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Positive male engagement with HIV & gender programmes.
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Are you working with Men & Boys?


When we talk about tackling gender inequality we're often actually talking about the barriers and discrimination faced by women, as well as lesbian, gay, bisexual, transgender, queer and intersex communities. But what about heterosexual men?

Because of the power and authority that men in most cultures around the world have we sometimes forget to think about the ways that gender can play out in the lives of men and boys, damaging them as well as women and girls. 
 

-Re-thinking Strength and Vulnerability 

Research has found that men’s beliefs about certain notions of manhood made them more likely to engage in risk-taking behaviour.[i] These beliefs included the idea that men are less able to control their sexual needs; that men should be tough and hide their emotions (Lee & Owens, 2002).[ii] Of course not all men behave like this but these feelings are often linked to ideas about being a ‘real man’ and they have consequences for the HIV agenda.  

Harmful notions of masculinity affect men and women differently but it makes all of us more vulnerable to HIV. Research carried out in Eastern Uganda found that 'HIV stigma threatened masculine notions of respectability, independence and emotional control', making it harder for men to participate in peer support or to admit that they needed external help (Mburu, G. et al., 2014).[iii] It also prevents them from testing and accessing treatment for HIV, which puts them at a higher risk for AIDS-related illnesses and death. In the process, many men undermine their wives' efforts to access and adhere to ART for themselves or their husbands.[iiii] Watch our Documentary ‘Seeking Safety: Stepping Stones in Malawi’ to see how husbands were preventing their wives from collecting their ART in Malawi - and how Stepping Stones helped men and women to work together to overcome this behaviour. 
 
‘I used to abuse my wife when she went to the hospital to collect her ARV treatment because she came back late and I didn’t like it. I stopped the abuse after COWLHA members came to my house to counsel me that what I was doing was violence’

-Stepping Stones for Peace and Prosperity 

This Stepping Stones adaptation was developed in Karamoja sub-region, Uganda in communities affected by small arms proliferation, conflict and sexual violence.

It is specifically designed to help facilitators to run workshops within communities to improve communication and relationship skills, so as to promote peace and prosperity by reducing conflict and violence. After the training both male and female participants reported an increased sharing of domestic chores and a decrease in domestic violence. This illustrates how intertwined issues of gender, violence and security are. In a previous newsletter we looked at the huge impact of conflict upon communities, both men and women, as well as the ways that Stepping Stones has been used to help communities to work together to overcome different types of conflict: Conflicted Communities.

Click here to see a PowerPoint presentation about how the training package works, created for the Men Engage Symposium held in Delhi in November 2014.  For an overview of the project and more evaluation results look at page 8 of our annual report  or contact us directly at: enquiries@steppingstonesfeedback.org.
Read below to see how Stepping Stones with Children is helping male and female care givers to establish strong, loving connections with the children they care for. 
 Men and Boys as Part of the Solution_
Men tend to be the key decision makers when it comes to sexual and reproductive health. Traditionally, many interventions designed to advance women's rights have not been gender equitable in their involvement of men and women. With Stepping Stones we have tried to do this, but it is hard to overturn the status quo. 
 
Here are some examples of exceptions to this trend.
  1. 'Three Case Studies: Involving Men to Address Gender Inequities, IGWG'
  2. 'Community Innovation: Achieving sexual and reproductive health and rights for women and girls through the HIV response, compiled by ATHENA for UNAIDS'
  3. SASA! works with men as well as women. It is a three year programme. Click here to access 'Stronger Together: Engaging both women and men in SASA! to prevent violence against women'. If your community benefits from Stepping Stones and wants to keep working and learning together; we recommend moving on to work with SASA!
  4. Stepping Stones and Creating Futures is a programme that uses Stepping Stones alongside an economic empowerment intervention.
Globally we still feel there is a lack of positive male engagement with gender programmes. By working with Men and Boys for HIV prevention and care, we can support them to reflect upon gender and the wider impact that their behaviour has upon women, themselves, our communities, our safety and our wellbeing.

_Stepping Stones leading the way_
The Stepping Stones training package was designed to bring together men and women, to explore gender roles and the effects these roles have on our lives. It was designed from the outset to engage with men and boys, women and girls, as equal partners deserving equal respect and attention. It enables participants to analyse what is good and what is difficult about their traditional gender roles, and supports them, male and female, old and young alike, to explore other ways of behaving, to decide how they might want to adopt these, and to support one another in their adoption.
 
As a result the Stepping Stones training programme has shown, time and again, changes in behaviour including reduction in conflict, gender-based violence, and alcohol consumption; increased practice of safer sex; and redistribution of household resources[i]. In all country settings reviewed Stepping Stones training resulted in better relationships between men and women and an improved ability to discuss sexual issues. Reducing gender based violence is especially important given that recent research has shown that women who have experienced violence are 1.5 times more likely to acquire HIV (WHO 201 3)[ii]; and that after diagnosis, many women experience increased violence from family, community and health-care settings (Orza et al 2015).[iii]
 
By using phylogenetic testing Dr Salim Abdool Karim and colleagues have  shown that young women are having sex with older men and that these age-disparate relationships are disproportionately responsible for young women contracting HIV.[iiii]

