeking. Am Psychol. 58(1):5-14.36

Chapter 4 - Substance Use4.1 The Risks of Alcohol Abuse and HIVObjectives1. To identify the effects (physical, mental, emotional, and behavioral) of alcohol2. To discuss situations in which alcohol consumption increases risk for STIs,including HIV/AIDS3. To reflect on how alcohol abuse can be reducedAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Any Level; Resources:MediumOne hourMaterials • Flipchart• Markers• Tape• Pieces of paper for all participants• Resource Sheet 7: Alcohol Abuse• Enough copies of Handout 4: Personal Attitudes and Experiences withAlcohol for all participantsFacilitator’snotesPrior to the session, it is important to identify services and supports in thecommunity for men who may have problems with alcohol. It would also be helpfulto research the minimum legal age for purchase and consumption of alcohol.StepsPart 1 – 30 minutes1. Give all participants a piece of paper and ask them to write down three ways mencan have fun. Tell them these can be situations they have experienced or observedin persons around them.2. Ask the participants to read their cards out loud. Write the answers on flipchartpaper, and note the activities that are most preferred.3. If the group has not mentioned it, ask them: “In which of these activities isalcohol or other substance use present?”4. Next ask: “Why do people consume alcohol?” Write the responses on anotherpiece of flipchart paper. Possible answers might include “to be accepted,” “tohave fun,” “to show who can drink the most,” or “to not look bad in front offriends.” All of these answers relate to what is socially expected of a man.Next, ask the participants to list the effects of alcohol consumption (physical, mental,emotional, and behavioral). Write the responses on another piece of flipchart paper.You can add to the list using information contained in the box below. It is importantyou explain that these effects are not the same for everyone in every situation. Theyvary, depending on the amount of alcohol consumed, speed or length of time ofdrinking, the size and weight of the person, etc.37

EFFECTS OF ALCOHOL CONSUMPTIONPhysical Mental Emotional BehavioralNausea,vomiting, loss ofbalance,numbness in theConfusion,difficultyconcentrating,thoughtFeeling of temporarywell-being,relaxation, state ofexaggeratedViolent, depressedbehavior,difficultyspeaking,uninhibitedlegs, loss of disturbances, loss of happiness/sadness/ behavior,coordination,reduction ofreflexesmemory of whatone does whileunderthe influence ofalcohol, alteredjudgment, badrecollections ofpersonalexperiences(a bitunclear,obsession,bad dreamsdisgust, sensation ofbeing omnipotentand invincibletearfulness6. Divide the participants into two groups and discuss how alcohol use can lead toHIV —that is, how can use of alcohol and other substances lead to risky sexualbehavior, unprotected sexual intercourse, situations of coercion, etc.? Then, askeach group to share their findings.Part 2 – 30 minutes1. Explain that participants will now have a chance to reflect on some questions thatlook at their personal experiences and attitudes about alcohol.2. Provide a copy of handout 4 to every participant. Allow them a few minutes tothink about the questions and respond to them.3. Ask each participant to pair up with someone they feel comfortable with anddiscuss the questions. Explain that they are free to talk about any of the questionsthey found interesting or important.4. Bring the group together and wrap up the discussion with the questions below:? What are the cultural norms around alcohol in your community/country?? What is the reaction when someone does not want to consume alcohol?? What actions can you take if a friend is abusing alcohol? (See Resource Sheet 7.)? How can you help to create other forms of fun and social activity in whichalcohol is not the most important thing?ClosingThe connection between alcohol use and HIV has long been confirmed. The use ofsubstances in general is associated with higher rates of unsafe sexual activity andSTIs/HIV/AIDS. Injecting drug use accounts for 10% of all HIV cases in the world.Additionally, in the long-term, substance abuse can give rise to dependency andvarious other health problems (including death) and can affect every aspect of aperson’s life. Men often use alcohol at higher rates than women, because they may38

elieve that using alcohol helps prove their manhood or helps them fit in with theirmale peer group. It is necessary to question the norms around alcohol use and tothink about how you and others can create forms of leisure and entertainment that donot place alcohol at the center.Trainingoptions1. Divide the participants into three or four small groups. Each will be given anassignment to draw a problem tree that looks at alcohol abuse.2. Draw a tree trunk in the center of a flipchart and label it “Alcohol Abuse.”3. Ask the group to discuss some of the causes of alcohol abuse. Each causeshould be depicted as one of the roots of the problem tree. After notingeach cause, the group should think about what contributes to that originalcause. For example, if one of the causes is “unemployment” then the groupshould think about what contributes to unemployment. One of thesubcauses could be “lack of economic opportunities.” This would then bedepicted as a subroot of the original cause.4. The problem tree will also look at the effects of alcohol abuse. Those effectswill be depicted as the branches of the problem tree. As with the causes, thegroups should brainstorm and identify the primary and secondary outcomesor effects. For example, domestic violence—which can result in serious harmor even death—is a secondary outcome of alcohol abuse.39

Resource Sheet: Alcohol AbuseCauses: Many factors can contribute to the causes of alcohol abuse. These can include stress, depression, adisruptive home life, peer pressure, and job problems. Those with a family history of alcoholism may haveinherited a genetically–lowered sensitivity to alcohol, which means they can drink more without feeling theeffects. It is difficult to separate the effects of environment and heredity as a cause of alcoholism.Short-term effects: There are numerous negative health consequences that result from alcohol abuse. In theshort term, alcohol suppresses the part of the brain that controls judgment, resulting in a loss of inhibitions.This loss of inhibition can affect sexual decision making (e.g., having sex or not; using a condom/protectionor not). Alcohol also affects physical coordination and causes blurred vision, slurred speech, and loss ofbalance. Drinking a very large quantity at one time (binge drinking) can lead to unconsciousness, coma, andeven death. Alcohol is implicated in a large proportion of fatal road accidents, assaults, and incidents ofdomestic violence.Long-term health effects: Long-term drinking can increase the risk of getting certain diseases and make otherdiseases worse. Excessive drinking over time is associated with: loss of brain cells, liver failure, irritatedstomach lining and bleeding from stomach ulcers, high blood pressure (which can lead to stroke), certaintypes of cancer, nerve damage, heart failure, and epilepsy. Excessive drinking has also been linked to: vitamindeficiency, obesity, sexual problems, infertility, muscle disease, skin problems, and inflammation of thepancreas.Additional long-term effects (beyond health) include loss of economic opportunities (e.g., unemploymentbased on inability to perform, as well as wasting money to buy alcohol that could be spent on other items),family disruptions, and becoming a public nuisance, which can lead to trouble with the police.Intervention: Although defined as an illness, society has not quite accepted the fact that many individualswho abuse alcohol are addicted, and have little control when abusing alcohol. Most people need assistanceand support to recognize their problem and take action to lesson the impact alcohol can have on their lives.40

Handout 4A: Personal Attitudes and Experiences with AlcoholYESNOI believe it is possible for a person to lead an enjoyable social life without consuming alcohol.I would feel out of place at a party if my friends offered me an alcoholic drink and I decidednot to have one.I would not be able to have fun at a party if there was no alcohol.If I were drinking and my friend was not, I would pressure him or her to drink.I have seen other people I care about harmed due to alcohol abuse.I have been personally harmed due to the alcohol abuse of others.I have personally harmed others due to my alcohol abuse.I have done things that I have regretted due to alcohol abuse.41

4.2 Decision Making and Substance UseObjectives 1. To reflect on peer pressure and decision making related to substance useAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:MediumOne hourMaterials • Enough copies of Handout 5: Individual Questionnaire: Decision making for•all participantsFlipchart• MarkersSteps1. Give each participant a copy of Handout 5 and ask them to complete it infive minutes. For low literacy groups, read the questions aloud and havethem discuss in pairs.2. Invite the participants to share their replies with each other. If the group islarge, the participants can be divided into smaller groups.3. After the participants have shared their responses, use the questions below tofacilitate a discussion.? Is peer pressure a big factor in why men use substances?? Do women also experience peer pressure to use substances?? In what ways is this peer pressure similar? In what ways is it different?? Can peer pressure contribute to risky behavior? If so, what kind of riskybehavior?? How does alcohol influence sex and decisions about sex? Does it help/hurt?? What other decisions or behaviors can alcohol or other drugs influence (e.g.driving, work, relationships, violence)?? How can you challenge some of the peer pressure men may face to usesubstances? How can you challenge some of the peer pressure women may faceto use substances?? What have you learned from this exercise? How can you apply this to your livesand relationships?ClosingIn many settings, it is common for men and women to use substances (e.g., alcohol)as part of their social interactions and gatherings. It is important for individuals toknow how to establish limits regarding substance use and to respect the limits ofothers. For example, some strategies for drinking responsibly include drinking a smallamount and not mixing drinks with other substances. It is also necessary to createother forms offun that do not put alcohol or other substances at the center, and torefrain from putting pressure on those who do not want to consume substances.42

Handout 4B: Individual Questionnaire: Decision MakingIndividual Questionnaire: Decision Making Yes No1- Would you feel out of place at a party or gathering with your friends ifthey offered you a drink (with alcohol) and you decided not to have one?Explain.2- Imagine that you are at a party or social gathering where they are servingalcohol and you are drinking, but one of your friends doesn’t want to drink.Would you view your friend as an oddball, a drag, or a nerd?Explain.3- Would you defend your friend’s decision not to drink to the other friends?Supposing that you decided to defend him or her, how do you think theother friends would judge you?Explain.4- Do you believe that to be accepted in a group you have to do what theother persons in the group want?Explain.5- Do you think that it is possible for a person to lead an enjoyable social lifewithout consuming alcoholic drinks?Explain.6- Can a person feel good about himself even without drinking?Explain.7- Can a man feel accepted without drinking?Explain.43

Chapter 5 - Healthy Relationships5.1 Sexual ConsentObjectives1. To identify situations in which consent for sexual activity is not given2. To identify ways men can better understand when consent for sex exists.AudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Any level; Resources:Low60 minutesMaterials • Two signs (“Consent” and “No Consent”). Review the scenarios providedbelow. Choose five or six that will produce the best discussion.1. A man has married a woman after paying lobola. They have had sex regularly, butthe woman tells her husband that she does not want to have sex on this occasion.The man forces sex with his wife anyway. (No consent)2. A young woman gets drunk at a party. She is flirting with and kissing a youngman. After dancing with him, she passes out in a bedroom. The young man hassex with her while she is sleeping. (No consent)3. A woman and man are kissing on a bed with their clothes off. They have neverhad sex before. The man inserts his penis inside her vagina and she asks him tostop. He doesn’t, even after she continually tells him to stop. (No consent)4. A woman and man are kissing on a bed with their clothes off. They have neverhad sex before. The man inserts his penis inside her vagina and she does not sayanything. (Not enough information—what would allow us to know that consentexisted?)5. A woman does not want to have sex. Her partner threatens to beat her if shedoes not sleep with him. She does not say anything as her partner has sex withher. (No consent)6. A women and a man are kissing on a bed with their clothes off. They have neverhad sex before. The man asks if it is okay if he inserts his penis inside her vaginaand she says it is okay. They continue and have intercourse. (Consent)Steps 1. Before the activity begins, put up the two signs on either side of the room.2. Refer participants to the earlier exercise on sexuality. Explain that the final circle,Sexuality to Control Others, often involves situations in which sexual activity isnot agreed to. This activity is going to explore when consent exists and when itdoes not.3. Tell the participants that the group will be discussing sexual consent. Review thedefinition of sexual consent: “Sexual activity that both people want and freelychoose.”4. Ask the group to share why it is important that every human being have the right44

to consent to sexual activity.5. Explain that you will be sharing some scenarios where the group will have todecide if a person wants and freely chooses sex.6. Read aloud the first statement you have chosen. Ask participants to stand nearthe sign that says what they think about the statement. Then ask one or twoparticipants beside each sign to explain why they are standing there. Ask themwhy they feel this way about the statement.7. After a few participants have talked about their attitudes towards the statement,ask if anyone wants to change their mind and move to another sign. After eachstatement, share whether or not the scenario actually does demonstrate consentor not. The correct response is given in parentheses. Clarify any misconceptionsfrom the participants.8. Bring everyone back together and read the next statement. Do this for each ofthe statements you have chosen.9. After discussing all of the statements, ask the discussion questions:? What statements were difficult to take a position on? Why?? What can men do in order to have a clear understanding of their partners’consent?? How can sex without consent contribute to the spread of HIV?? What are the effects on women if a man forces sex upon her?? What can a man do if it is unclear whether or not a woman wants to have sexwith him?? What can be done to improve men’s attitudes, understanding, and acceptance of awoman’s right to say no to sex?ClosingForcing someone to have sex against their will is against the law, is agross violation of human rights, and has a devastating effect on theperson being raped. It is important to remember that consent is necessary forevery sexual contact, even if the partners are married or have had sex before.Respect and good communication are the best strategies to ensure that sexualrelations are consensual and enjoyable for both partners.45

Chapter 6 - STI and HIV Prevention6.1 Positive or NegativeObjectives 1. To discuss the factors that make men and women vulnerable to HIV/AIDSAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:LowOne hour and 30 minutesMaterials • Small pieces of paper with selected profiles from Resource Sheet 8: HIV•ProfilesPieces of paper with positive and negative symbols written on themAdvancepreparationPrior to the session, choose five profiles from the Resource Sheet or create fiveprofiles that would best fit the context in which you are working. Write these phraseson small pieces of paper (one per paper). Note: The facilitator should not includethe HIV/AIDS test results on these pieces of paper. These results are only to berevealed later in the activity.Steps 1. Explain to the participants that this activity is to discuss men’s and women’svulnerability to HIV/AIDS.2. Review with the participants what HIV/AIDS is and how it is transmitted. Note:The time necessary for this review will be based on the background knowledge ofthe group. It is important, however, that the participants have a clearunderstanding of how HIV/AIDS is transmitted before they start this activity.3. Ask for five volunteers. Distribute the profiles you have written on the smallpieces of paper or for low-literacy groups, whisper a profile to each participant.Tell the volunteers they are going to put themselves in the shoes of the personwhose profile they received.4. Ask each volunteer to introduce herself to the larger group, according to theprofile that s/he received. Each volunteer should give his or her character a nameand feel free to incorporate mannerisms and behaviors into the presentation ofthe character.5. Explain to the other participants that they should ask questions to get to knowthese five characters better. Emphasize to the volunteers playing the charactersthat they should be creative in answering the questions, while always keeping theprofile descriptions in mind.6. After approximately 20 to 25 minutes of introductions and questions, thefacilitator should tell the group that these five women have gone in for anHIV/AIDS test and are about to receive the results. Ask them what they thinkwill be the results of each woman’s test.7. Distribute the test results to each participant playing a role (these should be basedon the results provided in the Resource Sheet alongside each profile), and thenshare these with the larger group.46

8. Use the questions below to facilitate a discussion about the group’s reactions tothe results and the complexities of men’s and women’s vulnerability toHIV/AIDS:? To the volunteers: How did you feel representing these characters? How did youfeel when you received the test result? Was the result what you expected based onthe description of your character? If not, why not?? Are these men’s and women’s experiences common? Does anyone know of anysimilar situations?? What characteristics are often associated with these men and women?? What are some explanations for the different results these men and womenreceived?? Were men or women more vulnerable in the sexual situations discussed in thecase studies?? How could the men in the case studies have used their privilege and powerdifferently?? What kinds of factors (social, economic, political) make men and women morevulnerable to HIV infection?? How can men and women protect themselves from HIV?? Do couples generally talk about HIV/AIDS? Why or why not?? What factors might inhibit a man from talking to his partner about HIV/AIDS?What factors might inhibit a woman from talking to her partner aboutHIV/AIDS?? What support do couples need to protect themselves from STIs and HIV? Is thiskind of support available in the community?? What have you learned in this activity? Have you learned anything that could beapplied to your own life and relationships?ClosingMen’s and women’s vulnerability to HIV/AIDS is largely determined by gendernorms about sexuality. It is often assumed that “real men” have lots of sexualrelations and that women should be coy and passive in sexual matters. As a result,women might not always have the power and/or skills to communicate and negotiatesexual behaviors and methods of prevention. Other factors, such as poverty, make iteven less likely that men and women will be able to negotiate protection or evenaccess important health information and services. Promoting women’s rights to befree from discrimination, coercion, and violence is an important step towardreducing vulnerability to HIV/AIDS. It is just as important to involve men indiscussions about the role of negative gender norms and encourage them to discussHIV/AIDS prevention with their partners.47

Resource Sheet: HIV ProfilesWoman, 30 years old, homemaker. She is married andhas a five-year-old daughter and a three-year-old son.Recently discovered that her husband has sex withother people.Woman, 18 years old, sex worker. She is married.Woman, 17 years old, dropped out of school at 12years old. She works to help her family pay the bills.Currently dating a man who is 26 years old.Woman, 15 years old, student. Likes to help her mom,has several friends, and is dating a 17-year-old guy. Heis the first person with whom she has had sex.Woman, 26 years old, homemaker and wife of a goldminer. Her husband only visits a few times a year andin order to help feed her children, she began to haveunprotected sex with a man who brought her food anda little money.Man, 32 years old, gold miner working 300 miles fromhis rural home. He lives in a hostel and sees his wifeonly a few times a year. After living away from his wifefor a while, he starts to have sex with women in thenearby townships.Man, 19 years old, vendor. He only has sex with men.Man, 23 years old, student, who has been sexuallyactive with girls his age and younger, and is currently ina monogamous relationship with a young woman.Man, 25 years old, schoolteacher. He is married butstill has other sex partners. He recently found out thathe has a STI and decides to wait for it to go awaybefore going to a doctor.POSITIVENEGATIVEPOSITIVEPOSITIVEPOSITIVENEGATIVENEGATIVENEGATIVEPOSITIVE48

