PRETORIA (AlertNet) - "Iraq does not harbour weapons of mass destruction. Africa does, and it is called HIV," says popular South African comedian Pieter-Dirk Uys. "What's killing us is the secret, not talking about AIDS. Silence kills."
Nodding vigorously among the audience is Believe Dhliwayo, a Zimbabwean in his early thirties. "I'm HIV positive because my parents never talked to me about sex," he said. "It's high time we change the aspects of our culture that spread the disease."
Uys performs his hilarious AIDS awareness skits free of charge at schools throughout South Africa. Dhliwayo works at The Centre, a group that provides counselling and support for people with AIDS and their families in Zimbabwe's capital Harare.
Noticing that men die earlier than women after diagnosis, The Centre concluded that men succumbed to opportunistic infections as a result of low self-esteem. "Our male identity says we can deal with all problems but we can't deal with HIV infection," Dhliwayo said.
Both Dhliwayo and Uys are part of a wave of fresh thinking about men and AIDS in southern Africa. It moves beyond "men drive the pandemic" to "how can men be more engaged in containing AIDS than in spreading it?"
According to the U.N.'s joint programme on HIV/AIDS (UNAIDS), national adult HIV prevalence has risen "higher than thought possible" in the region: Botswana 38.8 percent, Lesotho 31 percent, and Zimbabwe 33.7 percent. Namibia follows with 22.5 percent, Zambia 21.5 percent, Malawi 15 percent and South Africa 13 percent.
A variety of male-driven efforts were showcased at a conference on men and AIDS organised in Pretoria, South Africa, in February by the Regional AIDS Initiative of Southern Africa of Voluntary Services Overseas (RAISA/VSO).
A common thread was the pervasive silence surrounding male sexuality. Parents do not talk about sex with their children. Husbands do not talk with their wives. Men generally feel uncomfortable discussing intimate matters.
At the National Association for People Living with HIV/AIDS in Malawi (NAPHAM), nine out of 10 male members felt unable to disclose their HIV status to their wives.
Keeping it secret brought stress, risk of infection through unprotected sex and inability to change lifestyle. However, when NAPHAM started support groups for couples, 65 pecent of men brought their wives. Male membership increased. "The groups enabled men to talk," said Napham's Mark Kumbukani Black.
NON-THREATENING ENVIRONMENTS
A regional survey by Southern Africa AIDS Information and Dissemination Service (SAFAIDS) concluded: "Men need opportunities to explore and talk about their sexuality in non-threatening environments."
On a balmy summer evening, Regis Mtutu can be found at a beer hall in Bulawayo, Zimbabwe's second largest city, telling a bunch of young men that masturbation is harmless and manly.
Mtutu is an activist with the Men's Forum Padare/Enkudleni. The forum seeks to change stereotypes about manhood. Padare members go where men hang out, at bars and sports clubs, and to schools and churches. "We talk, talk and talk until we feel comfortable," says Mtutu.
In rural settings, they discuss inheritance and traditional beliefs. In towns, sugar daddies and domestic violence. Everywhere, they show there are alternatives to the dominant macho identity.
Research throughout the region shows that men are socialised into a notion of masculinity as sexual prowess, risk-taking behaviour and male dominance and superiority over women.
At the same time, men perceive their privileged space in society is under threat from a variety of factors, ranging from rural migration, Western culture seeping through mass media and growing recognition of women's rights.
"Many men are feeling a bit hopeless, like there's no place for them in the world," says Professor Graham Lindegge, of the School of Psychology at South Africa's Natal University.
In a study of how masculinity is constructed in schools in KwaZulu Natal, Lindegger found that the conflict between traditional and contemporary gender roles generates a sense of displacement and futility among boys and men.
The sense of loss undermines men's motivation for safe sex. "What point would there be in preserving oneself and others for a society in which one has no place in the future?" Lindegger asked.
Similar findings occurred in a survey of risk-taking behaviour among youths in Soweto, South Africa's largest township, where nearly half of young men are unemployed.
"If you have no job and no future, life becomes cheap, and sex a dangerous entertainment fuelled by boredom, alcohol and poverty," said Barbara Fisher, an academic with the University of Witwatersrand.
HEALERS, CHIEFS AND PRIESTS
From the other end of the social spectrum, a survey among traditional healers, chiefs and Zionist priests in nine provinces by the Promotion of Traditional Medicine Association of South Africa (PROMETRA) found that men felt socially disoriented through loss of leadership position in the family and community.
"Men have become spectators, irresponsible and indifferent," according to social scientist Douglas Kabanda, who led the research.
To change this, PROMETRA taps into the traditional notion of men being responsible for their families.
Cultural and traditional customs are maintained albeit in "safe and best practice." Male circumcision, wife inheritance, scarification (decorative scarring) and polygamy can be managed responsibly if people know about HIV infection risks.
"Traditional practices make up male identity; to attack them is self-defeating. We need to find viable ways of keeping tradition while getting men involved against AIDS," Kabanda said.
Dry sex, where women put herbs and potions in the vagina to make it hot, tight and dry, provokes lesions that make HIV infection easier.
Dry sex is prized by men. A wet vagina is not. The reason, according to Kabanda, is ignorance about the female body. "When we explain what causes wetness, their eyes open. We discourage dry sex," he said.
The wall of silence around Africa's ultimate taboo topics -- male rape and male-to-male sex -- is crumbling.
Ivan Louw, a 26-year-old businessman, was hijacked, raped and tortured by three men near Pretoria in 2001. At the hospital emergency ward, he couldn't tell the nurses he had been raped.
"Rape doesn't happen to a white, Christian, married, rugby-playing Afrikaaner man, right?" he said.
He refused to accept the stigma, went public with his story and founded Men United, a support group for male rape survivors and their families.
THREAT OF IMPRISONMENT
Namibia's President Sam Nujoma has denounced gay men and women as un-African and threatened them with imprisonment and deportation.
However, ethnographic research in the 19th century documents sex between men among the Himba, Herero and Ovambo peoples.
"Politically constructed homophobia has a negative impact on public health because it excludes homosexuals from prevention and awareness campaigns, making them vulnerable to HIV infection," said anthropologist Robert Lorway.
In field research among black gay and bisexual men in Katutura township, Lorway found they experienced regular verbal, physical and sexual forms of assault and discrimination from hospital staff, police, and army and church officials. Finding barriers in employment, they turn to commercial sex work.
Because sodomy is a criminal offence in Namibia, condoms cannot be distributed to prisoners, in spite of HIV prevalence of 27-30 percent in the country's 13 crowded prisons. "It could be seen as encouraging criminal behaviour," explained Pride Simana, an AIDS counsellor with the Prisons and Correctional Services.
New is men's involvement in home-based care, although nursing the sick has traditionally been a female preserve.
"If I fall sick, I can only think of women who would help me, no men," says Believe Dhliwayo. "We need men's support groups."
Out of 520 volunteers with Tovwirane AIDS organisation in 52 villages in northern Malawi, 40 percent are men. Kara Counselling in southern Zambia also has growing numbers of male caregivers.
Chiefs and church leaders help identify possible volunteers who are provided with training, bicycles and team support.
After 20 years of rampant spread, AIDS is forcing changes in male behaviour in southern Africa.
"Organisations are taking the bull by the horns and engaging men with some success," says RAISA/VSO coordinator Terina Stibbard.
