New role for men in HIV/AIDS fight

Health officials called it the largest gathering of males to ever attend an antenatal lecture in Swaziland, and a sign of the increasing participation of men in programmes aimed at mitigating the impact of HIV/AIDS. About 200 men and 100 women from the Ngculwini area, in the central Manzini region, attended the launch on Sunday of the 'Happy Baby Healthy Family' initiative, aimed at preventing mother-to-child transmission of HIV. They sat on the ground, listening to health motivators talk about how to prevent HIV/AIDS and the necessity of HIV blood tests, and watched a demonstration of the rapid response pinprick method. The Ngculwini meeting was a complete contrast to previous community meetings, when men stayed away but told their wives to attend if HIV/AIDS was going to be discussed. "In my five years here, I have never seen men outnumber women at a health meeting," said Alan Brody, the UN Children's Fund (UNICEF) Swaziland Representative. The 'Happy Baby Healthy Family' initiative is considered essential in a country where the HIV prevalence rate among pregnant women is 42.6 percent. The programme is backed by UNAIDS, the World Health Organisation, the World Food Programme and the UN population fund, UNFPA. Other partners include the Elizabeth Glaser Paediatric AIDS Foundation, sponsored by the United States government, and the Baylor University medical team, funded by the Bristol-Meyers-Squib pharmaceutical company. Efforts to eradicate the parent-to-child transmission of HIV have been hampered by the lack of involvement of Swazi men in family health issues. "I cannot talk to you about sexual matters - those things are between a husband and wife," said Simon, a middle-aged Ngculwini resident, at Sunday's gathering. Nonetheless, he stayed to watch a dramatic presentation, written by Brody, that included a scene at an antenatal care clinic - a place no Swazi man is likely to go - and a lively discussion, held by three women, about AIDS and pregnancy - a conversation few Swazi men are otherwise likely to hear. "This was a good play. I laughed a lot," Simon said at the end of the performance. The Ngculwini chief, a relatively young man in his thirties, told PlusNews, "I wanted the men here: AIDS is killing off whole families - I am losing people [in my chiefdom]. It is not just women, but men who can do things to stop this disease." Between 10 percent and 15 percent of Swazi women who take blood tests to determine their HIV status do not want to be told the results, a reluctance attributed to the lack of spousal support, or husbands who forbid them to know their status, said Siddharth Nirupam, the programme officer for health and nutrition at UNICEF Swaziland. "The woman refuses to hear the nurses who have the results, but the nurses have a way: every time they encounter the patient, they say, 'We have to have a talk'. By their tone the woman detects she is HIV positive; she knows, but she has not disobeyed her husband," said Nirupam. "The problem of male participation has emerged as a constraint [in AIDS prevention and mitigation efforts] not just in Swaziland, but in several African countries. Not too much has been done to approach this. I wrote a play to try to get through to men - to show how their behaviour can make things worse - because women can't do it alone," Brody explained. "Unless men take an active lead, they stand to lose not only their own lives, but their entire family lineage," he added. The Ngculwini meeting, which also introduced the men in the area to healthcare providers and the programmes available to their families, was not an isolated victory. Other Swazi chiefs, who number about 350, have attended seminars at the Ministry of Health, and are spreading the HIV/AIDS prevention message among their people. About 80 percent of Swazis live under chiefs, and all Swazis must have a chiefdom affiliation to obtain government documents. Chiefs and traditional leaders can exert considerable authority and influence in health and social welfare campaigns, and are heeding health officials' requests that their male subjects become more involved in AIDS issues. Albert Thwala, a health motivator with the ministry's reproductive health programme, said the prevention of mother-to-child transmission of HIV was but one step in guaranteeing healthy families. "Our testing programmes offered at the main government hospitals, and at some of the clinics in rural areas, do bring the mother and her baby together with her partner. When the pregnant mother takes an HIV test and is positive, for her to continue with the programme it is vital that her partner also tests - his health needs must be addressed along with the mother's and the baby's," said Thwala. The traditional women's regiments, the 'Lutsango LwakaNgwane', where women of the same age participate in community activities, have chosen to observe World AIDS Day this year for the first time, with the theme, 'Women and Girls: Love Them, Care For Them, Protect Them'. Amos Mavuso, a contractor who works in Manzini, said, "It is hard for a Swazi man to accept that the best way to protect your wife is by using a condom: you do that, and you admit you're having an affair with another women. Girlfriends are so common, but no man wants to admit it to his wife, so we take risks." Although polygamy is legal in Swaziland, the expense of making the obligatory gift of cattle to the bride's family, and maintaining multiple households at modern standards prevents many Swazi men from officially marrying in the traditional way. "Men take their first wife in a traditional ceremony, so they can later take other wives. But then they go through girlfriends, one after another, and never wed them - this is not the real Swazi way. It has spread HIV to where we are now," said Amos's brother, Samson Mavuso. Both men said they would consider taking blood tests and learn their HIV status, something they had previously resisted. "No man wants to know if he is HIV [positive] - most men think they are - they don't want to know they are going to die. But now they are telling us we don't have to die; there are treatments; we can keep AIDS from getting to our babies," said Amos.