Changing men's attitudes to reduce AIDS in Africa

In a community hall in Soweto, South Africa's largest township, 20 men and women try to imagine life in the other gender's shoes.

They compile two lists. The men complete the sentences, "I'm glad to be a man because" and "If I were a woman I could...." The women do the same, listing the reasons they are happy to be female and what it might be like if they were men.

"I'm glad I'm a man because I can have multiple partners," reads one entry on the men's list. "If I were a man I could sleep around the way I want," states a line on the women's.

The discussion that results heats up faster than the hall's corrugated iron roof under Soweto's sun. Men and women exchange verbal jabs during the first day of a four-day workshop that encourages frank discussion about sex, gender relations, and violence against women.

The ultimate goal of the Men as Partners (MAP) workshops, organized in 1998 by the international nongovernmetal organization EngenderHealth, are to curb South Africa's AIDS problem by shaping attitudes and behaviors, particularly those of the male participants, that experts say contribute to the spread of the disease.

An estimated 5.3 million South Africans have HIV/AIDS, the highest number of infections in the world.

The workshops, partially funded by President Bush's Emergency Fund for AIDS Relief, encourage men to be involved in preventing domestic violence, promoting safe sex, and sharing the burden of caring for those affected by HIV/AIDS.

There is no accurate way to measure how many HIV infections the MAP program has prevented, say those involved, but a United Nations Population Council study, now in its early stages, will evaluate changes in attitudes and behaviors in men who have been through the workshops.

A study conducted in 2002 found shifts in attitudes toward women and HIV/AIDS in 139 men who had been through MAP. Before the workshop, 61 percent of the men disagreed that women who "dress sexy" want to be raped, while three months after the workshop, 82 percent disagreed. Before taking the workshop, 43 percent of men disagreed that sometimes when a woman says "no" to sex, she doesn't really mean it; three months after the training, 59 percent disagreed. After the training, 70 percent of the men thought it was okay for a woman to refuse to have sex without a condom compared with 57 percent before the training.

The workshops are largely facilitated by volunteer "peer educators," usually young black men motivated by their own exposure to domestic violence and HIV/AIDS and convinced of the need for change.

"Five of my family members are HIV positive, and my father was abusive to my mum," says Lillo Phalandwa, who runs a MAP workshop in Soweto. "Before I went to the workshop, I thought it was normal because when I was three my father started abusing my mum. I was verbally abusive toward women. Now I treat them as equal to me."

The focus on men arose from research by the Johannesburg-based Reproductive Health Research Unit in 1998.

Their study revealed that 22 percent of the 2,000 South African men surveyed approved of hitting partners, and more than half blamed women for provoking rape by the way they dressed or by walking alone after dark.

These data, considered together with the fact that 58 percent of the men had never used a condom, though 35 percent had contracted a sexually transmitted disease, make evident the link between violence against women and the spread of HIV/AIDS, AIDS workers say.

Tshidiso Legwala, who works as a hairdresser in Soweto, has been attending MAP workshops for several months and says that it has changed his attitude toward women "in a huge way."

He admits he used to be abusive toward his former girlfriend when she became too emotional. "I didn't used to think women had the same rights as men," he says. "I communicate with women much better now."

Since it began seven years ago, EngenderHealth has expanded the MAP program by partnering with other organizations. Thousands of men across the country now participate in MAP workshops and activities every month. Most workshops run for five days, but one workshop is rarely enough to have a significant impact, say organizers.

"It could be five or six workshops before you can start to see change," says Sgidi Sibejo, a MAP coordinator, "and then there needs to be follow up and other interventions."

Jane Chege, who is overseeing the UN study, says that MAP has tremendous potential if it can succeed in broadening its reach and encouraging men to spread the message of the workshops in their communities. "You're talking about changing ideas people have grown up with, changing ideas that will cause them to lose a bit of power," Ms. Chege says.

"It doesn't take place quickly, but we're finding that for the younger generation, the room for change is there," she says.

Recognizing that one-time interventions are not always enough to change attitudes formed over a lifetime, EngenderHealth recently introduced the concept of Community Action Teams. [Editor's note: The original version mischaracterized the program as being only for teens.]

Groups of men who have been through the training also now meet monthly. They provide each other with support systems, and agree on taking action in their communities - visiting, for example, local bars to distribute condoms.