Elements for a Platform of Action to Engage Men and Adolescent Boys in the HIV Response and Fast-track the End of AIDS

Background

Gender inequalities and harmful gender norms are important drivers of the HIV epidemic and are major hindrances to an effective HIV response. While women and adolescent girls’ access to HIV services remains a concern, a growing body of evidence also shows that men and adolescent boys have limited access to HIV services.

Current efforts to advance gender equality, and sexual and reproductive health and rights (SRHR), as key elements of the HIV response do not adequately reflect the ways in which harmful gender norms and practices negatively affect women and girls and men and adolescent boys in all their diversity, increasing their HIV-related vulnerability and risk.

In order to respond to these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), Sonke Gender Justice and the International Planned Parenthood Federation (IPPF), convened a high-level meeting on the Rights, Roles and Responsibilities of Men in Fast-Tracking the End of AIDS on December 10–11, 2015, at UNAIDS Headquarters in Geneva.

Click here for a Final Concept Note for the meeting: FinalConceptNote_Men&AndBoys

Click here for a Draft discussion paper: DraftDiscussionPaper_Men&AndBoys

Purpose of the meeting

The meeting was convened to review the latest evidence on the HIV epidemic among men and adolescent boys, their access to and use of HIV services, the responsiveness of health systems to their needs, and the roles of harmful gender norms in driving the HIV epidemic among men and women, and boy and girls.

The meeting was also tasked with reviewing promising approaches for challenging harmful gender norms that heighten men’s and women’s HIV risks, and best practices that can enhance men’s access to and utilisation off HIV and other health services.

Main meeting objective

The meeting’s main objective was to agree on core elements for programmes to successfully Fast-Track the HIV response among men and adolescent boys in ways that will benefit the health of all.

Key findings of the meeting

  • Participants emphasized the timeliness of the meeting in the context of the shift towards a ‘treat all’ approach and the push to Fast-Track the HIV response.
  • The meeting emphasized the urgent need to reach men and adolescent boys with evidence-based HIV prevention, voluntary testing and counselling, treatment and care services that are informed by age-, sex- and geographically-disaggregated data (‘know your epidemic, know your response’).
  • This cannot be achieved in isolation from the ongoing efforts to advance gender equality and change harmful gender norms, including eliminating gender-based violence. The future of the HIV response hinges on more rapid and profound progress toward gender equality, particularly as it affects the realms of health and HIV. Gender equality and gender-sensitive approaches must be integral parts of the policies and actions that drive the HIV response.
  • Efforts to advance gender equality must take account of the interconnected nature of the challenge, and the various ways in which harmful gender norms affect men, women and adolescent boys and girls in all their diversity.
  • Along with continuing the vital work to reach more women and girls with prevention, voluntary testing and counselling, treatment and care services, it is essential to learn from, scale up and build on existing successful interventions that engage and reach men and adolescent boys in the HIV and sexual and reproductive health (SRH) responses, and to challenge harmful gender norms. These are interlinked challenges, not a zero-sum trade-off.
  • The meeting therefore stressed the urgent need for action to challenge harmful gender norms that negatively impact the health of women and men, and to improve access to and use of HIV services for everyone.
  • The meeting concluded in general agreement that there is a strong and growing evidence base showing that gender norms and relations can be transformed, but only by engaging both men and adolescent boys, and women and girls.

Proposed elements for a Platform of Action

Based on the findings of the high-level meeting, the following core elements were identified for taking collective action forward.