ObjectivesAudience6.2 Levels of HIV RiskTime1. To identify the level of HIV risk of various behaviors and sexually-pleasurablebehaviorsAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:LowOne hourMaterials • “Levels of Risk” cards (“Higher Risk,” “Medium Risk,” “Lower Risk,” and•“No Risk”) – see facilitator’s notes“Sexual Behavior” cards (16) – see facilitator’s notes• Enough copies of Handout 6: Levels of Risk for HIV Infection for allFacilitator’snotesparticipantsIn large letters, print each of the following titles on cards (or pieces of paper), onetitle per card: “Higher Risk,” “Medium Risk,” “Lower Risk,” and “No Risk.”In large letters, print each of the following sexual behaviors (or other behaviors thatare relevant to your area or client population) on cards (or pieces of paper). Writeone behavior per card.• Abstinence• Masturbation• Vaginal sex without a condom• Vaginal sex with a condom• Hugging a person who has AIDS• Fantasizing• Kissing• Dry sex - without a condom• Massage• Anal sex with a condom• Performing oral sex on a man without a condom• Performing oral sex on a man with a condom• Performing oral sex on a woman without protection• Performing oral sex on a woman with protection• Infant breastfeeding from an HIV-infected mother• Anal sex without a condom49

Steps 1. Explain to participants that they are going to do an activity about behaviorsthat carry a risk for HIV infection. Lay out the four “Levels of Risk” cards in aline on the floor. Start with “No Risk,” then “Lower Risk,” then “MediumRisk,” and finally “Higher Risk.”2. Give out the “Sexual Behavior” cards to participants. Ask one of theparticipants to read his/her card and to place it on the floor under the correctcategory (“Higher Risk,” “Medium Risk,” “Lower Risk,” or “No Risk”) forHIV transmission. Ask the participant to explain why he/she has placed itthere.3. Repeat step 2 until all of the cards have been placed on the floor. Once all ofthe cards are down, ask the participants to review where the cards have beenplaced. Then ask whether they:Disagree with the placement of any of the cardsDo not understand the placement of any of the cardsHad difficulty placing any of the cards4. Discuss the placement of cards that are not clear-cut in terms of risk. Alsodiscuss cards that are clearly in the wrong place. Use the information in keypoints and the handout to guide you on the correct placement.5. Ask the participants to look at the behaviors in the “Lower Risk” and “NoRisk” categories. Ask the group to identify other behaviors that could fit inthese categories. Emphasize the idea that some pleasurable sexual behaviorsinvolve low or no risk.6. Finish the activity by emphasizing that risk depends on the context of thebehavior, and review the handout.ClosingHIV risk depends on the context of the behavior.This includes:• How much HIV the infected person has in their body• Whether or not the person is the “giver” or “receiver” of the sexualbehavior• How weak are the immune systems of the people involved• The presence of cuts or openings on the skin where contact with HIV islikely (for example, as a result of STIs)• The presence of sores or bloody gums during oral sex• How well condoms and other protections are used50

Handout 6A: Levels of Risk for HIV InfectionLevelNo Risk =No contact with infected body fluids. HIV istransmitted in body fluids. If there is no contact withsuch fluids, there is no risk for HIV being passed froman infected person to an uninfected person.Lower Risk =The possibility of contact with HIV because of thefailure of protection. Using a condom still carriessome risk because no protective method is 100%effective.Medium Risk =Medium possibility of HIV transmission. This can bedue to a lack of protection in situations where there issome chance of HIV-infected fluids entering anotherperson’s body (oral sex without a condom). Or it canbe because protection is used, but there is a very strongchance that HIV-infected fluids will enter anotherperson’s body (anal sex with condom).Higher Risk =High probability of HIV transmission. This is becauseno protection is used and there is a very strong chancethat HIV-infected fluids will enter another person’sbody.Behavior• Abstinence• Masturbation• Hugging a person who has AIDS• Kissing• Fantasizing• Massage• Vaginal sex with a condom• Anal sex with a condom (the chancesof breakage are higher than for vaginalsex, so could be placed in next category.)• Performing oral sex on a man with acondom• Performing oral sex on a womanwith protection• Performing oral sex on a manwithout a condom• Performing oral sex on a womanwithout protection• Infant breastfeeding from an HIVinfectedmother• Vaginal sex without a condom• Anal sex without a condom• Dry sex n without a condomMany factors affect these levels of risk. The level of risk for many of these behaviors will vary, based ona range of factors. These include:• How much HIV the infected person has in his or her body• Whether or not the person is the “giver” or “receiver” of the sexual behavior• How weak are the immune systems of the people involved• The presence of cuts or openings on the skin where contact with HIV is likely (for example, as aresult of STIs)• The presence of sores or bloody gums during oral sex• How well condoms and other protections are used6.3 Taking Risks/Facing Risks51

Objectives1. To discuss situations that put men at risk for STIs, HIV/AIDS, and/or earlyparenthood2. To identify sources of support to reduce these risksAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:LowOne hour and 30 minutesMaterials • Selection of phrases from Resource Sheet 9: I Am at Risk When… writtenon small pieces of paper• Enough copies of Handout 7: Taking Risks/Facing Risks for allparticipantsSteps 1. Begin the activity by asking participants to think about situations that mayput them at risk for STIs or HIV. For example, if a person does not knowthat having sexual relations without a condom increases their risk for HIV,they are more vulnerable to contracting the infection than someone whohas this information.2. Next, ask the participants to divide into pairs. Give each a piece of paperwith a phrase written on it from Resource Sheet 9. Every pair should havea different phrase. Each can also be given more than one phrase.3. Ask each pair to read their phrase, discuss what it means, and decide if theyagree or disagree with the statement and why.4. When they have finished, each pair should read their phrase out loud andshare their responses with the larger group.5. Distribute and review the handout and then use the following questions tofacilitate a discussion.? What is the difference between taking risks and facing risks?? Who takes more risks with HIV? Women or Men? Why?? Who faces more risks for HIV? Women or Men? Why?? What can we do to help men and women reduce the risks they are taking?? What are alternatives to some of the most common risk behaviors of men?? What can we do to help men and women reduce the risks they face?Closing? What other type of support do men and women need to protect themselvesfrom STIs and HIV? Is this kind of support available in the community?Many of men’s risky sexual behaviors are rooted, to a large extent, in how boys andmen are raised and socialized. These behaviors often put both men and youngwomen at risk. It is important for men to be aware of how gender norms influencedecisions and behaviors and to think critically about the impact of those decisionsand behaviors.Resource Sheet : I Am at Risk When… 21 ?52

1. I am at risk when I think that nothing is going to happen to me.2. I am at risk when I have no one that I can count on to help me in times of need.3. I am at risk when I do something only to make someone like me.4. I am at risk when I will do anything to have sex.5. I am at risk when I am afraid to show how I feel.6. I am at risk when I do not think for myself.7. I am at risk when I do not take care of an STI symptom.8. I am at risk when I do not take responsibility for my own sexual behavior.9. I am at risk when I am under the influence of alcohol or drugs.10. I am at risk when I have multiple sexual partners.11. I am at risk when I do not talk to my partner about how to prevent an unintended pregnancy.12. I am at risk when I have sex with someone who has not been tested for HIV/AIDS.13. I am at risk when I do not use a condom consistently and correctly.53

Handout 6B: Taking Risks/Facing RisksGender norms/roles and inequalities in power have a huge impact on the HIV risks women and men take.However, other factors are important too, such as age, wealth/poverty, and location (village/town). Keypoints: Women face more risks for HIV than men because of their anatomies. Semen remains in the vagina for along time after penetrative sex. This increases women’s chances of infection from any single sexual act.There are also more viruses in men’s semen than in women’s vaginal fluid. The inside of the vagina isthin. This means it is more vulnerable than skin to cuts or tears that can easily allow HIV into the body.The penis is less vulnerable because it is protected by skin. Very young women are even more vulnerable. This is because the lining of their vagina has not fullydeveloped. With an STI, women are at least four times more vulnerable to infection. Women often donot know they have STIs, as they often show no signs of infection. Women face more risks for HIV than men because they lack power and control in their sexual lives.Women are not expected to discuss or make decisions about sexuality. The imbalance of power betweenmen and women means that women cannot ask for, or insist on, using a condom or other forms ofprotection. Poor women may rely on a male partner for their livelihood. This makes them unable to asktheir partners or husbands to use condoms. It also makes it difficult to refuse sex even when they knowthat they risk becoming pregnant or infected with a STI/HIV. Many women have to trade sex for money or other kinds of support. This includes women who work assex workers. But it also includes women and girls who exchange sex for payment of school fees, rent,food, or other forms of status and protection. Violence against women increases women’s risk for HIV. Men’s rape of women occurs worldwide. Thiscrime is linked to men’s power over women. Forced sex increases the risk for HIV transmission becauseof the bruising and cuts it may produce. Other kinds of physical and emotional violence increasewomen’s risk. Many women will not ask their male partners to use condoms for fear of men’s violentreaction. Women who must tell their partners about STIs/HIV may experience physical, mental, oremotional abuse, and even divorce. Men take more risks with HIV because of how they have been raised. Men are encouraged to beginhaving sex early to prove themselves as men. A sign of manhood and success is to have as many femalepartners as possible. For married and unmarried men, multiple partners are culturally accepted. Men aresometimes ridiculed if they do not show that they will take advantage of all sexual opportunities. Competition is another feature of living as a man. This applies to the sexuality. Men compete withoneanother over who is seen as the bigger and better man. One symbol of manhood is to be sexually daring.This can mean not protecting oneself with a condom, as this would signal vulnerability and weakness.Many men believe condoms lead to a lack of pleasure or are a sign of unfaithfulness. Using condoms alsogoes against one of the most important symbols of manhood, which is having as many children aspossible. Men are seeking younger partners in order to avoid infection. This is based on the belief that sex with avirgin cures AIDS and other infections. On the other hand, women are expected to have sexual relationswith, or marry, older men, who are more likely to be infected.54

6.4 Multiple Sexual Partners, Cross-Generational Sex, and Transactional SexObjectives1. To define concurrent multiple sexual partnerships, cross-generational sex, andtransactional sex2. To explore how rigid gender norms drive these high-risk sexual behaviors3. To identify risks and costs associated with these sexual behaviorsAudienceTimeMaterialsAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:Low60 minutesBlank sheets of paperPens/pencilsSteps 1. Explain that this session will explore three issues related to gender and sexualactivity: 1) men with concurrent multiple sexual partners, 2) men engaging incross-generational sex, and 3) men engaging in transactional sex.2. Divide the participants into three groups and assign one of the following issuesto each.• Group 1: Concurrent Multiple Sexual Partners• Group 2: Cross-Generational Sex• Group 3: Men Engaging in Transactional Sex3. Ask each group to provide a definition of their term. If they prefer, they cansimply provide an example of their term.4. Ask someone from each group to share their definition and/or example. Aseach group presents its definition, ask participants to provide additionalexamples. The definitions should be similar to the following:• Concurrent Multiple Sexual Partners—This means a person isinvolved in more than one sexual relationship at the same time (forexample, a man who is sexually active with his wife, but also has agirlfriend with whom he has sex). .• Cross-Generational Sex—This refers to two sexually-involvedindividuals with at least a 10-year difference in their ages (for example, a30-year-old man who is in a sexual relationship with a 15-year-old girl).• Transactional Sex—This refers to a sexual relationship or sexual actin which the exchange of gifts, services, or money is an important factor(for example, an older man buys a younger girl a cell phone or pays herschool fees in exchange for sex).5. After they have written their definitions, ask each group to discuss thefollowing question:55

? Why does your issue put men, women, and communities at risk for HIV?6. When they are ready, have someone from each group share their responseto the question. Be sure to include the following points if they are notmentioned:• Concurrent Multiple Sexual Partners—A person is much morelikely to pass on HIV if he or she has more than one sexual partner. It iseasiest to transmit HIV when a person is first infected. Therefore, ifsomeone is infected by one person, and has unprotected sex soon afterwith a second person, that second person will likely become infected, too.• Cross-Generational Sex—When a man has sex with a person whois at least 10 years younger than he, there is a major imbalance in power. Asa result, the younger person may find it difficult to say no to sexual activityand may be unable to negotiate safer sex.• Transactional Sex—A person who is receiving money, gifts, orservices may find it difficult to say no to sexual activity and may be unableto negotiate safer sex.7. After discussing the risk factors, ask the participants to return to theirgroups. Remind them of the “Act Like A Man” box that was discussedearlier in the workshop. Ask each group to explore how societal messagesabout masculinity perpetuate the issue they are examining.8. Ask someone from each group to share their response. Allow otherparticipants to make additional comments.9. Conclude the activity with the following discussion questions:?Why do you think men are more likely than women to have multiple sexualpartnerships??Why do you think men are more likely than women to engage in sex withpartners at least 10 years younger than they??Why do you think men are more likely than women to provide gifts,services, or money for sex??What are the costs and negative outcomes that come from men engaging inmultiple sexual partnerships, cross-generational sex, and transactional sex.?How can men challenge other men to stop engaging in multiple sexualpartnerships, cross-generational sex, and transactional sex?Closing?What did you learn from this session?Rigid gender norms often drive the HIV epidemic by facilitating unsafe behaviorsuch as concurrent multiple sexual partnerships, cross-generational sex, andtransactional sex. It is important for both men and women to realize this andidentify ways that these norms can be changed and/or addressed.56

Chapter 7 - Living with HIV7.1 Positive LifeObjectivesAudienceTime1. To understand better the personal impacts of HIV/AIDS2. To be able to identify roles that men can play in reducing the impact ofHIV/AIDSAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:Low75 minutesMaterials • Enough copies of Handout 8: General Life Questions for all participantsFacilitator’snotesPrior to the session, research local and/or national laws and policies concerningPLWHA rights, existing support networks, and the most up-to-date informationabout sexual partnerships between HIV-discordant persons (when one person isHIV-positive and the other is not) and the question of PLWHA who want to havechildren (what implications and risks are involved).It can be interesting to invite someone living with HIV/AIDS to come to thesession and share his or her experiences with the participants. If someone is able tocome, it will be important to help mediate the discussion between the guest and theparticipants, making them feel as comfortable as possible to ask questions. Anotheridea is to show and discuss a film that touches on experiences of PLWHA.This activity can be very personal and emotional. There may be participants in thegroup who are HIV-positive. Others may have close friends or family memberswho are living with HIV/AIDS. Remind the group that it is okay to pass on aquestion. Encourage the participants to only share the information they feelcomfortable sharing.Participants may not feel comfortable talking about this in pairs. One option is toask individuals to think about the first set of questions on their own and then go onto step 3.Remember that men’s and women’s experience of HIV/AIDS will also be affectedby age, class, caste, ethnicity, and other factors.Steps 1. Divide the participants into pairs. Pass out the handout and ask each person inthe pair to answer the following question in two minutes:? If I had HIV, in what ways would it change my life?Explain to the participants that they should refer to the questions in thehandout when thinking about how their lives would change if they had HIV.2. Then ask the pairs to take turns answering the following questions, allowingeach person four minutes to do so:? What would be the most difficult part about being infected with HIV?58

Why?? What changes would I want to make in my romantic and intimaterelationships?3. Bring everyone back together and lead a general discussion using the followingquestions:? What ideas did people come up with?? How did you feel answering the questions?? How do HIV-positive people you know or hear about deal with living withthe virus?? How do people who do not know their HIV status think about what lifewould be like if they were HIV-infected?4. Explain that you want to look more closely at the differences between theimpacts of HIV/AIDS on women and on men. Divide the participants intotwo groups. Ask the first group to discuss what it is like as a woman to livewith HIV/AIDS. Ask the second group to discuss how men are affected byHIV/AIDS.5. Allow 30 minutes for this group work and then ask each group to present thehighlights of their discussion. Then lead a discussion using the followingquestions:? What are the main differences between women and men in termsof living with HIV/AIDS?? What are the main differences between women and men in termsof being affected by HIV/AIDS?? What are the main differences between women and men in termsof caring for someone with HIV/AIDS?? Who can a HIV-positive young man or young woman go to forhelp? Is there any support network for PLWHAs in yourcommunity or region?? How can men get more involved in caring for people who areliving with HIV/AIDS?? What other roles can men play in reducing the impact ofHIV/AIDS on women and on other men?? What impact does HIV/AIDS have on a community in general?? How can we be more accepting of people in the community whoare living with HIV/AIDS?6. Make a note of any action suggestions on the Ecological Model and sum up thediscussion, making sure the key points in the closing are covered.59

ClosingNowadays, with advances in medicine and pharmacological resources and a greaterunderstanding of HIV/AIDS itself, the quality of life of people with HIV/AIDShas increased considerably. This means that PLWHAs can live lives that are similarto the rest of society. For example, they can continue to date, marry, have an activesexual life, bear children, and work.However, PLWHAs often suffer prejudice and discrimination in society and requirespecial health treatments and medications. Above all, they require and want respectand dignity. There are more and more people who have been infected for a longtime and who lead active and productive lives (try to find examples in yourcommunity, country, or region.). They are proof that a life with HIV/AIDS is notone that is “over,” but rather one that “continues.” To this end, it is fundamentalthat you and other people do your part to help build a community that is just andsupportive of all people, including those living with HIV/AIDS.Women are more heavily affected by HIV/AIDS than men. The health care offamily members is only one of women’s many responsibilities . This care is free, butit has a cost! If they are ill themselves or caring for ill people, women cannot dotheir other work. This has a serious impact on the long term well-being of thehousehold. Women bear a burden of guilt, fearing the possibly of infecting theirchildren. Living with the discrimination and stigma increases stress. Care does notend with the death of the person with AIDS. Women are often blamed for nothaving cared for the husband enough. Some are even accused of being a witch.Care of orphans fall on grandmothers and aunts. Women caregivers are often HIVpositivethemselves.Gender roles affect the way men deal with HIV/AIDS. Gender roles can harmthe health and well-being of men living with HIV. Research has shown that menchoose not to get involved in care and support activities because of fears of beingridiculed for doing women’s work. 26 Similarly, gender roles encourage men to viewseeking help as a sign of weakness. This prevents men from seeking counseling andsupport when they are infected and/or ill. This belief also prevents men fromsupporting each other in dealing with HIV/AIDS. These same gender roles alsoincrease the likelihood that men might use alcohol, drugs, or sex to ease feelings ofdespair and fear.Men can play a greater role in reducing the impact of HIV/AIDS. We needto help and challenge men to get more involved in care and support activities. Mencan also talk with the women in their lives about sharing the tasks in the family orhousehold more equally. This would reduce the burden on women. Men have acritical role to play in supporting other men to deal with HIV/AIDS, bothemotionally and practically.26 For instance, in a 1998 UNAIDS study, the authors revealed that in Kyela, Tanzania “male heads of households would wish to domore when their partners fell ill but were curtailed by cultural definitions of maleness and the roles defined which determinemasculinity.” Aggleton, P., & Warwick, I. 1998. A comparative analysis of findings from multisite studies of household and community responses toHIV and AIDS in developing countries. UNAIDS: Geneva.60

