HORIZON INTERNATIONAL SOLUTIONS SITE

Problem Overview:

In South Africa, as with many other countries, family planning and reproductive health services are targeted towards women. However, in many African households men are the sole-decision makers. Therefore, while women are equipped with the necessary knowledge to make better decisions about the well being of their lives, they are not empowered to make changes. This situation is exemplified in the circumstantial inability of a women to demand or negotiate condom use in consensual sex situations. Women understand and have the knowledge of the benefit of barrier method birth control yet they do not have agency in regards to their sexuality.

In order to begin healthy inter-gender dialogue about sexual behavior it is necessary to challenge current gender norms in South African society. Cultural notions of women as the weaker sex and women as property as still very active within South Africa. The prevalence of such attitudes do not allow women control over their own lives, sexuality and sexual decision-making power. This is demonstrated by the high rates of reported sexual violence against women. South Africa reports some of the highest rape figures in the world leading some to describe violence against women as 'endemic' to the country (Park, 2000). The National Institute for Crime Prevention and Rehabilitation Offenders (NICRO, 1993) estimates that a woman is raped every 83 seconds in South Africa, resulting in over one million rapes every year. South African Police Services (SAPS) estimates that a women is raped every 35 seconds (Park, 2000). Further, studies conducted on the culture of sexual violence suggest that 40% of men (out of 2059 interviewed) thought that punishing their wife was legitimate. Punishment included physical violence, financial punishment, verbal abuse, controlling freedom and withholding sex. The same study also revealed that one out of five men admitting to sexual intercourse with a women without her consent (Kruger, 2000).

Levels of disempowerment become magnified in an environment in which HIV is of such high prevalence and when women are disproportionately affected by the epidemic. It is currently estimated that 1 in 10 South African adults has tested positive for HIV. Current projects suggest that more that 50% of South Africans under the age of 15 will die of AIDS related causes over the next decade. HIV/AIDS education also goes hand-in-hand with the need to educate the South African population on Sexually Transmitted Infections which currently affect 35% of men (Matshidze, 1999).

In a country and region becoming consumed with the spread of HIV, the importance of educating both men and women on issues of reproductive health and sexuality becomes of primary concern. This begins by creating a space for men in reproductive health by educating men about their role in reproduction and by changing currently accepted gender norms in society at large. These objectives motivated the creation of the Men as Partners program.

Background:

Background to the Planned Parenthood Association of South Africa (PPASA) and the Men as Partners Program (MAP)

PPASA has several objectives:

• To be a dynamic national NGO committed to the principles enshrined in the South African constitution
• To provide leadership in sexual and reproductive health and rights, recognizing this as a keystone to gender equity and sustainable development
• To critique and actively promote sexual and reproductive heath policy both nationally and internationally
• To seek out opportunities to collaborate and form partnerships with underserved communities, civil society and government
• To pioneer quality programs which address sexual and reproductive health priorities
• To maximize the unique synergy of staff and volunteers to achieve its goals (http://www.ppasa.org.za/)

In April of 1999, PPASA and the Reproductive Health Research Unit (RHRU) commissioned the "National Male Sexual Health and Reproductive Health Survey”. The objective of the survey was to benchmark attitudes, knowledge and practices of men in respect to reproductive health. In total 2141 men were interviewed in urban and rural settings within all nine South African provinces.

The research began to lay the framework for understanding and defining the role of men in reproductive health and sexuality issues in South Africa. The average age of first sexual encounter was between the ages of 15-16. Only 15% of men had used contraception at their first sexual encounter. The majority of men understood the meaning of rape but over half of men blamed women for provoking rape by the way they dressed and waling alone after dark. More than half of the respondents did not believe in the concept of rape within a marriage (Matshidze 1999). Although these only represent a few of the lessons learned they exemplify the scope of the challenge that an education program would have to address to effectively change attitudes and behavior.

The findings demonstrated the need for a program targeted towards men and led to the development of the Men as Partners program. MAP is an initiative of AVSC (now EngenderHealth) and PPASA. The objectives of the MAP program are as follows:

• Improve men’s awareness and support of their partners reproductive health choices
• Increase awareness and responsibility for prevention of sexually transmitted disease and HIV/AIDS
• Increase understanding of gender equity and healthy relationships
• Increase awareness of and strive to prevent domestic and sexual violence
• Improve men’s access to reproductive health information and services (Kruger, 2000)

The philosophy of the MAP training program is set out as follows:

“The MAP program needs to approach men in a gentle, respectful, open-minded manner. Outreach efforts should be designed to match the needs of South African males. Universal values of equality, respect, responsibility, and honestly should be promoted to our male audience. Efforts that engage and motivate men should be used to draw in their involvement in an area that has traditionally focus on women (Kruger, 2000)”

Currently MAP is being conducted in six provinces in South Africa: Gauteng, KwaZulu Natal, Eastern Cape, North West, Northern and Free State.