  1. Generate and use evidence for decision-making at a local level
    • Know your epidemic at a local level: Collect, analyze and disseminate data of greater detail and disaggregate those data by age, sex, gender identity, sexual orientation, work status and occupation, school enrollment, and location, as relevant. Local data should be drawn from a variety of settings to guide effective, appropriate action. The data should be collected, used and disseminated in ways that respect and protect the confidentiality and safety of individuals.
    • Identify which men and adolescent boys are not being reached:  Collect, analyze and disseminate data that enhance understandings of available services and messages, of which men and adolescent boys are not using existing services and why this is so (including by leveraging existing knowledge-building processes such as the ‘All in to #EndAdolescentAIDS’ platform).
    • Analyze the gender dynamics: Conduct analyses to understand how gender relations and other dynamics of power shape HIV risk, and access to and the use of health services for men, women, boys and girls in all their diversity, including among key populations such as men who have sex with men, transgender women , sex workers and people who inject drugs.
    • Understand men’s perceptions and utilization of current services: Promote and strengthen gender-sensitive analysis of operational science evidence to understand the factors that shape men and adolescent boys’ access to and use of health services in specific settings.
  2. Expand men’s and adolescent boys’ access to and use of people-centered health services, and strengthen community-led responses  
    • Build on what works and engage existing networks and civil society groups: Expand community-led approaches and programmes that are proven to work and mobilize, emphasizing action while also collecting data to inform and adapt future programming.
    • Adapt existing services: Remove identified barriers, make services more attractive and responsive to the needs of men and adolescent boys in all their diversity, and expand those services. Actions should be based on reviews of evidence. Examples include: training service providers and peer educators; integrating HIV and other health services; offering relevant services; supporting and scaling up community-based HIV services.
    • Bring services closer to men and adolescent boys: Focus on reaching men and adolescent boys with innovative service delivery methods in workplaces, places of worship, sports gatherings, schools and other community venues. Use similar approaches to challenge harmful gender norms. This is particularly important for reaching people who live in poorly serviced settings or who are not in formal education and/or employment.
    • Monitor, evaluate and ensure accountability: Use existing monitoring and accountability mechanisms to evaluate interventions (including possible, unintended consequences) and use the findings to improve services. Ensure that participatory monitoring and evaluation processes promote the sustainability of interventions.
  3. Promote positive social norms to advance gender equality and improve the health of women and men, and girls and boys
    • Strengthen the policy framework: Develop, adopt, implement and mobilize funding for evidence-backed policies and programmes which challenge harmful gender norms, increase men’s and adolescent boys’ support for gender equality, use gender-sensitive approaches, reduce sexual and gender-based violence, and eliminate barriers and promote men’s and adolescent boys’ access to and use of health services.
    • Advance comprehensive sexuality education: Support the inclusion of comprehensive sexuality education, with strong gender equality components, in primary and secondary schools, as well as training for educators and for in- and out- of-school adolescents and young people.
    • Communication and advocacy: Use communication and advocacy tools, social media and channels innovatively to challenge harmful gender norms (including workers and employers’ structures, faith-based networks, and sports, entertainment and traditional leadership structures).
    • End violence: Address violence in all its forms (including in conflict settings), with a specific focus on ending sexual and gender-based violence, including against children. Actions should include guidance and support for scaled-up primary prevention to challenge harmful gender norms, programmes to support the survivors of sexual and gender-based violence, and interventions that engage perpetrators.
  4. Sustain the HIV response
    • Review and enforce the legal framework to advance gender equality and non-discrimination, guided by the findings and recommendations of the Global Commission on HIV and the Law.
    • Strengthen strategic alliances, partnerships and outreach at all levels, including with non-health ministries, the private sector, networks of key populations, youth organizations, trade unions, women’s organizations and networks working with men and adolescent boys. A key aim should be to provide leadership and support for engaging men and adolescent boys to challenge harmful gender norms and improve their health-seeking behaviors.
    • Engage adolescents and young people as beneficiaries, partners and leaders in the design, implementation and monitoring of interventions that are aimed at advancing gender equality, challenging harmful gender norms, and improving the health of women and men, and boys and girls, in all their diversity, using participatory platforms.
    • Scale up funding to genuinely address the gender inequalities and harmful gender norms at the root of women and men’s HIV vulnerabilities. Greater technical and financial resources are required, and these will need to be sourced more innovatively. The initiatives cannot rely entirely on traditional donors, nor can new programmes be supported from existing budgets without the risk of negatively affecting the situation of women and girls.