Handout 7A: General Life QuestionsAt home:1. How many people live together in your home?2. Do you do any housework?3. What is the atmosphere like in your home?4. How do you relate to the people that live in your home?At school:1. Do you go to school?2. Where do you study?3. What time?4. How many hours a day?5. What do you like most at school?6. What do you like least at school?Dating:1. Do you have a girlfriend (wife)?2. How long have you been going out?3. Do you generally see each other every day?4. Where do you go?5. What do you do together?6. What do you like most about her?7. What do you like the least about your relationship?At work:1. Do you work?2. What do you do?3. How many hours a day? What are your working hours?4. How do you get along with your colleagues?5. What do you expect from your job?With friends:1. When do you meet your friends (morning, afternoon, night)?2. What do you do together?3. Do you have a favorite place to go to (beach, bar, club, street, someone’s house)?4. Do you play any sport together?5. What do you do to have fun?Leisure:1. What are your leisure activities?2. Do you spend any time alone? How much? What do you generally do in this period?3. Do you do any activities by yourself? What? How often?61

7.2 Men, Women, and CaregivingObjectives1. To increase awareness about traditional gender divisions in caregiving2. To promote men’s increased participation in caregiving in their homes,relationships, and communitiesAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:HighOne hour and 30 minutesMaterials • Two empty boxes (a shoe box, for example)• Cut-outs• Photos or drawings of people, animals, plants, and other things men and•women care forResource Sheet 10: HIV and Caregiving• Enough copies of Handout 9: Tshepo’s Story for all participantsStepsPart 1 – 45 minutes1. Prior to the session, the facilitator should prepare up to 10 images (drawn orcut from newspapers or magazines) of babies, elderly persons, large and smallanimals, plants, houses, cars, clothing, diapers, garden tools, and otherpersons/objects that men and women “care” for. If possible, the facilitator canbring some of the objects themselves to the session. It is okay to have multiplecopies of certain images or objects. When working with school groups, thefigures can be replaced with words, but the use of images, even in these groups,makes the activity richer.2. At the beginning of the session, present the two boxes to the participants,saying that one of the boxes will be given to a man and the other to a woman.3. Present the images and objects to the participants and ask them to place theimages and objects that women know how to care for. or are better at caringfor, than men.4. In the man’s box, ask the participants to put the images and objects that menknow how to care for, or are better at caring for, than women.5. After they have done this, take the images and objects out of the box, one byone, showing them to the group.6. Then, try to explore how the men grouped the images and objects together,using the following questions: Why are some types of images and objects found only inthe man’s box?? Why are some types of images and objects found only in the woman’s box?? Why do some images and objects appear in both boxes?? Looking at the images and objects in the box for women, do you think that a62

man could properly care for these things?? Looking at the images and objects in the box for men, do you think that awoman could properly care for these things?1. Write the words “female carer” and “male protector” on flipchart paper. Askparticipants what the differences are between being a “carer” and being a“protector.” Use the information in Resource Sheet 10 to explain thisdifference and its impact on women.2. Ask participants what they know about the burden of AIDS care carried bywomen. Look for and share further information on this from Resource Sheet10. Make the point that AIDS makes it more important than ever that menshare the burden of care.3. Explain that you want to look at the pressures that prevent men from gettingmore involved in caring for others. Divide participants into three groups. Askthe first group to discuss the social pressures that make it hard for men to takeon the role of “carer.” Ask the second group to discuss the economicpressures that make it hard for men to take on the role of “carer.” Ask thethird group to discuss the psychological pressures that make it hard for men totake on the role of “carer.” Ask each group to discuss ways to reduce thesepressures, so that more men can become carers.4. Allow 20 to 30 minutes for this group work. Then bring the groups backtogether. Ask them to take turns reporting back to the other two groups.Allow a few minutes for questions at the end of every report. When all havedone so, lead a discussion with these questions:? What pressures (social, economic, psychological) have the biggest impact onpreventing men from being carers?What opportunities are there for men to get more involved in caring forothers?? What actions are needed to support men in being carers?Part 2 – 45 minutes1.”Divide the participants into three smaller groups. Ask each group to read thecase study and discuss the set of questions afterward.2. Bring the participants together and ask participants to share some of the issuesthey discussed in their small groups.3. Conclude the session with the following questions:? Do you think men in your community face similar challenges to Tshepo? Whyor why not?? What could be done in your community to help men play a greater role in careand support for people living with HIV and AIDS?63

After considering the specific groupings,(what groupings?) open up the discussionwith the questions below:? Can men and women learn to care for things in different ways?Or, is the way we care for things part of our culture or ourbiology?? Do men take care of themselves? Why or why not?? Do women take care of themselves? Why or why not?? Other than children, who else do men and women care for(siblings, grandparents, etc.)? Who, in general, cares more for thesepeople, men or women? Why?? Are there men in your families or communities who are goodcaregivers? What do other people in your family or communitythink of these men?? Are there men in your families or communities who are goodcaregivers for PLWAs? In what way?? Have you ever taken care of a person or object? How did it feel tobe a caregiver? What did others think of you in this role?? From what you have heard in this discussion, is there a change youmight like to make in your life around caregiving?ClosingIt is common to assign the task of caring for people, animals, and plants, as well asdaily housework, to women. On the other hand, men are expected to care forobjects, such as cars, electrical work in the house, painting the walls, repairing theroof, etc (depending on local culture). It is important to stress that many of theseideas about caregiving come about as a result of learned behavior. For example,girls are encouraged, from an early age, to play with dolls, practicing whatsupposedly lies ahead for them: domestic life and caring for family members. Onthe other hand, boys are generally discouraged from playing with dolls or helpingout with domestic chores. This lack of male involvement in caregiving often meansthat women carry a heavy burden and that men miss out on many of the pleasuresinvolved in caring for children. As you think about promoting equity between menand women in your communities, it is important to start in the home and thinkabout how you, as men, can participate more in caregiving tasks in your family, aswell as how you can encourage other men to do the same in their homes.64

Handout 7B: Tshepo’s StoryTshepo is a 23-year-old man. He matriculated five years ago, and now does construction work. Tshepolives at home with his mother, his older sister Thembi, and her three young children ages 2, 6, and 12.Thembi is living with AIDS, and has been experiencing serious health problems for the past year. On manydays, she is too weak to leave her bed. Thembi’s husband died of an AIDS-related infection last year.Tshepo’s mother is diabetic, and therefore has health concerns of her own. Nonetheless, she continues towork as a maid, and spends all of her free time caring for her three grandchildren. Thembi’s youngest childVusi, is HIV-positive, and therefore often requires special attention.Tshepo has been noting the strain thatThembi’s and Vusi’s illnesses have placed on the rest of his family.His mother is so busy that she does not get adequate rest, further complicating her struggle with diabetes.Meanwhile, Thembi’s oldest daughter has dropped out of school in order to help with care for the family.Tshepo has felt compelled to do his part, and initially tried to help in the house. Tshepo tried to help hismother and niece in caring for Thembi and Vusi, but there have been many challenges. Tshepo had neverlearned to cook or clean, and found he lacked the skills to do this. He felt embarrassed to ask. When he didtry to wash clothes, his mother complained that he did it incorrectly, saying, “men are useless in thesematters!” Tshepo also found little support from his peers. His friends tease him for cooking, and becomeannoyed when he doesn’t join them for drinking on the weekends. They often say, “Why are you doingwomen’s work? That is your mother’s job!”Discussion Questions1. What challenges does Tshepo face as he tries to play a role in the care and support for his family?What other challenges do you think he may be facing?2. What could Tshepo do to overcome these challenges?3. How could Tshepo’s friends and family help him overcome these challenges?65

Resource Sheet: HIV and CaregivingWomen bear the brunt of the burden of AIDS care. Research in many countries has found that themajority of the AIDS caregivers are women or girls—many of them younger than 18 years. School-aged girlsare increasingly pulled out of school to take care of the sick and to assume household responsibilitiespreviously carried out by their mothers. At the other end of the lifespan, elderly women are often required totake care of children orphaned by AIDS, finding themselves emotionally and physically taxed by tasks usuallyperformed by much younger women.The burden borne by women in areas without access to running water is enormous. Research shows that onein six AIDS-sick individuals in households cannot control their bowels and about the same number cannotcontrol their bladders. Caring for a person sick with full blown AIDS requires 24 buckets of water a day toclean up diarrhea and vomitprepare for several baths a day, and to cook. This is an unbearable burden formany women who must walk miles to get the water, and still do all the other chores thatneed doing.Social pressures on men: Strict gender roles saying that “real men” don’t do household chores makes ithard for them to share the burden of AIDS care with their wives. Those men who do attempt to share theburden may face ridicule from other men and women.Economic pressures: It remains true that men typically earn more than women for doing the same kind ofwork. This greater earning potential means that it can make economic sense for men to focus on their paidwork and leave the unpaid caring work to women. However, the world of work is changing. New jobs areincreasingly being taken by women and male unemployment is increasing. In this situation, it makeseconomic sense for the man to take on the role of carer at home.Psychological pressures on men: These pressures come from men’s own sense of themselves and theirattitudes about what is appropriate for a man to do. These attitudes are based on the gender roles discussedabove. They are the internal expression of the external pressure from society’s ideas about the differencebetween being a man and being a woman.Actions to increase men’s role in AIDS care: There are many ways to help to get more men involved inAIDS care. Such actions need to change men’s attitudes, build men’s caring skills, and create a moresupportive environment of policy and public opinion for men as “carers.”66

Chapter 8 - Violence8.1 What is Violence?Objective1. To identify different types of violence that may occur in intimate relationships andcommunitiesAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:MediumOne hour and 30 minutesMaterials • Flipchart• Marker pens• Resource Sheet 11: Case Studies on Violence and Resource Sheet 12: Whatis Gender-Based Violence?Facilitator’snotesPrior to the sessions on violence, it is important to research locally-relevantinformation concerning violence, including existing laws and social supports forthose who inflict and/or suffer from violence. It is also important to be prepared torefer a participant to the appropriate services if he reveals that he is a victim ofviolence or abuse.As the facilitator, you can assist the group in this discussion by:• Explaining that this is not a support group, but that you can talk toanyone afterwards to tell them about any support services you know about.• Being aware of people’s reactions and body language and remindingthe group of the importance of people taking care of themselves (e.g., it is okayto take a break).• Explaining that keeping full confidentiality is usually very difficultand that participants who want to talk about their own experience, but who donot want others outside the group to know about it, can choose to talk about theviolence that “people like them” experience.• Challenging participants who try to deny or reduce the significanceof violence, in particular violence against women and children.The case studies included in Resource Sheet 11 depict diverse examples of violence,including men’s use of physical, sexual, and emotional violence against women inintimate relationships (case studies #1, 2, and 3); men’s use of physical violenceagainst women outside the context of an intimate relationship (case study #3);physical violence between men (case study #4); and community-level, orinstitutional, violence against individuals and groups of people (case study #5). Ifnecessary, you can adapt these case studies or create new ones to address other typesof violence that also occur in intimate relationships, families, or communities.StepsPart 1 – What Does Violence Mean to Us? (30 minutes)1. Ask the group to sit in a circle and to think silently for a few moments aboutwhat violence means to them.67

2. Using the talking stick, invite each participant to share with the group whatviolence means to them. Write the responses on flipchart paper.3. Discuss some of the common points in their responses, as well as some of theunique points. Review the definitions of violence below and tell the participantsthat there is not always a clear or simple definition of violence and thatduringthe second part of the exercise, you will read a series of case studies tohelp them think about the different meanings and types of violence.Physical violence: Using physical force such as hitting, slapping, orpushing.Emotional/psychological violence: Often the most difficult form ofviolence to identify. It may include humiliating, threatening, insulting,pressuring, and expressing jealousy or possessiveness (e.g., bycontrolling decisions and activities).Sexual violence: pressuring or forcing someone to perform sexual acts(from kissing to sex) against their will, or making sexual comments thatmake someone feel humiliated or uncomfortable. It does not matter ifthere has been prior consenting sexual behavior.Part 2 – Discussion of Different Types of Violence (One hour) Read the casestudies on violence and follow up each one with the following questions, using thetalking stick.? What kinds of violence most often occurs in intimate relationshipsbetween men and women? What causes this violence? (Examples may includephysical, emotional, and/or sexual violence that men use against girlfriends orwives, as well as violence women use against their boyfriends or husbands.)? What kinds of violence most often occur in families? What causesthis violence? (Examples may include parents’ use of physical, emotional, orsexual violence against children or other types of violence between familymembers.)? What kinds of violence most often occur outside relationships andfamilies? What causes this violence? (Examples may include physical violencebetween men, gang or war-related violence, stranger rape, and emotionalviolence or stigmatizing certain individuals or groups in the community)? Are some acts of violence related to a person’s sex? What is themost common type of violence practiced against women? (See Resource Sheet12: What is Gender-Based Violence?) Against men?? Are only men violent, or are women also violent? What is the mostcommon type of violence men use against others? What is the most commontype of violence that women use against others?? Does a man or woman ever “deserve” to be hit or suffer violence?? What are the consequences of violence on individuals? Onrelationships? On communities?? What are the consequences of violence, in relation to condomusage? In relation to HIV transmission?68

? What can you and other men do to stop violence in yourcommunity?ClosingLinks:Violence can be defined as the use of force (or the threat of force) by one individualagainst another. Violence is often used as a way to control another person, to havepower over them. It happens all around the world and often stems from the wayindividuals, especially men, are raised to deal with anger and conflict. It is commonlyassumed that violence is a “natural” or “normal” part of being a man. However,violence is a learned behavior, and in that sense, it can be unlearned and prevented.As discussed in other sessions, men are often socialized to repress their emotions,and anger is sometimes one of the few socially acceptable ways for men to expresstheir feelings. Moreover, men are sometimes raised to believe that they have the“right” to expect certain things from women (domestic tasks or sex, for example),and the right to use physical or verbal abuse if women do not provide these things.Men may also resort to violence to assert their views or decisions, thereby makingcommunication among partners about condom-usage, sex, and HIV almostimpossible. It is important to think about how these rigid gender roles regardinghow men should express their emotions and how they should interact with womenare harmful both to men and their relationships. In your daily lives, it is essentialthat you, as men, think about what you can do to speak out against other men’s useof violence.This activity can also be linked to the earlier one on “Expressing My Emotions”and to a discussion about how to handle anger.69

Handout 8A: Case Studies on ViolenceCase Study #1Mtitu and Latifa are married. Mtitu’s family is coming over to their home for dinner. He is very anxious thatthey should have a good time, and he wants to show them that his wife is a great cook. But when he getshome that night, nothing is prepared. Latifa has not been feeling well, and she has not started making thedinner yet. Mtitu is very upset. He does not want his family to think that he cannot control his wife. Theybegin to argue and yell at each other. The fight quickly escalates, and Mtitu hits her.⇒ Do you think that Mtitu was right to hit Latifa?⇒ How should Latifa react?⇒ Could Mtitu have reacted differently in this situation?Case Study #2You are dancing with a group of friends at the disco. When you are about to leave, you see a couple(presumably a boyfriend and girlfriend) arguing at the entrance. He calls her a bitch and asks her why she wasflirting with another guy. She says, “I was not looking at him... and even if I was, aren’t I with you?” Heshouts at her again. Finally, she says, “You don’t have the right to treat me like that.” He calls her worthlessand tells her to get out of his face, that he can’t stand to look at her. He then hits her, and she falls down.She screams at him, saying that he has no right to do that.⇒ What would you do? Would you leave? Would you say anything? Why or why not?⇒ Would it be different if it were a guy hitting another guy?⇒ What can you do in situations like this one? What are your options?⇒ What is our responsibility to prevent others from using violence?Case Study #3Michael is an older boy who comes from a wealthy family. He meets Pili one day on her way home fromschool and they chat a little. The next day, he meets up with her again. This continues until one day he tellsPili how much he likes her. They start to kiss, and Michael starts touching Pili under her blouse. But then Pilistops and says that she doesn’t want to go any further. Michael is furious. He tells her that he has spent lots oftime with her and says, “What are my friends going to say?” He pressures her to to change her mind. First, hetries to be seductive, then he yells at her in frustration. He begins pulling at her forcefully, pushing her down.He then forces her to have sex, even though she keeps saying, “No, stop!”⇒ Is this a kind of violence? Why or why not?⇒ What do you think Michael should have done?⇒ What do you think Pili should have done?Case Study #4A group of friends go dancing. One of them, John, sees that some guy is staring at his girlfriend. John walksup to the guy and shoves him and a fight begins.⇒ Why did John react this way? Do you think that he was right to shove the other guy?⇒ How else could he have reacted?⇒ What should his friends have done?Case Study #5In many communities, people who are living with HIV/AIDS are shunned. They are insulted. Sometimestheir children are not allowed to go to school.⇒ Is this a type of violence?⇒ Do you think that this type of discrimination hurts people living with HIV/AIDS?⇒ What can be done to stop these types of things from happening?70

Resource Sheet: What is Gender-Based Violence?In many settings, most laws and policies use “family violence” or “domestic violence” to indicate acts ofviolence against women and children by an intimate partner, usually a man. However, there has been anincreasing shift toward the use of “gender-based violence” or “violence against women” to encompass thebroad range acts of violence that women suffer from intimate partners, family members, and otherindividuals outside the family. These terms also draw focus to the fact that gender dynamics and norms areintricately tied to the use of violence against women (Velseboer, 2003).Below is a definition of gender-based violence and violence against women based on the United NationsGeneral Assembly Declaration on the Elimination of Violence Against Women in 1994:…any act that results in, or is likely to result in, physical, sexual or psychological harm orsuffering to women including threats of such acts, coercion or arbitrary deprivation ofliberty, whether occurring in public or in private life.…shall be understood to encompass, but not be limited to the following:a. Physical, sexual and psychological violence occurring in the family, including battering, sexualexploitation, sexual abuse of children in the household, dowry-related violence, marital rape, femalegenital mutilation and other traditional practices harmful to women, non-spousal violence andviolence related to exploitationb. Physical, sexual and psychological violence occurring within the general community,including rape, sexual abuse, sexual harassment and intimidation at work, in educational institutionsand elsewhere, trafficking in women and forced prostitutionc. Physical, sexual and psychological violence perpetrated or condoned by the State andinstitutions, wherever it occurs.71