Methodology and Structure of MAP

Map is a one, three, or five day interactive workshop. The curriculum includes gender and sexuality, male and female sexual health, HIV / AIDS and STD education, relationships, communication, and violence. Each curriculum area is discussion and activity based promoting an interactive learning atmosphere.

There are several “levels” to the training. A Training of Trainers (TOT) allows PPASA to train and empower leaders within a community to conduct the MAP workshop. In a TOT participants are also given facilitation, conflict resolution, and leadership skills to equip them as trainers for MAP. PPASA MAP trainers and those members of the community trained through TOT then solicit other men and women to become participants in the workshop. The target group is disadvantaged men. The strategy for obtaining maximum attendance by the target group is to market the program to currently existing structures. Such structures include associations of truck and taxi drivers, churches, community groups, and businesses in the private sector.

The curriculum of the MAP program was and is created through a process of testing and feedback. The original South African handbook was the product of a collaborative effort between PPASA and EngenderHealth. This was done by testing existing American curriculum being reevaluated for the South African context and tested during a workshop of potential MAP trainers. The curriculum was then modified for the South African participant. After the initial curriculum was drafted 10 master trainers were then trained for PPASA provincial offices.

Challenges

There have been several challenges in the implementation of MAP. A key issue has become reaching out to “unreachable” populations. There are many men who would be considered a target audience for MAP, however, they do not participate in community structures or organizations that would allow them to be easily approached. In order to overcome this challenge PPASA staff and MAP trainers will have to continue their strong participation in communities in which they operate. MAP trainers and PPASA will also have to continue developing strategies, such as shabeen visits, which are non traditional.

Another major challenge has been the attitude of private sector businesses in offering their employees training which will take them away from labor. For example, many mines and factories that rely on inexpensive human labor are hesitant to sacrifice production for a week for HIV/AIDS and gender training. This challenge is overcome by explaining the long-term benefits on production, labor and profit when are healthy and making better lifestyle choices. While this appears to be rational enough, the large number of unskilled labor in South Africa often undermines any need for private sector corporations from investing in the health of their employees.

Other challenges in implementation are cultural and come with any desire to instigate social change. Resistance to learning and resistance to participation by males is common. Often people are resistant to commit long days to learning when potential earning time is lost. This is especially true of those people working in the informal sector. This challenge can be overcome by offering non-monetary based incentives such as certificates. However, the need for earnings and immediate benefit is often far greater than the long term investment that is being made in health by participating in the program.

Evaluation

Project Evaluation and Research Services formally evaluated MAP in September of 2000. The evaluation was conducted in order to gauge the programs effectiveness and make recommendations for improved impact. The report acknowledged that MAP is one of the few programs in the area of reproductive health that is aimed at targeting men.

The evaluation included an overview of the program, a review of the curriculum manual, interviews with past participants, control groups and educators.

The overall evaluation was very positive:

“All information obtained during the evaluation process points to the fact that the MAP program is unique, well designed, valuable, and achieves its overall objectives. For those persons who have had the opportunity to go through the MAP training, their levels of awareness in respect to reproductive health, gender equity, sexually transmitted diseases and HIV/AIDS, and issues around domestic violence and sexual violence has undoubtedly increased.”

The report also stated, “The MAP program should be enhanced and extended to as many men in South Africa as possible” which speaks to the need for replicability of the MAP program within the country. The MAP South Africa program was created specifically for South Africa and addresses country specific issues through its curriculum. Teaching tools within the curriculum (i.e. games) are culture specific using South African contexts and names. Therefore, replication internationally would demand a basic reevaluation of the curriculum. Replication within Sub Saharan Africa would require fewer changes as many cultural components and contexts are common with South Africa. The curriculum can be easily adjusted to various cultural contexts because the key issues, objectives and challenges being discussed are universal. MAP provides a framework for male focused programs globally.

  Web Links:

Planned Parenthood Association of South Africa

Contacts:

Planned Parenthood Association of South Africa
Sipho Dayel, CEO
PPASA
PO Box 1008
Melville 2109
31 Plantation Road
Auckland Park 2092
Johannesburg, South Africa
Tel: 011-482-4601