By having all four peer groups working together on the same issues Stepping Stones is able to work with older men and younger women together on the same issues. Stepping Stones was developed to help to bridge the gap of understanding between the genders and the generations and to promote real, lasting change.
Key enabling factors to engage Men and Boys are: 
  • Providing men with opportunities to improve their knowledge and skills & to address their concerns;
  • Working separately with older & younger men, who often have different needs and concerns;
  • Building trust within peer groups & helping older and younger men to comfortably explore their own attitudes, behaviour and vulnerability;
  • Enabling men to hear the perceptions of women & to consider the impact of their attitudes & behaviours on the situation of women;
  • Recruiting & training skilled male facilitators;
  • Creating positive peer & community pressure for behaviour change.
_Workshop Structure: Fission and Fusion_
Some programmes designed to reduce gender inequities will work with either men or women and only with one generation. However, working with women only, for example, doesn’t deal with men’s greater power in the majority of sexual relationships. Some programmes work with both men and women but, in schools for example, education may focus on girls and their need for protection, whilst boys may be blamed for girls’ problems. Women might be unwilling to talk about personal issues in front of men; younger men may be unable to talk in front of older men and older women can dominate over younger women. They all need their separate spaces!

What makes Stepping Stones unique is that it works with older and younger (adolescent) men and women simultaneously, in different peer groups, and provides opportunities for these separate groups to come together regularly, feedback, listen and grow. 

Stepping Stones asks participants to divide themselves into the peer group that they most identify with. Each peer group works through the same exercises separately and comes together at intervals to share. This format works because we learn best from those that are most like us. It creates a safe space for people to focus upon their own lives. Finally, the whole community meets to watch dramas created by each of the peer groups and to hear their ‘special requests’ for change.

_COWLHA: Getting it Right_

The Coalition of Women living with HIV and AIDS (COWLHA) was established to create a united voice for women and girls living with HIV and AIDS in Malawi. It implemented Stepping Stones with men and women living with HIV to reduce the high levels of intimate partner violence[i]. being experienced by women living with HIV. By working with couples, COWLHA was able to engage higher levels of participation by men in this particular project compared to other gender programmes.

The Results 
As a result of this unique approach COWLHA was able to impact, not only a decrease in intimate partner violence, but an increase in communication about HIV and about treatment between male and female participants. Participants were significantly more likely to tell their partners that they were going to get an HIV test after attending Stepping Stones, with many more couples attending HIV testing together. One health facility included in the evaluation reported that the number of men accessing HIV related services had more than doubled after the Stepping Stones training.

I have realized that I was subjecting my wife to domestic violence which is a crime before the law. Through Stepping Stones I came to realize the root cause of my problem, which was my addiction to alcohol, once I stopped that, everything has changed for the betterment of our household' A Male workshop participant
 

As Annie Banda, Director of COWLHA, said in a recent documentary about the programme, where adults are happy, we find that children are happy too. This shows how programmes with a holistic approach to working with men and women together can really benefit the next generation.

COWLHA have successfully scaled up their programme across 144 sites in 12 districts of Malawi. This is a rare example of taking an evidence-based programme to scale in this way. COWLHA are to be warmly congratulated for achieving these great results. Read the evaluation in full here. 
Men and Boys and HIV: Global workshops

Click on the links below to find many resources produced by organisations working on gender-based violence, involvement of men and boys, and the meaningful involvement of women living with HIV in the context of HIV. 
 
Children learning together through creative activities. 
_Stepping Stones with Children_
In Africa, traditional gender roles often leave women with the sole burden of caring for those who are ill with AIDS-related illnesses. Stereotypes about the woman’s ‘natural’ role as carer means that HIV care programmes have neglected to involve men and boys, except in paid roles. By failing to work with men, reproductive and sexual health services are continuing to place the burden of care squarely on the shoulders of women, who may already be feeling overwhelmed.

The Stepping Stones with Children training package began as a holistic response to this situation. It works with caregivers and children aged 5 - 14 years who are directly affected by HIV. In this adaptation, the peer groups are divided into three peer groups: of older and younger children and caregivers. At times, each peer group also subdivides to work on specific issues by gender. By working with young boys and girls together, and their caregivers, we can support both adults and children to think about gender. This helps children to reflect upon and choose how they want to behave as they move on their journeys towards adulthood.

In a film made by Salamander Trust about the impact of the Stepping Stones with Children training upon participants' lives, one male caregiver claimed that the programme helped him to see the importance of showing love and care when raising children. This outcome is important because children who experience violence at home, from either male or female care givers, are more likely to be violent – or be with partners who are violent - themselves later in life, replicating the damaging behaviours that they learned from those around them. By working with boys as well as girls and male as well as female carers, Stepping Stones with Children can help to stop these life-cycles of violence, instead creating life-cycles of safety and security for children as they grow up to become adults and caregivers themselves. What's more, we hope that Stepping Stones with Children will be used holistically alongside the original Stepping Stones programme, to ensure that men and boys can be meaningfully involved, alongside women and girls, in gender programmes throughout their lives.
Watch our films!
To  learn about other other effective responses to Gender-Based Violence and HIV in Africa, watch other outcomes from Salamander Trust's film training and documentary programme. It was developed to showcase the extraordinary grassroots leadership of women living with HIV by clicking here.
 Coming Soon..._
Stepping Stones with Children and a wholly revised and updated edition of Stepping Stones, now incorporating Stepping Stones Plus will be published shortly by Practical Action Publishing. 
 
More news to follow soon!
 
We hope you have found this newsletter interesting and useful.
For more information visit our dedicated websites
www.steppingstonesfeedback.orgwww.salamandertrust.net
Or contact us at enquiries@steppingstonesfeedback.org.
 
Email content written by Salamander Associate, Nell Osborne
Copyright © 2016 Salamander Trust, All rights reserved.


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