Objectives8.2 Sexual Violence in the Daily Routine1. To better understand the many ways in which women’s (and men’s) lives arelimited by male violence, especially sexual violenceAudienceTimeAge: Youth or adults; Sex: Men (with adaptation) or mixed groups; Literacy: Anylevel; Resources: Medium60 minutesMaterials • Flipchart• MarkersFacilitator’snotesThis activity is critical for setting and establishing a clear understanding of the extentand impact of men’s violence against women. Be sure to allow ample time! Thisactivity works best in mixed gender workshops where the ratio of men to women isreasonably balanced. But it can be included in any workshop.If men are defensive, make sure to look more closely at their reactions. Make it clearthat you’re not accusing anyone in the room of having created such a climate of fear.Remind the group that you are trying to show how common and how devastatingviolence against women is.Some people have strong emotional reactions to this activity. These reactions caninclude anger, outrage, astonishment, shame, embarrassment, and defensiveness. Asworkshop participants show their feelings, let them know that their reaction isnormal and appropriate. Many people are shocked and become angry when theylearn the extent and impact of violence against women. Remind them that angercan be a powerful motivating force for change. Encourage them to identify ways touse their anger and outrage usefully to prevent violence and to promote genderequity.Be aware that some men may think that they need to protect women from violence.If some men in the group say this, remind the group that it is important for each ofus to be working to create a world of less violence. Men and women need to worktogether as allies in this effort. The danger of saying that it is up to men to protectwomen is that we take away women’s power to protect themselves.Steps 1. Draw a line down the middle of a flipchart paper from top to bottom. On oneside, draw a picture of a man and on the other, a woman. Let the participantsknow that you want them to reflect on a question in silence for a moment. Tellthem that you will give them plenty of time to share their answers once theyhave thought it over in silence. Ask the question:? “What do you do on a daily basis to protect yourself from sexual violence?”2. Ask the men in the group to share their answers to the question. Most likely,none of the men will identify doing anything to protect themselves. If a mandoes identify something, make sure it is a serious answer before writing it down.Leave the column blank unless there is a convincing answer from a man. Pointout that the column is empty or nearly empty because men don’t usually eventhink about having to protect themselves from sexual violence.72

3. If there are women in the group, ask the same question. If there are no women,ask the men to think of their wives, girlfriends, sisters, nieces, and mothers andimagine what these women do on a daily basis to protect themselves from sexualviolence.4. Once you have captured ALL the ways in which women limit their lives toprotect themselves from sexual violence, break the group into pairs and tell eachpair to ask each other the following question. Each person has five minutes toanswer:? “What does it feel like to see all the ways that women limit their lives because oftheir fear and experience of men’s violence?”5. Bring the pairs back together after 10 minutes and ask people to share theiranswers and their feelings. Allow plenty of time for this discussion, as it canoften be emotional. Then ask each pair to find two other pairs (to form groupsof six people) and discuss the following questions for 15 minutes:? How much did you already know about the impact of men’sviolence on women’s lives?? What does it feel like to have not known much about it before?How do you think you were able to not notice this, given its significant impacton women?? How does men’s violence damage men’s lives as well?? What are the consequences of sexual violence in relation toHIV?? What do you think you can do to change this trend and tocreate a world in which women don’t live in fear of men’s violence?6. Bring the small groups back together after 15 minutes and ask each group toreport back on its discussion. Sum up the discussion, making sure all points in theclosing are covered.ClosingSexual violence and the threat of violence is an everyday fact for women.Because men do not live with the daily threat of sexual violence, they do notrealize the extent of the problem women face. Men usually do not understandhow sexual violence—actual and threatened—is such a regular feature ofwomen’s daily lives. However, men’s lives are damaged too by sexual violenceagainst women. It is men’s sisters, mothers, daughters, cousins, and colleagueswho are targeted—women that men care about are being harmed by sexualviolence everyday. Social acceptance of this violence against women gives menpermission to treat women as unequal and makes it harder for men to bevulnerable with their partners, wives, and female friends. Sexual violence makesit impossible for a woman to negotiate condom use and eliminates any elementof choice regarding the decision to have sex or not. Also, as mentioned in otheractivities, the tearing of tissue during rape dramatically increases the risk forHIV transmission. Therefore, the prevention of sexual violence is key toreducing HIV.73

Chapter 9 - Making Change, Taking Action9.1 Men’s Role in Health PromotionObjectivesAudienceTime1. To identify key roles that men can play in promoting healthAge: Youth or adults; Sex: Men or mixed groups; Literacy: Any level; Resources:Medium60 minutesMaterials • Flipchart• MarkersAdvancepreparationOn flipchart paper, write six roles that men play in social and economic life, asfollows:Partner or Husband or BoyfriendBrother or CousinFather or UncleFriend or ColleagueManager or SupervisorCommunity leaderSteps 1. Explain that this activity looks at what men can do in each of these roles topromote health and (awkward phrasing. Want to say: “…promote health, and,most importantly, how they can prevent…”how they can help preventunintended pregnancies and HIV/STIs (including prevention of mother tochild transmission—PMTCT).2. Begin the session by drawing a problem tree. Explain that you would like tolook at causes and consequences of men not being supportive of sexual andreproductive health services. Once causes and consequences have beendiscussed,focus the group’s attention on what men can do to affect thosecauses3. Divide into six groups. Give each group one of the following roles:• Partner or Husband or Boyfriend• Brother or Cousin• Father or Uncle• Friend or Colleague• Manager or Supervisor• Community leader4. Ask each group to discuss what men in their specific role could do toprevent unintended pregnancies and STI/HIV infection. Allow 15minutes for this small group work. Ask the groups to write this list of possibleactions on a sheet of flipchart paper.74

5. Bring everyone back together. Ask each small group put up their flipchart andreport back on their discussion. After each report, allow a few minutes for therest of the group to ask questions and make comments.6. Discuss the actions recommended by the small groups, using the followingquestions and the information in the closing to discuss the answers:? How best can men use their privilege and power to promote health andprevent pregnancies/HIV/STIs?? What can men do to be more involved in caring for family and friends whoare living with HIV/AIDS (e.g., home-based care).? How do men’s roles in promoting health and prevention link to genderequality?7. Make a note of the group’s suggestions for action on men’s roles in HIVprevention on the Ecological Model.ClosingMen can use their privilege and power in several ways to prevent HIV/STIsand unintended pregnancies. The most immediate role men have in sexualhealth is in their own sexual lives. The privilege that men are granted because oftheir gender give them power over women in sexual decision making. With powercomes responsibility. Men can use this responsibility to protect themselves andtheir sexual partners from HIV/STI infection and unintended pregnancy. But menalso have power in the family, the community, and the workplace. They can use thispower to promote STI/HIV and pregnancy prevention, and support genderequality in order to reduce women’s sexual vulnerability.Promoting gender equality must be central to men’s roles in HIV prevention.Acting in their roles in the family and community, one of the biggest contributionsmen can make to HIV prevention, is to promote gender equality. Women’s lowersocial, economic, and political power is the basis of their greater vulnerability toHIV. Increasingly, HIV/AIDS is becoming a women’s disease in Africa. In takingaction on HIV, men need to listen to women, act as allies rather than protectors,and challenge sexist attitudes, behaviors, and policies.75

9.2 New Kinds of CourageObjectivesAudienceTimeMaterials1. To identify and encourage strategies that promote healthy relationships2. To understand ways to develop fairer and more responsible sexual practices3. To understand ways to challenge and take responsibility for men’s violenceagainst womenAge: Youth or adults; Sex: Men; Literacy: Medium; Resources: Medium75 minutesSet of Action Sheets; Signs with “Least Courage” and “Most Courage”; Tape;Markers; FlipchartScenarios for Action Sheets:• Ignore a domestic dispute taking place in the street in front of your house• Tell a friend that you are concerned that they are going to get hurt by theirpartner• Tell a man that you don’t know very well that you don’t appreciate himmaking jokes about women’s bodies• Tell a friend that you don’t like it when they tell jokes about gays andlesbians• Walk up to a couple that is arguing to see if someone needs help• Call the police if you hear fighting from a neighbor’s house• Tell your partner about your HIV-positive status• Encourage your son who is pursuing a career in nursing• Keep quiet when you hear jokes that excuse or promote violence againstwomen• Defend gay rights when you are with your friends at a bar• Walk up to a group of men and tell them to stop harassing girls when theywalk by• Tell a colleague that you think he is sexually harassing female co-workers• Let your partner have the last word in an argument• Put your arm around a male friend who is upset• Encourage your son to always treat women with respect• Encourage your daughter to pursue any career she chooses• Speak to your cousin about using condoms• Tell a male friend that you admire the way he looks after his children• Cook for your partner and children after a long week at work• Participate in a men’s march protesting violence against women andchildren• Tell your son that it is okay if he cries76

• Cry in public when you feel like crying• Encourage a neighbor to seek counseling for his abusive behavior• Tell a sexual partner you are not ready to have sex with them• Insist on using a condom even when your sexual partner does not want toAdvancepreparationBefore the session begins, create a “Spectrum of Courage” on a wall in the trainingroom by posting the “Least Courage” sign on the left side of the room and the“Most Courage” sign on the right.Steps 1. 1. To begin, ask the participants whythey think men should be concerned about violence against women andchildren. During the discussion, review the key points and ensure that they arecovered.2. 2. Next, ask the group to develop ashort list of actions that men can take to prevent violence, especially againstwomen and children, and to promote gender equity in their own relationshipsand in the community-at-large. Write these on a flipchart.3. 3. Pass out the cards to participants.4. 4. Ask the participants to examine thefollowing situations and determine where they fall on the “Least Courage-Most Courage” spectrum posted on the wall.5. 5. After all the cards have been postedon the wall, review each and discuss with the entire group whether they agreeor not with the placements of the cards.6. 6. Divide the participants into groupsof six to seven people. Hand out three to four cards and ask each group tocome up with a role-play that depicts one of these situations. Ask them to beclear about what they would say and do to promote gender equality, respect forothers, and healthy relationships.7. 7. Once each group has presented itsrole-play, discuss the strategies used, and action taken, to prevent violence.Closing8. 8. Summarize, by first askingparticipants what they have learned from the session, and if they think theycan take action to end violence. End the session by reviewing the key points.Men can play a critical role in setting a positive example for other men by treatingall others with respect and challenging other men’s oppressive attitudes andbehaviors. Most men care deeply about the women and girls in their lives, whetherthey are their wives, girlfriends, daughters, cousins, other family members orfriends, colleagues, fellow parishioners, or neighbors.When some men commit acts of violence, it becomes more difficult for women totrust any men. In other words, as a result of the actions of some men, all men areseen as potential rapists and perpetrators. Men commit the vast majority ofdomestic and sexual violence and therefore have a special responsibility to end theviolence. It is, in other words, men’s work to end violence committed by men.77

9.3 Don’t Stand By, Take ActionObjectives1. To identify the roles that men can play as active bystanders in stopping men’sviolence2. To identify the supports that will help men take on these roles as active bystandersAudienceTimeAge: Youth or adults; Sex: Men; Literacy: Medium; Resources: Medium75 minutesMaterials • Flipchart• Markers• Enough copies of Handout 10: What Men Can Do As ActiveBystanders and Handout 11: Scenarios for all participantsFacilitator’snotesPay attention to participants’ reactions to this activity. It may remind some people ofexperiences in their own lives—when they were a target of violence and bystandersdid not do enough to stop the violence, or when they were a bystander and did notdo enough to stop the violence. Remind participants that it is okay to step out ofthe activity to take care of themselves. Make yourself available at the end of thesession if anyone needs support.Be clear that the aim of this activity is not to make anyone feel guilty for not havingdone enough in the past to stop violence. Rather, it is to look to the future and tosee what more we can do to help stop the violence in our communities.Steps 1. Introduce the idea of the “active bystander.” Use the definition in Handout 10,if needed. Ask participants to share examples of people taking on the role ofbeing an active bystander and ask:? What did these active bystanders do?? Why was it important that they took some form of action?2. Ask the group why it is so important that men take more action as activebystanders in trying to stop men’s violence (see Handout 32).3. Brainstorm with the group some of the things that men could do as activebystanders in their community to stop the violence (see Handout 11.)4. Explain that one of the challenges of men taking on the role of active bystanderis that this role can get confused with the sexist idea that men are supposed toprotect women. Ask the group and use the information in Handout 11 to discusstheir answers:? What problems do you see with the idea that men are supposed to protectwomen?5. Brainstorm with the group some of the main reasons men give for not being78

more active as a bystander trying to stop men’s violence (see the Example inHandout 11).6. Pass out Handout 12. Divide the participants into smaller groups and assigneach group a scenario from Handout 12, to prepare as a short role-play. Eachrole-play illustrates a conversation between a reluctant bystander and a friendwho persuades him to become active and take action.7. Run the role-plays and then debrief, using these questions:? In the role-plays, what worked well and what didn’t work so well when itcame to persuading the person to become an active bystander?? How can we persuade more people to become active bystanders?? What stops men from being more active bystanders?? What is needed to help men become more active bystanders?8. Ask participants to get back into their small groups and give each group one ofthe scenarios to discuss for 15 minutes.9. Bring the groups back to share the highlights from their discussion and theiranswers to the questions.10. Summarize the discussion by highlighting the need for men to become moreactive bystanders, what kind of action those men can take, and the support menmight need to do so.ClosingViolence occurs every day, but many people prefer to ignore it or deny it,especially men’s violence against women. An active bystander is someone whochooses not to stand by and let the violence continue, but takes some form ofaction to help stop the violence. Reducing the level of violence in society willrequire many more men to step up as active bystanders. Most violence iscommitted by men, and many men are more likely to listen to another man thanthey are to a woman. These two facts make it essential that more men getinvolved as active bystanders intervening to stop other men from being violent..It is also important to mobilize mobilize men with power, includinggovernment, community, and business leaders, as well as policy-makers, to thinkof themselves as active bystanders in the effort to end violence” ) Taking stepsas an active bystander is often not easy, especially for men who are taking actionto stop other men’s violence. It is important for men to identify ways they cansupport each other in their efforts to be more active bystanders.Sexist gender norms expect men to be the protectors of women. One danger inthe active bystander approach is that some men will think that their role as anactive bystander is to protect women. But the male protector role only ends upreinforcing women’s disempowerment, which is the goal of men’s violence inthe first place. A core principle of the active bystander approach is that it muststrengthen rather than weaken the empowerment of those who are targeted byviolence.79

Handout 9A: What Men Can Do as Active BystandersThere are many ways that bystanders can prevent, interrupt, or intervene in abusive and violent behaviors,and the majority carry little or no risk for physical confrontation. Since these interventions are not alwaysapparent to people, work with men as active bystanders should introduce as many nonviolent,nonthreatening options as possible. A key element of the Active Bystander approach is facilitating adiscussion of options that bystanders have in a variety of realistic scenarios.Here are some examples of nonviolent options for bystander actions:• Talk to a friend who is verbally or physically abusive to his partner in a private, calmmoment, rather than in public or directly after an abusive incident.• Talk to a group of the perpetrator's friends and strategize a group intervention of somesort. (There is strength in numbers.)• If you have witnessed a friend or colleague abusing a partner, talk to a group of thevictim's friends and strategize a group response.• If you are a school or college student, approach a trusted teacher, professor, socialworker, or health professional. Tell them what you've observed and ask them to do something, or askthem to advise you on how you might proceed/Adapted from: Online Toolkit for Working with Men and Boys, Family Violence PreventionFund, San Francisco, Ca., USAExample Reasons given for not being an active bystander“It’s a private affair—it’s not my business.”“My friends will not take me seriously if I speak out against violence.”“I may get hurt myself if I get involved.”“That is the job of the police.”81

Scenario 1Boys Will be BoysHandout 9B: ScenariosYou are walking down a street and see a group of male construction workers verbally harassing awoman.Questions for group to discuss:? What can you do in this situation?? What possible consequences may happen to you? To the woman? To the men?? Could anything be done to prevent this situation?Scenario 2NeighborlinessYour neighbors are a married couple. You often hear your neighbors arguing with each other. Onenight, you are asleep and are woken up by the sounds of your female neighbor screaming as if sheis being hurt and her husband shouting at her.Questions for group to discuss:? What can you do in this situation?? What possible consequences may happen to you? To the woman? To the man?? Could anything be done to prevent this situation?Scenario 3PartyYou are with some friends at a house party. One of your male friends is talking about how he isalways getting with “hot chicks.” You have heard from other people that he doesn’t always treatwomen with respect. You notice one of your female friends is very drunk and is being sweettalked by this guy. You see them leaving the party and go outside.Questions for group to discuss:? What can you do in this situation?? What possible consequences may happen to you? To the woman? To the man?? Could anything be done to prevent this situation?Scenario 4Across the StreetYou are at a friend’s house watching television. You hear a woman’s voice screaming for help.You and your friends run outside and see a man forcing a woman to have sex in the park acrossthe street. You are not sure if he has a weapon or not.Questions for group to discuss:? What can you do in this situation?? What possible consequences may happen to you? To the woman? To the man?? Could anything be done to prevent this situation?82

9.4 Men Holding Men AccountableObjectivesTo identify ways in which men can hold each other accountable in being genderequitableAudienceTimeAge: Youth or adults; Sex: Men or mixed groups; Literacy: Medium; Resources:MediumOne hourMaterials • Flipchart• Markers• Enough copies of Handout 12: Case Studies for all participantsSteps1. Begin by asking the participants the following question:? What does it mean for men to be gender equitable?1. Ask participants to think about it on their own for two minutes and then turnto their neighbor and discuss the question.2. After about five minutes, ask for volunteers to share what they discussed andrecord their answers on a flipchart.3. Next, explain that this list is an ideal and that it is often challenging to live upto this ideal. A good way, however, to affect change is for individuals to keepeach other accountable.4. Divide the participants into four groups and pass out the handout and ask eachgroup to discuss one of the case studies. Give them about 15 minutes todiscuss the situation and come up with solutions/answers to the questions.5. Have them report back and conclude with the following questions:? What can men do to keep each other accountable?? Was this session helpful?? What did you learn from this session?? Do you think it’s possible for men to develop individual “codes ofconduct” for themselves?? What would be the components of that code of conduct?Closing? How could the code be enforced?6. Time permitting, give participants about 20 minutes to develop such codes ofconduct. Once they have finished, they can share in pairs.Changing your attitudes and behaviors is not always easy. It is important to keepthis in mind and to think about how you can support each other to make thesechanges in your lives and relationships. Try to also think about how you can sharethe information you have learned in these activities with other men in yourcommunity, and engage them in the kinds of questioning and discussions you havehad here. Remember, we all have a role to play in building more equitable andpeaceful communities.Starting with our own lives and relationships is an importantfirst step.83

Handout 9C: Case StudiesCase Study 1: Thabiso is a MAP peer educator who travels at times to conduct workshops. He has beendating Mpho for the past two years and they have a good relationship. Every once in a while, when Thabisois traveling, he engages in sex with other people. He thinks this is harmless because his encounters are “onenight stands” and he is honest with the other partners about how he is involved with someone (usually afterhe has had sex with them). Mpho thinks their relationships is monogamous and is proud to be datingThabiso because he is such a good guy.You are a friend to both Mpho and Thabiso. You know what Thabiso is doing and you are not sure if he isalways using protection. What should you do in this situation?Case Study 2: Mike is a ME facilitator. Mike is married to Precious and they have two children. Mike is areally nice guy, very good-looking, and a bit of a charmer. Recently, he began dating another woman andfathered a child with her. This is the second time he has done such a thing— and he now has four children—two with Precious and one each with these other women. Recently, Mike hit Precious when they werearguing about his activities with other women. Mike apologized to her, but it was not the first time.You are a friend of Mike’s. At a recent MAP workshop, you hear some participants who know Mikegossiping about him and wondering how he can stand up there as a MAP facilitator when his personal life isnot going so well. What should you do in this situation?Case Study 3: Hudson is a youth pastor. He is single and enjoys going out with friends, playing snooker, anddrinking. Every weekend, he gets very drunk and tends to go home with a different woman. He says it isokay because he always uses condoms. You are his friend and a member of the same church. What shouldyou do in this situation?Case Study 4: Kenneth is an accounting intern. He has a long-term girlfriend who is living far away atuniversity. They are very much in love and trust each other. Kenneth enjoys going out to clubs and hangingout with his friends. From time to time, he flirts with other women and when they ask, he denies having agirlfriend. You trust Kenneth when he says he has never cheated on his girlfriend, but you have seen himkissing a few women. From Kenneth’s point of view, it is all harmless, as he is not having sex with thesewomen. When the other women push things, he backs off and does not return their phone calls.84

Chapter 10 - Introductory Activities – CommunityEngagementObjectives10.1 Why Work With Men on HIV and AIDSTime1. To develop a better understanding of the reasons for, and benefits of, working withmen on HIV and AIDS90 minutesMaterials • Flipchart• MarkersFacilitator’snotesWhen doing work in the community, participants may encounter resistance frompeople who think that HIV and AIDS or gender equity are not important issues formen to be involved with. This exercise helps to break down some of those ideas andprepares participants so they can respond positively to gender stereotypes andresistance they may encounter in the community.Steps1. Ask participants the following questions:? Why work with men?? Why should men care about gender equity? Why should they care about HIVand AIDS?2. Small Group Work (20 minutes)After the large-group brainstorm, divide the participants into smaller groups. Askthem to continue exploring the reasons for working with men, including some of thestereotypes or resistance that the participants might encounter in the community. Askeach group to create a performance that illustrates how to deal with the resistance andstresses the positive reasons for male engagement. (If necessary, use some of thereasons listed under Step. 5.)3. Performances (30 minutes)Ask each small group to present their performance.4. Debrief/Discussion (30 minutes)After the performances, ask participants the following questions:? What feelings came up while watching the performances? Could you relateto the performances?? What themes related to gender did you notice?? What themes about men and male engagement did you notice?? How does it benefit men to change?5. When closing, be sure that the key points listed below were covered in this session.Some of the reasons to work with men might include:• Men need to be aware of HIV and AIDS, safe sex, and reproductive health inorder to maintain their own health and protect their families.• Men are often leaders and role models in their families and the community;they have the responsibility and the opportunity to make a difference onthese issues.85

• We can begin to change stereotypes of men as perpetrators, and createimages of strong, gender-conscious men working for community safety andservices.• Men listen to other men.• Men are affected by HIV. It can affect them, their partners and theirchildren.• Men can play an active role in the care and support of people with HIV andAIDS.The performances will likely generate a lot of discussion. Themes that come upmight include:• Change occurs through interactions with others, especially with other men.• Men may have a hard time listening to women—culturally and socially it isseen as a weakness.• Men and women CAN choose to defy gender stereotypes.• The behavior of some men sometimes leads to the perception that “all menare bad,” rather than “there are a few bad apples.”• Men are important potential role models and shapers of norms andideologies—they can make a difference.• We need to challenge the idea that men believe they are entitled to sex andwomen’s bodies.• There is a sense that men have to give up some power (and maybe they do).Men are often threatened by women’s rights.86

Objectives10.2 What Does Community Engagement Mean to You? 27TimeMaterials1. To discuss key concepts related to community engagement75 minutes• Ten colored strips, each with one of the following words written in large letterson it: Community, Empowerment, Action, Team, Allies, Stakeholders, Male Involvement,Strategy, Tactic, and Leadership. Cut each strip into two to three jigsaw pieces, andmix them up.• Flipchart papers and markers for each small groupSteps• Enough copies of Handout 13: Definitions of Community Engagement for allparticipants.1. Explain to participants that this activity introduces key concepts that will come upin community mobilization activities and is a fun way to start a discussion about whatthey mean. The purpose is to draw out the knowledge and experience of individualswho will be working on community activities.There are two training options you can use with the participants. Use either option Aor B with the participants.Option A:2. Matching Jigsaws (Five minutes)Provide an overview of the activity, and then distribute the jigsaw pieces among theparticipants. Ask them to form a group with those that hold the other pieces to theirword.3. Group Analysis of Key Words (10 minutes)Ask each small group to discuss the meaning of their word and to record their ideason flipchart paper.4. Presentations (30 minutes)Ask each group to briefly summarize its definitions to the large group, using theflipchart. After all the presentations, ask the other participants to add any points theybelieve are missing. Once they have done so, distribute Handout 13: “Definitions ofCommunity Engagement” handout. Skip to step 5.Option B:2. Pair Work (Five minutes)Distribute one complete term to each pair in the group.3. Analysis (10 minutes)Ask each pair to discuss the meaning of the term and record the ideas they will reportback to the larger group.27 This exercise was adapted from Nadeau, Denise. 1996. Counting Our Victories: Popular Education and Organizing: A Training Guide onPopular Education and Organizing. Repeal the Deal Productions: .87

4. Report Back (30 minutes)Each pair reports back on what it discussed and provides a definition for the word.Ask the rest of the group if they agree or if they want to add something else to thedefinition. Distribute Handout 3 and compare the group definitions to those in thehandout. See if there is a need to change the group definition.5. Experiences of Community Action (30 minutes)Once you have completed the definitions, ask all the participants if they have anyexperience with community action. Ask them the following questions:• What actions were effective in creating change?• What group(s) did you work with?• Reflecting on all the experiences discussed, how would you define communityengagement?88

Handout 10A: Definitions of Community EngagementCommunity Engagement is the mobilization of all sectors/stakeholders within a certain community toactively participate in the process of solving a specific challenge or problem (e.g., HIV/AIDS).It is about getting the community on board to address differences among themselves. It is the entirecommunity working together to address the issues/challenges.Community: A group of people living in the same area or sharing the same interest (e.g., culture, religion,resources, social amenities)Empowerment: Equipping a person or group of people with knowledge and skills in order to maximizetheir well-beingAction: Putting ideas into practice in order to address the specific challenges/issues of the communityTeam: A group of people who share an interest work toward a common goalAllies: Different organizations within a community that join together to combat a problem or problems (e.g.,violence against women and children)Stakeholders: Those involved in resolving or identifying the problemMale involvement: Engaging men in “activities” (such as HIV prevention or community initiatives (onhealth issues such as HIV prevention)Strategy: Method used to achieve a goalTactic: Specific activities/approach used to implement the strategyLeadership: Being able to lead; support; be in control of the activities/intervention89

Chapter 11 - Different Community Engagement Activities11.1ObjectivesTimeWorking With Theater Practitioners1. To help community members or groups plan a theatrical performance about gender,HIV, and male involvement.90 minutesMaterials • Flipchart paper and markers• Enough copies of Handout 14: Theatrical Performances/Street Drama andStepsHandout 15: South African Street Theatre for all participants1. Ask if any participants have ever conducted a theatrical performance/street drama toreach communities or groups. Ask them to share that experience, including whatworked and did not work. (Five minutes)2. Ask participants to discuss the benefits and challenges of theatricalperformance/street dramas. If the following benefits and challenges have not beenmentioned after five minutes, add them to the list:Benefits• Can reach large numbers of people• Can be very interactive• May require few resources (depending on props used)Challenges• Chance of unclear or diffuse messages, if performance is not focused• Cannot always control your “audience,” if performance is in publicplace3. Pass out Handout 14: Theatrical Performances to the participants. Reviewthe key points.Optional step: Review the case study, Handout 15: South African StreetTheatre, and discuss the example.4. Divide the participants into four groups and assign one of the topics below to eachgroup. Ask two of the groups to use ambush theater (see definition below) and havethe other two incorporate audience feedback into their performances.• Encouraging men to take an active role in home-based care and support• Raising awareness about the dangers of transactional sex amongcommunity members• Raising awareness about preventing mother-to-child transmission• Importance of couples communication around HIVBefore presenting their performances, each group should explain who their targetaudience is to the other participants.5. Debrief by asking the following questions:? What did participants find difficult when performing the dramas?? What did they enjoy about putting on the performances?? Is this a technique that they could see using in their programs? In whatway?90

Handout 11A: Theatrical Performances/Street DramaWhen designing the performance, keep the following in mind:AudienceIdentifying your audience is the first step toward ensuring that the performance and its messages reach theright people. While you may consider targeting only one particular audience, you might find that theperformances are appropriate for a variety of audiences. Ask yourself these questions:• Who do you want to reach (e.g., church groups, young men, young women, local political forums orcommunity leaders, ladies groups, etc.)?• When and where can this audience be reached?• How will the audience be reached? What will you use to draw your audience to the play or performance?• How will you entertain your audience?• What interesting elements can your play employ to engage the audience? Some ideas include:ooInterrupting the play at various points to ask the audience what should happen nextUsing Ambush Theater, which means staging the play in a “public” place so that theaudience is not aware that this is actually a performance (See example below.)Theme/Key MessageWhen planning your performance, it is important to determine its central theme. You will then need toidentify three key messages you want the performance to communicate. This will help keep the performancefocused. Too many messages may confuse the audience.Production/Human Resources?You’ll need a variety of people to carry out and develop a performance.• One or more people to coordinate and retain overall responsibility for the event. This person orpersons should be motivated and able to work well with others to ensure that the plans for theperformance remain on track.• One or more people to develop the performance. This person or persons needs to be creative and tounderstand what will appeal to the audience.• People who can serve as actors. You may want to pick multiple people to learn each role, in casesomeone isn’t available on the day of a performance.Financial ResourcesWhen planning your performance, you will need to identify your financial needs. For example, the actor(s)may require loud speakers, or if they are traveling to different communities, they will need funds fortransportation.91

Handout 11B: South African Street TheaterSouth African Street Theater Challenges Men's Perceptions of Violence, HIV and AIDS, and GenderEqualityStory by Kristy SiegfriedAdapted for the Stories from the Field series by Nina BratenIt's evening rush hour at the railway station in Tembisa and a train from Johannesburg has just deposited hundredsof commuters onto the platform. The sound of raised voices and signs of an impending scuffle persuade many ofthem to linger for a few moments.A circle forms around the drama unfolding in this most public of public places. The voices belong to a man and hiswife and two other men. The man is accusing his wife of having an affair with a colleague accompanying her on thetrain. He knows this to be true, he yells, because last night she asked him to use a condom. The man movesthreateningly toward his wife, but her friend blocks him and the two men start shoving each other and exchanginginsults. The crowd starts to look uncomfortable; some laugh nervously, others mumble disapproval, but no onesteps forward to intervene. Finally, some spectators become irritated by the commotion and break up the crowd.There is no time to inform them that the scene they just witnessed was a performance and the participants wereactors.The young performers belong to EngenderHealth's partner, the Youth Channel Group (YCG), a Tembisa-basednongovernmental organization that uses "ambush theater" to educate and mobilize their local community on issuesrevolving around HIV and AIDS, domestic violence, and gender inequities.The goal of the performance was to spark a discussion with the onlookers about condoms and gender-basedviolence. But part of the nature of ambush theater is its unpredictability."It went well, except we didn't have a chance to distribute the condoms," commented one of the performers.Undeterred, the troupe of actors and facilitators moved down the road and re-enacted the scene in front of an allmalehostel. This time, the actors had time to freeze the action and reveal that the scene was fictional. Some of theonlookers felt deceived and moved on, but others lingered to engage in debate with the YCG group and to acceptthe free condoms they handed out.Another performer asked some of the male onlookers how they would react if their wife asked them to wear acondom."I would think that she has a disease," responded one man."I can't satisfy my wife while I'm using a condom," said another.When asked whether the performances had any impact on them, one man replied: "It gives me some knowledgeand it makes me think about it."YCG's founder, Dan Sebetha, has had plenty of opportunity to see how effective this type of performance art canbe, especially in reaching young people. He started the group with four others in 1996, with the goal of using dramato address crime. The focus shifted to HIV and AIDS and gender equality in 2001, when the group partnered withEngenderHealth.92

Sebatha came up with the idea of using drama as an educational tool by observing how preachers hold the attentionof passengers on long train rides."As artists, we wanted to entertain people while educating them, so after we saw the preachers on the trains, wewould imitate them.... And believe me, it's working," he said.YCG added ambush theater to its outreach activities when several members of the group, including the currentdirector, George Chauke, attended a community mobilization workshop organized by EngenderHealth. Given thechance during the workshop to practice the "ambush" approach at a Soweto taxi stand, Chauke found it to be "apowerful tool.""Sometimes it's not easy to draw people's attention to come listen to you," he explained, "but when we hit the streetwith ambush, we get their attention."YCG recruits actors, as well as dancers, poets, and rap artists, mainly from local high schools. The 10-to-20-minutescene usually follows a basic script, but off-the-cuff adaptations are often used, depending on the audience and theirlikely response.The young actors also receive training and information on the issues they are depicting. Part of their traininginvolves attending Men As Partners (MAP) workshops conducted by EngenderHealth. The workshops are designedto help men understand how gender stereotypes and inequities can lead to unhealthy relationships, domesticviolence, and even the spread of HIV and AIDS.Themba Skosana began attending YCG MAP workshops after he dropped out of school in 2003."At the time, I didn't have much self-esteem or confidence," he acknowledged, "but I saw how positive andconfident the MAP facilitators were. Now I embrace equality and I always help with chores at home, I don't thinkit's my mother's job only."Sebatha was an HIV and AIDS educator for several years before learning about gender and domestic violence."MAP has changed my life," he admitted. "I was abusive before. After attending workshops, I realized that waswrong. The woman I was with, we separated, but now we're back together. At first she wasn't sure I'd reallychanged, but now she's happy."93

11.2ObjectivesTimeWorking With Visual Artists1. To use art to reinforce message(s) around gender, HIV, and male involvement.45 minutesMaterials • Flipchart paper and markers• Enough copies of Handout 16: Painting Murals to Engage Young Men for allStepsparticipants1. Pass out the Handout 16 and ask the participants to review it.2. Follow up with the these questions:? What were the strategies and goals of the team designing the murals?What might be their next steps for action?? How could the team members have used the mural to generate discussion?? What kinds of questions might a team ask in the community to help themdevelop a strong message for a mural or other visual arts appropriate totheir target audience?? What other visual or performing arts can be used to achieve what the teamwas trying to do with the mural?? What opportunities are available in your community to work with artists orperformers on creative community engagement activities concerning maleinvolvement?94

Handout 11C: Painting Murals to Engage Young Men 28Every day, thousands of people leave and enter Soweto, Johannesburg from the taxi rank 29 opposite ChrisHani Baragwanath Hospital. Now, if they glance up as they board a mini-bus, they will see a colorful muralwith a clear message. The bright, cartoon-like images show men in positive roles: as an involved and lovingfather, as a caregiver to those sick with HIV/AIDS, as a visitor choosing to get tested for HIV at a clinic, andas a man taking a stand against domestic violence. If the mural’s message resonates with just a fraction of thepeople who pass it, the collaboration between MAP and a group of artists will have achieved its goal.As one young male volunteer who participated in the design of the mural put it: “This mural, it’s lifechanging,it carries more than you could ever think it does, it shows exactly what’s happening in our society.We’re at war with a lot of things and these are very personal issues for me.”The mural was a product of a group of young male artists involved with the Artists Proof Studios (APS) whohad been to MAP workshops, along with peer educators and participants from the MAP Network. Togetherthis group of young people, mostly men, took the initiative to create a visual message to the community,advocating constructive male involvement. The project was timed to coincide with “16 Days of ActivismAgainst Gender Violence,” an awareness-raising campaign in its seventh year in South Africa.Standing back to admire his handiwork on the mural, APS student Cyprian Bekwaphi described hisexperience of attending a MAP workshop. Around him, other team members filled in the sketches withbright colors, bringing the MAP messages to life. “It was eye-opening. It made us realize a lot of thingsabout taking care of people and not just corny ‘use a condom’ phrases. It got into why you should respectwomen and respect yourself.”The “MAP Mural CAT” chose this action based on what they knew of their community. The location for themural was strategic—it is one that nearly everyone in Soweto sees. The message for the mural grew out oftheir experience with workshops, meetings, “ambush theater” at taxi stands, and community residents andleaders. By portraying positive images of male involvement, the team felt confident of sparking conversationand re-evaluation of men’s role in the family and community. The campaign also provided opportunities forindividuals to get involved, to develop leadership, and to reach out to a range of “stakeholders” in thecommunity.28 Adapted from a case study prepared for MAP by Kristy Siegfried, December 2004.29 This taxi rank, or bus station, is the largest transportation hub in all of Africa.95

11.3ObjectivesTimeMedia Campaigns and Social Marketing1. To understand the principles of social marketing and practice the steps fordeveloping a community-based or mass media campaign.Two hoursMaterials • Flipchart paper and markers• Enough copies of Handout 17: Media Campaigns and Social Marketing and•Handout 18: Creating Campaigns: Step By Step for all participantsResource Sheet13: Examples of Social-Marketing Media and Community-Facilitator’sNotesBased CampaignsCampaigns are coordinated sets of activities that aim to promotechanges in individual behaviors and/or promote the socio-cultural and political normsnecessary to support these changes. Campaigns often include some form of mediaand target large numbers of people.Community-based media, such as street theatre, often provides more depth andinteraction, whereas mass media may offer less depth and interaction, but oftenprovides wider reach of messages. The decision to use community-based or massmedia, or a combination of both types, will depend on available resources, theintended audience, and depth of contact expected.PART 1: Principles of Campaigns (30 minutes)1. Ask the participants to brainstorm examples of good TV/radio commercialsand/or print advertisements.2. Ask the participants to identify the messages or strategies thatmade those commercials and advertisements successful.3. Explain to the participants that public health campaigns areincreasingly using principles from commercial marketing to successfully“sell” healthy behaviors and lifestyles. Review Handout 17: Media Campaigns andSocial Marketing with the participants and ask them for examples of social marketingcampaigns they have seen, if those campaigns were successful, and why. Askparticipants to volunteer a definition for social marketing, BCC (Behavior ChangeCommunication), and IEC (Information, Education and Communication).4. Explain to the participants that behavior and lifestyle is often influenced bypeople’s perceptions of what is “normal” or “typical,” that is, what they believe mostof their peers do. However, many individuals often misperceive the typical behaviorsor attitudes of their peers. For example, young men may believe that a majority oftheir peers engage in certain risk behaviors, such as excessive drinking, when in mostsettings, the majority of young men do not.5. Use the following questions to engage the participants in adiscussion about how social norms and the media influence young men’s behaviorsand lifestyles:? Does the media influence our behavior? How?? What are some misperceptions or rigid ideas that men and others(partners, families, etc.) may have about typical behaviors of men? Doesthe media perpetuate these misperceptions? How?? What kind of behaviors can these misperceptions spur?96

? How can campaigns change these misperceptions?Optional:Bring magazines and ask pairs of participants to flip through a magazine and selectsome advertisements that are gender sensitive, neutral, or exploitative.PART 2: Developing a Campaign (One hour and 30 minutes)1. Divide participants into groups and explain that they will spend the sessionsimulating the steps for developing a campaign. Emphasize that the actual length oftime necessary for developing a campaign will vary, depending on resources available,and can range from weeks to months.2. Give each group 15 minutes to brainstorm men’s gender-related attitudes,knowledge about HIV/AIDS, and behaviors and practices related to prevention, aswell as media and social networks that could be used to reach them. The facilitatorcan encourage the groups to think about the men with whom they will primarily beworking OR assign them different target groups, e.g., young men in school, marriedadult men, men living in refugee camps.3. Distribute Resource Sheet 13: Examples of Social-Marketing Media andCommunity-Based Campaigns to the participants and briefly go over the twoexamples in the resource sheet.4. Go over Handout 18: Creating Campaigns: Step By Step, focusing on developingthe profile of a “typical” man.5. Ask each group to create a profile of a “typical” man in their target group, thinkingabout such factors as socio-demographics, hobbies, attitudes about gender roles,sexual behaviors (including condom use and number and type of partners), access toand use of social services and programs, knowledge about HIV/AIDS transmission,HIV/AIDS risk perception, and general aspirations. It can be helpful to give a nameto this man and to create a physical appearance for him. Allow the groups 10 minutesto develop the profiles.6. Ask the groups to identify the sub-theme for their campaign, e.g., communicationwith partners about abstinence or condom use, involvement of men in caregiving forPLWHA. The sub-theme should be identified based on the identified behaviors andneeds of the target group.7. Once the groups have identified their sub-themes, give them 25 minutes to developbasic campaign messages. Explain that this is the step which often requires the mostcreativity and time and that they should keep in mind that campaigns messages whichare positive and action-oriented are often more attractive and inspiring than thosewhich demean men and/or focus only on negative consequences. Tell the groups thatthey should also identify the kind of media (e.g., radio, magazines, billboards) andsocial channels (e.g., peer educators, local celebrities) that would most effectivelyconvey the campaign messages to their target man. They should keep in mind whatkind of access this man will have to these channels, as well as the technical andfinancial feasibility of utilizing them.8. Invite the groups to present the profiles of their target men, their campaignmessages, and dissemination strategies. Encourage the participants in other groups to97

ask questions and give feedback.9. In closing ask the group:• What did you find challenging about developing the campaign message?• What steps/ideas for developing a campaign did they find most useful?• Do they feel they can begin to develop a media or community campaign afterthis activity?98

Handout 11D: Media Campaigns and Social MarketingCampaigns are coordinated sets of activities that aim to promote changes in individual behaviors and/orpromote the socio-cultural and political norms necessary to support these changes. In terms of HIV, theyseek to raise risk perception around HIV and to change social norms and behaviors. Campaigns often includesome form of media and target large numbers of people. There are two key features to successfulcampaigns: 1) they move beyond simple information provision and address underlying norms andperceptions related to behaviors. 2) they are linked to interpersonal activities that allow for individualreflection and skills-building and promote access to services.MEDIA-BASED CAMPAIGNS AND SOCIAL MARKETINGIn the last few decades, there have been rapid developments in communication technologies, multiplying theavailable media channels for reaching audiences, particularly youth (MacDowall and Mitchell 2006). Frombillboards and radio to internet and mobile phones, people are constantly exposed to a large amount ofinformation and messages. These can have a powerful influence (both positive and negative) on social normsabout what it means to be a man and how a man should behave or aspire to behave. To be effective in thiscrowded media environment, it is necessary to package campaigns in ways that can easily catch the attentionof men and other stakeholders, and most importantly, persuade them to adopt and promote healthy andmore-equitable attitudes and behaviors.Traditional public health campaigns have focused solely on “informing” people of unhealthy behaviors andtheir consequences and have often employed dictating or moralizing tones to do so. Experience has shownhowever that these types of campaigns are rarely adequate for effectively engaging audiences and motivatingbehavior change. To this end, public health campaigns are increasingly using principles from commercialmarketing to “sell” healthy behaviors and lifestyles. Social marketing, as this approach is called, entailsmaking specific behaviors and lifestyles more attractive to a given audience through an emphasis on benefitsand advantages.To develop a social marketing campaign, it is important to first understand the underlying socio-culturalnorms which contribute to and support particular behaviors 30 . Much of people’s behavior is influenced bytheir perceptions of what is “normal” or “typical,” that is, what they believe most of their peers do.However, many individuals, including youth, often misperceive the typical behaviors or attitudes of theirpeers. For example, young men may believe that a majority of their peers engage in certain risk behaviors,such as excessive drinking, when in most settings the majority of young men do not. Often, thesemisperceptions are fueled by the media or social norms of what is considered a “real” man. Thesemisperceptions, in turn, may make young men more likely to engage in these behaviors themselves. In thissense, it is important that campaigns address misperceptions or rigid ideas men and others (partners, families,etc.) may have about typical behaviors for men and promote more positive norms around what it means to bea man.Social marketing campaigns can be carried out at local levels through the use of community-based media orat broader levels through the use of mass media. Community-based media, such as street theater, oftenprovides more depth and interaction, whereas, mass media, such as TV dramas produced by commercialstudios with professional actors and technicians, may offer less depth and interaction, but often provideswider reach of messages. The decision to use community-based or mass media or a combination of both willdepend on available resources and the intended audience and depth of contact expected.30 There is a specific form of social marketing known as social norms marketing which is based on applying social marketingtechniques to social norms theory. The central concept of social norms theory is that much of people's behavior is influenced bytheir perceptions of what is "normal" or "typical." To this end, the premise of social norms marketing is that informing people thatthe majority of their peers are acting in a positive or healthy way can create an environment in which people actively strive to emulatewhat they believe is typical of their peers. This approach has proven effective in areas such as preventing tobacco use and drinkingand driving, among other issues. For more information visit the Most of Us website at www.mostofus.org.99

What is condom social marketing?In the mid-1980s condom social marketing emerged as a popular HIV/AIDS prevention strategy (UNAIDS2000). It is a specific form of social marketing that promotes the availability, affordability, and acceptabilityof condoms. In Latin America and the Caribbean, and other settings, a variety of condom social-marketingprograms have demonstrated success in raising general awareness of HIV/AIDS transmission andprevention, increasing sales of marketed condom brands, as well as affecting attitude change towardscondom use in targeted groups, including young men (FHI 2002; Horizons 2004; JHUCCP 1997; UNAIDS2000—see example of Hora H below).Regardless of whether a campaign is a local or mass media effort, men should be involved throughout itsdevelopment, implementation, and evaluation. Often, they and other beneficiaries or stakeholders, are onlyinvolved as respondents in the data collection for a needs assessment or to give feedback during the testing offinal messages and images. It is, however, more effective to involve men throughout all stages, from thedesign of the formative research questions to the actual development of messages and images. It is alsoimportant to involve strategic secondary audiences, including families, community leaders, women, andpolicymakers, in these stages. Given the sensitive nature of many topics related to gender and HIV/AIDSprevention, the involvement of secondary stakeholders can help to minimize possible backlash.Campaigns Spokespersons: Celebrity or Everyday Men?A common question about campaigns is whether it is more effective to use celebrity or everyday men asspokespersons. Big-name musicians, athletes, and other celebrities often have the attention and respect oflarge numbers of men and can be powerful spokespersons for drawing attention to a campaign and thepositive attitudes and behaviors it aims to promote. On the other hand, coaches, fathers, religious leaders,co-workers, supervisors, and other everyday men who play a role in men’s lives, can also be very engagingand effective spokespersons. The peer modeling (not sure of style, but probably “modeling”) of certainattitudes and behaviors can help to make them more credible and tangible to men than those perhapspromoted by celebrities who may live different realities and face different pressures. As part of theformative research process, it is important to work with men to identify the appeal and influence of differentspokespersons and determine who would be most effective in positively influencing men in a given context.100

Handout 11E: Creating Media Campaigns: Step by StepBelow are steps to creating an HIV/AIDS media campaign that incorporates a gender perspective. Asmentioned before, the goal of an HIV prevention HIV campaign is to raise risk perception around HIVand to change social norms and behaviors. It is important that men and other stakeholders be involvedin all steps. Often they are only involved as respondents in the data collection for a needs assessment orduring the testing of campaign images and messages. However, campaigns are more likely to be engagingand effective when men and other stakeholders are involved throughout the process. Carry out a needs assessment. This should include information about men’s gender-relatedattitudes, knowledge about HIV/AIDS, and behaviors and practices related to prevention. It shouldalso include a mapping of media and social networks that could be tapped into as part of campaignstrategies. Develop a profile of a “typical” man for each of the campaign target areas or populations. Auseful technique for laying out the characteristics of the target group is to create a character profile.This involves developing a profile of a “typical” man from the target group, thinking about suchfactors as socio-demographics, hobbies, attitudes about gender roles, sexual behaviors (includingcondom use and number and type of partners), access to and use of social services and programs,knowledge about HIV/AIDS transmission, HIV/AIDS risk perception, and general aspirations. Itcan be helpful to give a name to this man and to create a physical appearance for him. For example,for the development of the Hora H campaign in Brazil, peer promoters created a fictional charactercalled Calixto, a man, aged 19, from their community (see below).Character Sketch for Calixto: Calixto is 19 and likes to play football, go to funk dances, and hangout in the local plaza. He is a young man who takes care of himself and keeps his hair short. At 13,he had sex for the first time with his cousin Suzi. He does not use condoms often. He once gavehis girlfriend a slap because she asked if he would use a condom. He got a bit nervous, thinkingthat she was not being faithful or that she thought he was not being faithful. He talks to his friendsabout his sexual conquests. Some of his friends use condoms from time to time, often just thefirst time they have sex in a night, but not the second time. Calixto has the basic information, buthe does not worry too much about STIs or HIV/AIDS.Although this technique requires a degree of generalization about the target group, it is not intendedto diminish the diversity that exists among men, but rather, assist in the process of developingmessages and strategies that would be attractive to, and appropriate for, the target group as a whole. Define sub-themes for the campaign. Within the themes of gender-equity and HIV/AIDSprevention, it is necessary to identify sub-themes, such as communication with partners aboutcondom use, concurrent partners, transactional sex and HIV/AIDS testing, which will be the basisfor the campaign. Establish these sub-themes based on what the needs assessment identifies asnecessary to and/or appropriate for the target group. Develop basic messages for each of the campaign themes. This often requires the mostcreativity and time. As discussed in this activity, campaign messages that are positive and actionorientedare often more attractive and inspiring than those that demean men and/or focus only onnegative consequences. Constructive examples include the Hora H campaign in Brazil, whichpromotes a “cool” and hip lifestyle for young men based on caring and equitable attitudes, and theStrength Campaign in the U.S.A., which emphasizes that a man’s real strength is demonstratedthrough respect and compassion, not force or dominance.101

Map sources of influence and information. This involves identifying and understanding thedifferent sources of influence and information that shape men’s attitudes and behaviors related togender, relationships, and HIV/AIDS prevention. These can be groups of people, like peers andfamily, such institutions as schools and health services, or media vehicles like newspapers or TV.Again, this should come from information collected during the needs assessment, as well as from theinput of men and other stakeholders involved in the process (see other Campaign Tool). Identify the most strategic media and social channels, based on the profile and the mappingof influence and information. Using the profile and mapping results, the next step is to identifythe kind of media (e.g., radio, magazines, billboards) and social channels (e.g., peer educators, localcelebrities) channels that would best convey the messages about positive models of masculinity andHIV/AIDS prevention to the men and/or secondary audiences. It is important to also keep in mindwhat kind of access the men have to these channels, as well as the technical and financial feasibilityof utilizing them for the campaign. Pre-test with men and secondary audiences. This is the process of confirming that campaignmessages are clear and relevant and inform and/or mobilize men as intended. Involving men andsecondary audiences in the campaign-development process helps to ensure the relevance and impactof messages, however, it is also necessary to conduct extensive pre-testing to make certain thatmessages are widely understood. Pre-testing can be done through one-on-one interviews and/orfocus groups with selected men from the target group. It is also important to pre-test messages withsecondary stakeholders, to verify that they are acceptable and appropriate and will not generatebacklash.102

Resource Sheet : Examples of Social-Marketing Media and Community-Based CampaignsThe Strength Campaign, USADeveloped by Men Can Stop Rape (MCSR), the Strength Campaign employs different media and communityoutreach and mobilization strategies to engage young men in more positive and equitable behaviors,including as allies in the prevention of dating violence. The campaign’s media initiative is organized aroundthe slogan "My Strength Is Not for Hurting," and strives to refocus the traditional perception of malestrength as respect and communication, not force and domination. In addition to the media initiative, theStrength Campaign also includes an educational component called the Men of Strength (MOST) Club.Young men in MOST Clubs participate in a series of sessions intended to raise their awareness of theimportance of male involvement in rape prevention and mobilize them as active allies in preventing men’sviolence against women and girls.Originally started in Washington DC, an important piece to the success of the Strength Campaign has beenbuilding connections with school staff and other school-based initiatives. School administrators, teachers,and other staff participate in awareness-building workshops and are invited to serve as members of thecampaign's advisory committee and participate in the design and management of in-school activities. In thisway, campaign efforts are not isolated from other school-based efforts, but rather “owned” and implementedlocally.The campaign focus on promoting positive gender norms allows for it to also be adapted to engage men inother social and health problems. Since the campaign’s launch, more than two hundred local, regional, andnational organizations have used the campaign posters and materials, creating a nationwide presence. Thematerials have also been used in other countries.The Strength Campaign messages present the common male norm of strength as respect andcommunication, not force and domination. One of the most salient concerns which emerged from theformative research and testing was that young men feared that if they spoke out about violence againstwomen, or changed their ways, they would be alone. For this reason, the campaign images show young menwith partners and/or with other young men in order to emphasize the benefits and solidarity related totaking a stand against men’s violence and speaking openly about respecting women.For more information visit the Men Can Stop Rape website: www.mencanstoprape.org103

Hora H, BrazilDeveloped by Promundo and JohnSnowBrasil, with financial support from SSL International, the Hora HCampaign, which translates into “In the heat of the moment,” builds upon social-marketing principles topromote an attractive and more gender-equitable lifestyle for young men. Campaign messages describe a“real” man as one who demonstrates more gender-equitable attitudes in his relationships, particularly in themore challenging moments. The name of the campaign was developed by young men themselves, whofrequently heard their peers say: “Everybody knows you shouldn’t hit your girlfriend, but in the heat of themoment you lose control” or, “Everybody knows that you should use a condom, but in the heat of themoment….” In this context, the Hora H campaign emphasizes that a “real” man is respectful and caring inhis relationship with his partner, or more specifically, he does not use violence, he discusses condom use, andhe shares parenting responsibilities.The Hora Campaign also includes an associated condom brand, and although the campaign messagespromote condom use as an important behavior in and of itself, the emphasis of the campaign is on thelifestyle symbolized by condom use. The link between the Hora H condom (a product) and a lifestyle drawsfrom principles of commercial marketing, in which advertisements for cars, shoes, and other products focuson the lifestyle associated with ownership of the product, rather than the qualities of the product itself. Inthe case of Hora H, this strategy is used to market healthy and equitable behaviors, such as condom use, aspart of a cool and hip lifestyle for young men.The campaign models, or spokespersons, are the same young men who were involved in the design andimplementation of the campaign activities, including the distribution of the media materials and running ofinformation and condom sales booths at community dances. These young men were from the samecommunities in which the campaign was active and became references in the community, in some ways, localcelebrities. They provided “proof ” to other young men in the community that these kinds of attitudes andbehaviors were indeed possible. At the same time, the campaign also engaged rap musicians who presentedmessages during their concerts. The endorsement of the campaign by these celebrities helped to bring moremainstream coverage to the campaign and reinforce its appeal among young men.(Translation: Man with a capital M.He listens. He accepts. He cares.In the heat of the moment: The attitude makes the difference.)104

(Translation: Man with a capital M.He assumes. He shares. He cares.In the heat of the moment: The attitude makes the difference.)The Hora H Campaign posters shown here present messages about gender-equity and relationships throughtwo specific issues: condom use and fatherhood. The first emphasizes the importance of listening andaccepting a partner’s decision to use a condom, and the second describes the need for young men who arefathers to assume and share responsibility and care.The campaign logo of the green letter H (for homem, the Portuguese word for man) became a powerfulmarker of the campaign and the “cool” and gender-equitable lifestyle it promoted. The T-shirt that sportedthe logo became a popular commodity among young men in the community, highlighting the effect ofcommercial-marketing strategies to catch young men’s attention and mobilize them.For more information visit the Promundo website at: www.promundo.org.br105

11.4ObjectivesTimeHealth Fairs on HIV and Gender1. To help community members or community groups plan a health fair on gender,HIV and male involvement.60 minutesMaterials • Flipchart paper and markers• Enough copies of Handout 19: Community Health Fairs for all participantsSteps1. Ask if any participants have ever set up a health fair to reach communities orgroups. Explain that a health fair is an event at which people can gather informationon various topics. Ask them to share that experience, including what worked and didnot work. (Five minutes)2. Ask participants to discuss the benefits and challenges of health fairs.Note the following benefits and challenges if they haven’t been mentionedafter five minutes:Benefits• Can reach large numbers of people• Can be very interactive• Can be low resource (depending on props used)• Can focus on many broad topicsChallenges• May need to provide refreshment, food, chairs, prizes, which can be costly• Need to be interactive and ““fun” to hold the attention of the audience3. Pass out Handout 19: Community Health Fairs to participants. Review the keypoints.4. Divide the participants into two groups and ask them to develop a health fair with$300 in resources (amount can change based on country context). Each group shouldfocus on one of the topics below.• Increase men’s use of VCT (Voluntary Counseling and Testing) andARV (Anti-Retroviral) treatment and support of PPTCT (Prevention ofParent to Child Transmission).• Increase knowledge about GBV (Gender-Based Violence) and HIV5. Once they have developed their ideas, ask them the following:? Who was the audience?? How was the health fair structured?? What resource people did they invite or use?? What other resources did they need?? How did they spend the funds they were given?? How did they ensure that the audience participated in the health fair andcontinued to stay interested?6. Debrief by asking the following questions:? What was difficult about designing the health fairs?? What did they enjoy about it?? Is this a tool they could see using in their programs? In what way? (Howwould it be helpful?)106

Handout 11F: Health FairsWhen designing the health fair, keep in mind the following:1. AudienceIdentifying your audience is the first step toward ensuring the performance’s messages are well-targeted.Some topics may be appropriate for many audiences, while others may be relevant for only a few. Forexample, focusing on PMTCT may not be appropriate for very young children; if they are part of youraudience, be sure there are other activities with messages that are more relevant for them. It’s important toask questions like:• Who do you want to reach? (church groups, young men, young women, local political forums, ladiesgroups, etc.)?• How will you provide the information—through booths, activities, resource people, etc.?• How will you draw your audience to the fair?• How will you entertain your audience?• What interesting elements can your health fair employ to engage the audience (include as many interactiveactivities as possible)? Didactic presentations, for example, may not keep your audience interested. Tryfun, interactive activities, such as debates, quizzes, and musical competitions. These can all relate to thekey issues you want to present. Alternatively, you can include interactive activities that are unrelated toyour messages, like sports competitions and performances by local artists, but that get the audienceinterested and willing to participate in the health fair.2. Theme/Key MessageIt is important to identify the theme(s) on which you would like to focus when planning your health fair.Limit it to just a few key messages, so that people do not get overloaded. A theme may be involving men inpreventing HIV and the key messages may be: 1. Ending violence against women. 2. Joint decision-makingabout sexual and reproductive health.3. Preparation/Human ResourcesSeveral types of people are needed to mount a health fair:• One or more people to coordinate and retain overall responsibility for the event: This person orpersons should be motivated and able to work well with others to ensure that the plans for the health fairremain on track.• One or more resource people at the health fair to either sit at the “booths” and answer questions orprovide information to the whole audience. For example, you can have a teacher talk about HIVprevention or a doctor talk about ARV treatment. Be sure their presentations are dynamic or theaudience may lose interest.• Food vendors: Who will provide food and refreshments, if you choose to serve them?• What entertainers, if any, would you like to perform at the fair?4. Financial ResourcesWhen planning your fair, you will need to identify your financial needs. For example, you may need fundingfor food, drinks, booths, posters, signboards, prizes, etc.107

11.5ObjectivesTimeGroup Discussions1. To develop the skills necessary to conduct group discussions around gender andHIV.60 minutesMaterials • Flipchart paper and markers• Enough copies of Handout 20: The Facilitator’s Role in Group DiscussionsStepsfor all participants1. Explain that many programs have used participatory group discussions to generatean exchange of ideas about gender and HIV. Group discussions are a useful toolbecause they are low-cost and can take place in different venues and with differentgroups of people.2. Ask participants to share any experiences they have had either facilitating orparticipating in group discussions. What did they like or not like about it?3. Explain that in this activity, participants will use various tools to implement groupdiscussions. Ask them how they have started group discussions. If they are notmentioned, add the ideas below:• Show a video or movie clip focusing on issues related to gender.• Ask participants to develop a “collage” from magazines illustrating what itmeans to be a man and/or a woman.• Share IEC materials on HIV prevention with the group and then ask themfor their thoughts.• Invite a resource person to speak about issues related to HIV.4. Divide the participants into groups of three. Ask each group to choose afacilitator. Rotate facilitators every 10 minutes to give more participants achance to practice. The rest of the group will serve as the participants. Thefacilitators can lead a discussion on any topic related to HIV. Ask them to beas creative as possible.5. After 30 minutes, bring the participants together and discuss thefollowing:? What did the facilitators do well? What was difficult for them?? What creative elements did they use?? What are important skills for facilitators to possess?? What is important to keep in mind when planning group discussions? Addthe following, if it has not been mentioned by the participants:• Size and composition of the audience—does it encourageparticipation?• The discussion’s location—is it comfortable and secure enough forparticipants to share their views?• Knowledge and skill level of the facilitator—is the facilitator able tokeep the discussion focused? If the discussion is technical, does s/he haveenough knowledge? Can the facilitator draw in different participants ordoes s/he allow some to dominate the conversation?• Interest of the group—are they engaged?6. Pass out Handout 20: The Facilitator’s Role in Group Discussions. Reviewit with participants, and ask if they have any questions.108

7. Ask participants for suggestions on how group discussions can be incorporatedinto their program. Encourage them to be as specific as possible.109

Handout 11G: The Facilitator’s Role in Group Discussions Plans the meeting ahead of time and creates an agendao Consults with CAT (Community Action Team) members or other stakeholders to plan themeeting and make sure the goals and agenda are clearo Prepares materials and distributes them ahead of time (if appropriate) Guides the processo Helps with creating the process so the CAT can create the content. Asks CAT members tomake choices about the process they will use for the group discussions (such as how theywant to make decisions)o In general, the facilitator should not be the resource person for content. In other words, thecontent should come from the CAT or from other resources identified by them.o Has an awareness of where the group is energetically and what process will lead them to thenext phase of their work Encourages participationo Makes eye contact (where culturally appropriate) with allo Creates a safe environment, especially for those who tend to participate less or have lesspower in the groupo Varies the ways that people work (individual reflection, pairs, small groups, whole group) Helps the group reach conclusionso Guides each discussion to an eventual closeo Checks for agreement (consensus or vote)o Keeps track of action items and “parking lot” items to look at latero Celebrates the meeting’s achievementso Distributes meeting notes or decisions as appropriate Pays attention to gender and other group dynamicso Can step outside of the agenda and have the group deal with social attitudes that arecontrary to gender equality and respectful relationships that may emerge during thediscussions.o At other times, it might be more beneficial to discuss the problematic comment or actionoutside of the meeting itself.o Should be assertive in dealing with disruptive or disrespectful behavior, or else other CATmembers may feel reluctant to participate.110

11.6ObjectivesTimeTalk Shows1. To engage the participants and their community guests in an activity and adiscussion that includes proposed solutions for issues and themes appearing in thismanualTwo hours and 20 minutes. (This activity can take place in one long session, but twoor more sessions are recommended so that other community members, includingfamily and friends of the participants, can also be engaged.)Materials • Flip-chart and markers.• Enough copies of Handout 21: Case Studies for Talk Shows for allparticipantsAdvancePreparationSteps• Optional: poster boards, crayons/colored pencils, tape, presentation props.For this activity, the participants will dramatize a talk show focusing on a problem intheir community. In addition to casting the participants in the roles of talk showparticipants, the facilitator might want to bring in a real “specialist”—doctor, lawyer,psychologist, or other expert who can offer advice and and/or counseling on theshow. It is essential that the specialist be briefed on the objectives of the workshopsand “talk show” prior to the session(s).Part 1: Preparation for the Talk Show (One hour and 30 minutes)1. Ask the audience if they have ever seen a talk show and to discuss the positives andnegatives of dramatizing a talk show.2. Explain that the participants will produce a talk show, during which a communityissue is addressed and possible solutions are proposed.3. Review the various issues that have been discussed in the workshops.4. Pass out Handout 21: Case Studies for Talk Shows or ask a few participants to readaloud the case studies from the handout.5. Ask participants if they want to vote on which of the handout’s case studies to useas the theme of the talk show, if they would prefer to use a case study from aprevious workshop, or if they want to create a case study of their own.6. Once a case study has been selected, brainstorm all its issues and potentialsolutions.7. Review the general format of talk shows, using examples from television.8. Make a list of the possible “characters” to appear on the talk show. For example, ifthe group selects Case Study No. 1, they might include: Maria, Jose, one of Maria’sfriends, one of Jose’s friends, another young woman and/or young man who hasexperienced a similar situation, a nurse or a doctor, and a family member. Thereshould be between three and six characters.9. Divide the participants into the same number of groups as there are characters and111

assign each group one of the characters. Have them discuss their character’sperspective on the issue as well as their relationship to the other characters.10. Allow 20 minutes for them to discuss the following questions:? How is the character affected by the issue?? How does the character feel about the other characters on the talk show?? How does the character think the issue should be resolved?11. Invite the groups to present what they have discussed.12. Assign the roles of the characters and talk show hostess (see Text Box—Tips forBeing a Talk Show Hostess) to the participants. The remaining participants will playthe audience members. The facilitator may also suggest secondary characters, such asthe in-studio camera crew or producer for participants who are apprehensive aboutappearing in the production, or if the size of the group is large.13. Allow 15 minutes for the participants to prepare for their roles and recommend aperformance time of 20 to 30 minutes. Those participants playing the audiencemembers should prepare possible questions for the characters. NOTE: If the talkshow is to be presented in a separate session, the facilitator can extend this time andencourage the participants to “rehearse” the talk show in its entirety. The facilitatorand participants should also brainstorm what “specialist” they should invite to thetalk show.Part 2: Presenting the Talk Show (50 minutes)1. Allow groups to present the talk show and the rest of the participants to pretend tobe audience members (or the community in which the talk show would be presented).2. Following the presentation of the talk show, the facilitator shouldlead a discussion about how the experience of organizing and presenting the talkshow might help participants make changes in their lives and communities. Explainsome of the following tips for being a talk show host:Tips for Being a Talk Show Host Welcome the audience and briefly introduce the show’s theme. Introduce the guests (characters), and ask each one to give his or her perspective. Focus on the points of disagreement and tension between the guests. Involve the other guests (friends, family members, etc.) by asking for theiropinions of the situation. Solicit questions from the audience. Involve the “specialist” in the discussion. Attempt to seek some kind of resolution, perhaps with the aid of the specialist.3. (OPTIONAL) Engage members of the larger community toparticipate in the talk show. This may require additional rehearsal sessions. Studentsshould tell family and friends about the upcoming performance, and post signs in thecommunity announcing the topic, date, and place. Before the actual talk show, thefacilitator will explain to the audience how the theme was selected and why. It is alsoimportant to make clear that this is an “open class” performance and that participants112

may not have acted before.3. Afterwards, engage the participants (or the community) by asking the followingquestions:? What do you think of the various characters?? Do you agree that this problem exists in the community? What are thecauses?? Has this presentation helped you think about the problem in a new way? Ifyes, how?? What are some solutions to this problem?? How can people in the community participate in these solutions?4. In closing, emphasize that there are many issues not often discussed in acommunity-wide forum. This talk show helps participants get involved byencouraging them to raise awareness about an important theme. The group candecide if there are follow-up steps they want to take, and how they will proceed to dothat.113

Handout 11H: Case Studies for Talk ShowsCase Study No. 1Mary and John are both 17, and have dated for one month. They talk about getting married one day. Lastweek, they went to a party together, and ended up having sex without using protection against STIs orpregnancy. Mary regrets that they didn’t use protection and feels like John talked her out of it. She wonderswhat she could have done differently. John doesn’t know why Mary won’t return his phone calls.Case Study No. 2Julie just got a job as a saleswoman at a clothing store. Her female supervisor has made comments about herneeding to straighten her hair and lose a couple of pounds because their clients prefer to be helped by“stylish and pretty” women. Julie ignored her at first, but then her supervisor threatened to fire her if shedidn’t comply. Some of her friends agree with her supervisor, but others think her suggestion is outrageous.Julie thinks she already is stylish and pretty, but doesn’t want to lose her job.Case Study No. 3Anne is 21 years old and comes from a small town. Last year, she met a boy from the capitol of her countrywho became her boyfriend during his three-week visit. She didn’t tell her family about him. Although he was abit older than her, she enjoyed going out with him, particularly because his extravagant lifestyle meant he tookher on outings to nice places and bought her expensive things. At the end of his visit, he convinced her tocome back and live with him in his hometown. Once they arrived there, he immediately became verycontrolling, and sometimes verbally and physically abusive. She felt very isolated, with no friends or family,and out of place in the big city.114

11.7ObjectivesTimeMarches/Rallies Linked to Gender and HIV1. To develop the skills needed to organize a march or rally to mobilize communitiesto take action on gender, HIV, and male involvement.30 minutesMaterials • Flipchart paper and markers• Enough copies of Handout 22: Marches/Rallies for all participantsSteps 1. Ask participants if any of them have ever organized a march or rally to mobilizecommunities or groups. Explain that a march or rally is an event at which organizerscan inform and motivate entire communities to take action on various issues. Askthem to share their experiences, including what worked and did not work. (Fiveminutes)Ask participants to discuss the strengths and challenges of marches or rallies. If thefollowing hasn’t been mentioned after five minutes, add it to the list:Benefits• Can reach large numbers of people• Can motivate participants• Can be low-resource—if staffed by volunteers or the march is tied in withanother event• Can help a community ”respond” to a crisis (e.g., by giving people a place tovent their anger or show their support)Challenges• Often requires permits from local authorities, which can take time• Is dependent on weather• Can be high resource—if expensive sound systems are needed2. Pass out Handout 21: Marches/Rallies to participants. Review its key points.3. Divide the participants into three groups, each in charge of planning a part of themarch or rally.Group 1: Theme and messages of the march or rallyGroup 2: Preparations needed to ensure a successful eventGroup 3: Resources required for a successful eventOnce the groups have developed their ideas, ask each to share its findings.Ask the other groups for additional ideas.Debrief, by asking the following questions:? What was difficult about designing the rallies or marches?? What did they enjoy about designing the rallies or marches?? Is this a tool they can see using in their programs? In what way?115

Handout 11I: Marches or RalliesWhen organizing a march or rally, keep in mind the following:1. Theme/Key MessageIt is important to identify the theme(s) of your rally or march and to focus on just a few key messages sopeople do not get overwhelmed. Rallies or Marches work best when planned for a particular day (e.g.,Father’s Day; National VCT Day; World AIDS Day) and can help individuals and communities respond to ahorrific event. For example, if a violent act is committed in a community, a march or rally can help residents”reclaim” the negative space.2. Preparation/Human ResourcesYou’ll need a variety of people to plan and carry out a rally or march:• One or more people to coordinate and retain overall responsibility for the event. This person orpersons should be motivated and able to work well with others, to ensure that the plans for therally/march remain on track.• One or more “motivational” resource people to get the crowd “warmed up” before the march orrally and to champion the issue at the end. People well known to the community are best, but dynamic,motivating people are all that is needed.• Entertainment at the rally. A good public address (PA) system is needed to attract a crowd. Hiringlive musicians is best, but playing recorded music may be enough.• You will need to check with local authorities, such as the police about the permits necessary to stagea march or rally. Involving the police can result in support on the day, which can be helpful in attracting acrowd as well.• The support and participation of Community Members is needed to make the event successful.There is nothing worse than calling a rally or march and having only five people show up.Media is also important to assist in publicizing the event before it happens and reporting on it after the fact,for greater impact.3. Financial ResourcesWhen planning your rally or march, you will need to identify your financial needs and resources. For example,you may need funding for a PA system, a stage, food, drinks, posters, signboards, or prizes.116

11.8ObjectivesTimeReaching Men Through Sports1. To identify methods of using sports to reach men and the communityOne hour and 30 minutesMaterials • Paper• Pens• Markers• Flipchart paper• Enough copies of Handout 23: Prevention and Gender Through Sports for allparticipantsSteps1. Explain to the participants that sports can be used in a variety of ways to communicatemessages and involve persons in educational or informational activities. Sports’ wide reach,especially when it comes to male and youth audiences, makes it a powerful vehicle foradvocacy and social change related to gender and HIV and AIDS.Discussion:? Are there projects in your country/community that use sports to promote healthor social development?? What do you think of those projects?? What do you think of sports as a way to effect social change?2. Facilitate a discussion about sports and gender. Ask the participants to name sportsfigures who are role models for men in their community/country. In what ways are theserole models positive or negative? Brainstorm how these sports role models and how sports,in general, can reinforce negative gender norms. Ask participants to list ways in whichsports can be used to reinforce positive values, including positive gender roles.3. Divide participants into groups and ask them to review Handout 23: Prevention andGender Through. Give the groups 10 minutes to brainstorm some examples of how touse sports activities for the promotion of gender equity, HIV/AIDS prevention, andviolence prevention. Ask them to list some of their ideas on the flipchart.4. Ask the groups to select an idea from the flipchart, consider its pros and cons, resourcesneeded, and what sport activity they will use. Allow 20 minutes.5. Allow the groups 40 minutes to develop a plan for the activity selected. This shouldinclude identifying the beneficiaries—both direct, such as the players, and indirect, such asthe spectators or peers. They should also think about who will involved in theimplementation of the activities (e.g., coaches, peers, staff trainers, or facilitators), and howmale engagement will be included within the sporting event or activity.6. Invite the groups to present their plan for a sports activity for male engagement. Afterthe presentations, the facilitator can lead a discussion about the usefulness of this approachand summarize the difficulties and benefits the groups encountered in working with sports.117

Handout 11J: Prevention and Gender Through SportsThroughout the world, sports are popular among men and can serve as a powerful and far-reaching mediumfor engaging men in activities and messages related to gender equity and HIV/AIDS prevention. At the sametime, using sports as a form of communication requires careful handling (Cohen and Burger, 2000). Manysports emphasize aggressiveness or competitive masculinity; it is important that campaigns or othercommunication strategies do not reinforce these qualities, but rather emphasize cooperation and respect.There are a variety of ways in which sports can be utilized for male engagement —from using sports toattract young men to participate in educational workshops or services to integrating HIV/AIDS preventioninformation and related messages about gender into sports activities. The latter may include enlistinginfluential sports role models to speak during half-time about HIV/AIDS prevention and positive andequitable ways of being men, distributing materials about gender-equity and HIV/AIDS at sporting events,and recruiting coaches and/or sports figures to serve as peer educators for other team members and/or thecommunity. Coaches can be powerful allies when it comes to instructing young men about HIV/AIDSprevention and making them reflect on gender, whether through formal lessons or informal communications(IGWG, 2003).A Violence Prevention Guide for Football CoachesThe Family Violence Prevention Fund has created a guide for working with football coaches to preventviolence among men. Part of the work includes a strategy called Teachable Moments, opportunities on thefield and off when coaches can intervene and teach principles of non-violence and respect for others. Thismight happen when a fight breaks out between opposing team members, players make lewd comments abouta woman on the sidelines or in the stands, or a famous sports figure is charged with a violent act. The guideprovides discussion points and strategies for intervening and dealing with these different issues.The full guide is available at: http://www.unicef.org/southafrica/SAF_resources_boysIImen.pdfSports and Gender: Mainstreaming Gender in Sports ProjectThis document by the Swiss Agency for Development Cooperation gives some recommendations forworking with gender using sports. It also looks at how gender influences and is influenced by sports.http://www.sportanddev.org/data/document/document/210.pdfSports for Social Change NetworkThe SSCN is a four-year global initiative using sports for social change. The overall goal of the SSCN is topromote the use of sports as the entry point into local communities to address the underlying causes ofpoverty, and as a vehicle to effect lasting social change. The SSCN will achieve this by building the capacity oflocal organizations; increasing the number of sports-based community-development programs; contributingto the growing body of evidence that shows how sports can be used effectively in development; and finally,by providing funding to the sports-for-development sector, which demonstrates the value of sports indevelopment.http://www.sportanddev.org/en/initiatives-and-networks/sport-for-social-change-network-sscn/index.htmKicking AIDS Out!Kicking AIDS Out! promotes the use of sports as a tool for development.The program builds awareness about HIV/AIDS through educational sports games and physical activitiesthat encourage young men to discuss issues affecting their lives and communities. Programs implemented bymember organizations integrate sport skills and life skills through movement, games, role-plays, drama andother cultural and recreational activities. Central to success and sustainability is capacity building. KickingAIDS Out! develops programs to train coaches, trainers and leaders, building capacity at the individual,organizational, and community level.http://www.kickingaidsout.net/118

11.9ObjectivesTimeDoor-to-Door Visits1. To provide participants with the skills to make door-to-door visits in their communities.60 minutesMaterials • Flipchart and markersSteps1. (15 Minutes)• Ask if anyone in the group has experience making door-to-door visits (to sell a product,collect signatures, etc,). Ask them what that experience was like and how they prepared forit.• Door-to-door visits can be a low-cost way of reaching people in the community. Discussthe positive effects of interpersonal communication on behavior change and how talkingabout gender or HIV prevention with someone visiting the home may provide communitymembers with information they might otherwise be unable to access. Also, somecommunity members may feel more comfortable talking about these issues in their homesthan in a public setting.• It is important for group and peer educators to determine what areas and people in theircommunities would be most receptive to the information delivered in a door-to-door visit.It is also important to consider the best time of day for the visits. For example, if targetingyoung men, a peer educator must identify when young men are most likely to be at home.The educator needs to also think about whether the door-to-door visits are best made aloneor with a partner. Finally, educators should discuss strategies for dealing with hostilecommunity members who do not want to listen or who disagree with the messages; it isbest to address a possibly negative situation before encountering it.2. (30 Minutes) Ask for two pairs of volunteers and two groups of four to five volunteers.Take the two pairs out of the room and tell them that they will each role-play a door-to-doorvisit. The two groups of four to five volunteers will play the families: one group will be afriendly family that will listen and the other will be an unfriendly family with little time. Onepair will be assigned to the friendly family and another to the unfriendly family. Ask thevolunteers to make it as realistic as possible. Give the two groups of 4-5 volunteers, and thetwo pairs, 10 minutes to prepare and five minutes for each role-play.After both groups have completed the role-plays, ask them what it was like to conduct the doorto-doorvisits. What were the challenges?3. Come back together as a large group. Ask the group for ideas on dealing with householdsthat are receptive and unreceptive. Go over what they think they need to do to prepare for adoor-to-door visit and list their ideas on a flipchart. If no one mentions it, be sure to suggestcreating door-to-door visit scripts with ideas for dealing with receptive and unreceptivehouseholds. Stress the importance of practicing for both scenarios.119

11.10ObjectivesTimeOne-on-One Discussions/Peer Outreach1. To discuss strategies for reaching men through peer outreach30 minutesMaterials • Flipchart and markersFacilitator’sNoteStepsWhen doing this activity, it important to emphasize the following to participants: malegender norm transformation involves deep cultural changes, focusing on questioningcurrent and/or harmful gender norms. Indeed, such transformation takes time.However, one-on-one discussions among friends and relatives are often part of themost successful intervention in reaching men. Thus, it is vital to have communitychange agents work with men via informal social settings. For example, talking tomen at weddings, funerals, bars, and sports fields has been a very effective strategyand is gaining momentum for a community movement. This is how social changehappens.1. Begin by asking the group to brainstorm the places men gather in their community.List the locations and add the following, if not mentioned:• Workplaces• Schools• Youth Clubs• Sports Clubs/Groups• Weddings/Funerals/Family Events• Faith Communities• Bars/Clubs/Tea Circles• Markets2. Once the list has been generated, ask if any of the group has had experienceconducting peer outreach programs to men/boys in such settings. Ask those whohave conducted peer outreach to share their experiences, highlighting some strategiesthey used to reach men.3. Next, ask participants to find a partner and brainstorm strategies that would beeffective in reaching men in such settings.4. After 10 minutes, go from one team to the next, asking each for a strategy theydeveloped that hasn’t yet been mentioned. Once you list all the strategies, ask thegroup the following questions:• Do you think peer outreach is an effective way to reachmen? Why?• What did you learn from this exercise?120

11.11Action PlanningObjectives 1. To develop an action plan for reaching menthrough group education2. To identify organizations with which to link inorder to leverage work with menTime90 minutesMaterials • Flipchart and markers• Enough copies of the Handout 24: The Ecological Model and Handout 25:Detailed Activity Information for all participantsSteps 1. Explain that you would like to focus on how the tools and key lessons from thetraining can be turned into concrete action.2. Distribute Handout 24: The Ecological Model. If there is more than oneparticipant from the same organization, ask them to work together. Since manyof the organizations attending the training are already working with men, askthem to note such work on the Ecological Model, in the column listing existingactivities. To the extent possible, they should separate the activities accordingto the different levels of the Ecological Model. If any activity or program fitsinto more than one level, they can add it to either one of the levels or to all thelevels in which it fits. Remind them that it is fine if they don’t have activitiesfor all the levels. Allow 20 minutes for this. Ask any participants not currentlycarrying out activities with men to think about the kinds of activities with menthey would like to pursue.3. Since this training has focused on the individual and group educational levels,ask participants to look at those two levels in the Ecological Model. Pass outthe handout titled Handout 25: Detailed Activity Information. For each level,they should note all the steps needed to carry out the activity. They should listwho in their organization will carry out each step, their deadline for completingit, what resources are required, and what other organizations they may workwith. Once they have filled out the Individual Level, ask them to do the samefor Creating Supportive and Family Structures. Allow 30 to 40 minutes to dothis.4. Call all the participants back to the larger group and ask each to present theEcological Model focusing on their planned activities.121

Handout 11K: The Ecological ModelEXISTINGACTIVITIESNEWACTIVITIESWHO?Person ororganizationWHATWILL BENEEDED?(technical,human, andfinancial)1. StrengtheningIndividualKnowledge andSkills this textsmaller thanothers2. CreatingSupportive Peerand FamilyStructures3. Educating HealthService Providers4. MobilizingCommunityMembers5. ChangingOrganizationalPractices6. InfluencingPolicy Legislationat the SocietalLevel122

Handout 11L: Detailed Activity InformationLevel: Strengthening Individual Knowledge and SkillsActivityTargetGroup (e.g.,age,geographiclocation)Step(s)ByWhomByWhenTA/ResourcesNeededLinkages withOtherOrganizations123

Chapter 1 2 - Working with Men at the Service DeliveryLevel12.1 A Framework for Working with Male ClientsObjectives 1. To describe a framework for working with male clients2. To identify four approaches to providing men’s reproductivehealth services3. To identify new ways of working with male clients4. To identify new ways of reaching male clients that can beimplemented at the participants’ facilitiesTimeMaterials/AdvancePreparation1 Hour• Flipcharts, markers, and tape• Paper or index cards• Resource 14: Male-Involvement Activities• Enough Copies of Handout 26: A Framework for Working withMale ClientsAdvance Preparation• Write the following terms on flipcharts, one term per flipchart:“Social Marketing/Motivation, “Persuasion,” “CommunityEducation/Information-Giving,” “Counseling,” and “Clinical Services.”Display the flipcharts on the wall in a row, leaving enough space under eachflipchart for the participants to post their sheets of paper under it.• On separate sheets of paper, write each of the male involvementactivities listed in Trainer’s Resource: Male-Involvement Activities, oneactivity per sheet of paper. Make sure that you have enough sheets of paperto give one or more to each participant.• Prepare strips of tape for posting the male involvement sheets on thewall.Steps 1. Introduce the activity by explaining that since men are oftenunaccustomed to seeking services at a health facility, it is important to reachmen outside of the clinic walls.2. Review pages of the text, which describe the framework for workingwith male clients. Make sure that all participants understand the differencesamong the various approaches discussed in the framework.3. Explain that the four approaches covered in “The Differencesamong the Four Approaches to Involving Men in Reproductive HealthServices” can overlap one another and provide one or two examples: Whensatisfied clients promote vasectomy in the community, socialmarketing/motivation and community education/information-giving overlap;when a service provider conducts group counseling for vasectomy,community education/information-giving and counseling overlap.4. Explain that each participant will receive one or more sheets ofpaper listing a male involvement activity and that each participant is to placethe sheet of paper on the wall where he or she thinks it fits along thecontinuum between social marketing, community education, and counseling.124

Training TipShuffle the male involvement activities sheets to make sure that the activitiesfor each approach are not grouped together, and randomly distribute one ormore of the sheets of paper to each participant.5. Ask the participants to walk up to the wall, take a few pieces of tape,and post the sheets of paper where they think they belong.6. Once all sheets are posted on the wall, review them with theparticipants and move any that the group feels should be changed to adifferent spot on the continuum.7. Conclude the activity by discussing the questions below.Discussion Questions• Is your facility currently involved in any social marketing/motivation,community education/information-giving, or counseling activities for men?If so, what types of activities are they?• Did this activity provide you with new ideas for male-involvementactivities? If so, which new activities might be possible at your facility?During this activity, the participants may disagree on whether to categorizecertain male involvement activities as either social marketing/motivation,community education/information-giving, or counseling. Remind participantsthat it may be difficult to determine exactly where each of these activities shouldbe placed due to a lack of specific information. However, the activity is stillimportant because it helps the participants recognize the variety of approachesand activities that can be used to reach men.125

Participant Handout 12A: A Framework for Working with Male ClientsThere are many approaches that HIV and AIDS programs use to involve men. Most of these approaches canbe classified under one of five categories: 1) Social Marketing/Motivation; 2) Information-giving; 3)Counseling; 4) Clinical Services and 5) Supportive Environment. The figure below provides a visualrepresentation of the relationship between these approaches. It is important to recognize that theseapproaches are often overlapping and integrated, and therefore rarely stand alone.ClinicalServicesCounselingSupportiveEnvironmentInformation GivingMotivation/Social MarketingA pyramid is used to represent the number of clients that actually benefit from a particular approach. Socialmarketing can reach more clients than actual clinical services can so it therefore has a larger section of thepyramid. The pyramid also represents the logical progression of a client seeking services. Social marketingmay create interest so the client then may seek out information. Once the client has information he may seekout counseling. If the client has counseling he may decide that a clinical service is necessary.The definitions for these approaches are as follows:• Social Marketing/Motivation – Motivating behavior change in an individual by marketing aproduct, service, or action.• Information Giving – Transmitting or exchanging knowledge and skills in order to help clientsadopt healthy behaviors.• Counseling – Exchanging information with an individual (or couple) directly in order to makevoluntary and informed decisions about his health and well-being.126

• Clinical Male Reproductive Health Services – HIV-related clinical services provided for men thatinclude HIV testing, ARVs, STI services, and the treatment of opportunistic infections.• Supportive Environment – Addressing the HIV epidemic the lives of people living with HIVthrough advocacy, policy, care and support.The differences between social marketing, information-giving, counseling, and clinical services can beillustrated by the table below:Activity Goal Content ExampleSocial Marketing /MotivationInfluencing behavior in aparticular directionPersuasion – focus onbenefitsA Billboard that encouragesVCTInformation GivingProviding Facts and raisingawarenessKnowledge and skillsSchool health talks,informational pamphletsCounselingThe clients free andinformed choiceFacts; client’s feelings,needs,concernsHIV pre-test counselingClinical ServicesTo provide a medicalservice to a clientMedical services, FPmethods, medicineART127

Resource Sheet: Male Involvement Activities• A doctor responds to a client’s concern about VCT by explaining that the results will not be sharedwith anyone else• A nurse helps a young couple decide on the type of family planning method to use• Satisfied VCT clients promote the service to other men in the community• A radio show that encourages men to go for VCT services• A health worker informs a group of young men about the signs and symptoms of STIs• A TV advertisement encouraging men to be faithful• A doctor visits a workplace to provide STI diagnosis and treatment for male employees• A theater group acts out domestic violence situations and discusses them• A program where young men give talks in school about preventing HIV• A radio call-in show that answers men’s questions about reproductive health• A health worker helps a young man assess his risk for HIV infection• A young man discusses STI prevention with his peers at a bar• A large health event is organized on campus to provide information to men about HIV and AIDS• A billboard shows a photograph of a man and woman entering a HIV clinic together• A brochure discusses strategies on how to abstain from sexual contact• Health workers visit churches to discuss reproductive health issues with men• A discordant couple talks with a nurse about their safe sex options• A poster explaining how a man can take care of his reproductive health• Antiretroviral Treatment• A doctor provides a complete physical for a young man• A lab conducts a CD4 count on a male client• A group of men make home visits to support other men living with AIDS• A law ensures that people living with HIV can not de discriminated against.• Schools adopt a new policy on how to address the needs of HIV-positive students• A community garden is established to improve the nutrition of people living with HIV• An HIV-positive man is treated for thrush128

12.2 Getting Tested for HIVObjectives • To explore the reasons why few men test for HIV.• To consider the benefits that exists for HIV testing.• To identify strategies for increasing men’s use of HIV testing.TimeMaterials60 minutesA4 paper; Scissors; Markers; Tape;Handout 27: Research Findings on Men’s Use of HIV TestingSteps 1. Explain that some studies have found that men are less likely than women totest for HIV. This session will try to explore why that is and how to addressit.2. Lead the group through a plenary discussion to explore some reasons whymen do not test for HIV. As ideas are shared, write them down on a sheet offlip chart paper.3. Continue the plenary discussion by asking the group to identify reasons whymen test for HIV. Write these on flip chart paper as well.4. Pass out the participant handout and explain that these are findings from arecent study in South Africa looking at factors that influence men testing forHIV. Discuss the findings and allow for questions. Ask participants to reflecton whether or not these research findings seem similar or different fromwhat they find in their own communities.5. Divide participants into 3 groups and ask each to consider strategies thatcould be implemented to increase men’s use of HIV testing. Each groupshould record their answers on flip charts.6. After the groups complete their assignment, a representative from eachgroup will present their strategies. Discuss the ideas and allow the audienceto ask questions to the other group.7. Conclude the activity with the discussion questions.• What do you think are the biggest factors that hinder men fromtesting? Why?• Do you think the reasons why men do not test are different thanthe reasons why women do not test? Why or why not?• What strategies seem most likely to be effective in getting more•men to test for HIV? Why?How feasible are the strategies that were suggested? Whichwould be easy for you to implement and which ones would be more•difficult?Who could your clinic partner with in order to carry out thesestrategies?129

Handout 12B: Research Findings on Men’s Use of HIV testingFactors that hinder men from HIV testingIndividual Factors•Using partner’s status as own•Fear of results/death•High-risk activity causing fear•No value seen in knowing status•No sense of vulnerabilityMen not testingInstitutional Factors•Poor quality of services•Lack of confidentialitySocietal Factors•Stigma of HIV•Socialization of MenFactors that influence men to test for HIVHealthProblemsInfluencefrom Partneror FriendMen testingPeace ofmindKnowingsomeonewith HIVResponsibilityand MoralityFrom Levack,A. “Understanding Men’s Low Utilization of HIV Voluntary Counseling and Testing in Soweto, SouthAfrica” University of Washington, 2005.130