Thehealthprovider vol 2 no 2

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Health He ealth h Provider Prroviider A

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A PUBLICA PUBLICATION TION N OF THE NA NATIONAL TIONAL L FAMILY FAMIL F AMIL LY PLANNING BOARD

Men & Contraception Why Should Men be More Involved in Contraception

VOLUME 2 NUMBER 2

REPRODUCTIVE HEALTH SERVICES TO MEN Risky Behaviours in Men and the Impact of Counselling

ealth Provider MEN’S REPRODUCTIVE HEALTH

CREDITS NEwSlETTER Co-oRDINaToR Harriett M. Clarke Communications Officer (Writer) CoNSulTINg EDIToRS Dr. Olivia McDonald Executive Director Dianne Thomas Director Outreach Programmes Kevin Bell Director Policy Formulation, Monitoring & Evaluation

Editorial

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his newsletter focuses on the reproductive health concerns of men in an attempt to explore the concept that family planning services have been primarily established to benefit women and their reproductive health. It also looks at the fact that the majority of condom users, who are men, source methods outside of the clinic. The International Conference on Population and Development, held in Cairo in 1994 stated “in most societies men exercise preponderant power in nearly every sphere of life, ranging from personal decisions regarding the size of families to the policy and programme decisions taken at all levels of government.” Men are therefore seen as critical to gender equality and to a large extent for the continuation and maintenance of contraception within the family.

The National Family Planning Board has been focusing on men as a target group via its strategic element of expanding access to reproductive health information and services to men through increased participation and sharing of responsibility of men in the practice of family planning; and Promoting safe sexual behaviour, attitudes and practices to reduce the prevalence of STDs including HIV/AIDS.

‘encourage males to become more involved in the reproductive health process.’

The article which explores risky sexual behaviours in men is also a very enlightening piece as it features the comments and opinions of Professor Barry Chevannes, Lecturer at the University of the West Indies, spokesman and one of the founding members of the organisation Father’s Inc. The article on Men and Contraception aims to provide health providers with more information on male contraceptive methods and the mechanisms of action in order for them to encourage males to become more involved in the reproductive health process.

It also explores techniques in couple communication and negotiation, and gives tips to the health providers on how to package information for the men.

Without further ado I invite you to read and garner the information in this newsletter on men for your work environment and if there are any challenges or the need for more information, contact the National Family Planning Notwithstanding the focus of the Board at 5 Sylvan Avenue Kingston 5.

National Family Planning Board there is, made possible within this issue, room Olivia McDonald (Dr.) for suggestions and opinions as the Executive Director article by Dr. Karen Carpenter points National Family Planning Board out reasons for male involvement in the contraception process.

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Risky Behaviours in Men and the Impact of Counselling ABstrAct: This article seeks to understand the relationship between men’s risky behaviour and adequate counselling. It will also look at the 2008 HIV/AIDS Knowledge Attitudes Behaviour (KAB) survey on men as it relates to risky behaviours, condom use with multi partners, steady and non steady partners. It is the intention of the article to make the health providers aware of the existing situation as it prevails in the male target groups in order to foster change and encourage alternative ways of structuring programmes. It is hoped that this information will facilitate an environment of support to accommodate these individuals in a suitable and customer friendly environment in the clinics.

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states “that more than a third (36.4 percent) of the total sample or almost a half (49 percent) of the sexually active sample of men had engaged in behavior which could increase their risk of exposure to sexually transmitted infections including HIV/AIDS.” Such behaviours consist of having multiple partners (more than 1), having transactional sex and having casual partners (a Incidentally the Knowledge Attitude Behaviour new partner, one night stand or someone picked survey (KAB) views risky behaviours as having up in a bar or club in the last year). multiple partners; engaging in transactional sex and having causal partners. This captures the very Professor Chevannes’ definition may explain essence of risk perception, especially in men having men’s behaviours as they relate specifically to a somewhat cavalier approach to these issues. condom use in steady and non-steady relationships and multiple partnerships.

Traditionally, risky sexual behaviour is associated with men. These behaviours can be found in the The Knowledge Attitudes Behaviour (KAB) 2008 cultural dynamics of a society, impacting on the study indicated that compared to girls aged 15-24 ways in which males are socialised versus females. which is 15.9 percent, the percentage of boys in The gender construct eventually defines the psy- the same age cohorts who engaged in sexual inchological make-up of individuals which affects tercourse before ages 15-24 was 56.6 percent. how they relate to the realities pertaining to their This may not necessarily set the stage for men to reproductive and sexual health concerns. have more sexual partners in their lifetime but it does impact and increase exposure to sexually This definition however, is also in keeping with transmitted infections. This in itself affects the statistical data given by the 2008 KAB as it negatively their sexual and reproductive health at n defining risky behaviour, Professor Barry Chevannes, founding member of Fathers’ Incorporated and Senior Lecturer at the University of the West Indies stated, “risky behaviour especially in men, is the perception of a dangerous challenge and taking a chance to beat the possibility of a negative outcome, just by sheer luck.”

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Risky Behaviours in men

(cont’d...)

a much earlier age and also has adverse reper- Table 1 indicates that more than a third (38.9 cussions for the sexual and reproductive health percent) of sexually active respondents reported having multiple partners [in the 12 months of their future partners. preceding the data collection]. Incidence of The Knowledge Attitude Behavior (KAB) study multiple partnerships was significantly higher indicates that in the last twelve months of 2004 among males and persons 15-24 years. Table 1 56.2 percent of the men 15 to 24 years engaged also indicates that, for males, 61.5 percent had in multiple partnerships, with an increase to 76.2 multiple partners compared to 16.8 percent of percent in 2008. For men aged 25-49, the data females. Between the ages 15-24 years, 42.7 indicated a percentage increase of 12.5 percent, percent had multiple partners compared to 32.6 between the years 2004 and 2008 from 39.2 percent of respondents between the ages 25-49 percent to 51.7 percent for the respective years. years.

Professor Chevannes suggested that since his collaboration on the study and subsequent report on Males’ Sexual Beliefs and Behaviour published in 1986 by the NFPB; there is still a 5 out of 10 ratio existing with regards to males having multiple partnerships, with slight increases. This is indicative of the fact that the culture which endorses males seeking out and engaging in multiple partnerships has not changed over the years. He referred to one reason for the slight change was because of the economic landscape and reality in which these men find themselves, rendering them unable to financially provide for a multiple partnership life style and as a result the numbers may have been contained somewhat.

transactional sex Another risky sexual practice in which men are engaged is transactional sex. Transactional sex is the exchange of gifts or money for sexual favours. The KAB report stated that men were significantly more likely to engage in transactional sex and five (5) times more likely to have been both the giver and recipient of help.

The percentages of men in the 15-24 age groups reporting sex with a sex worker in the last twelve (12) months were marginal with a 1 percentage point difference between 2004 and 2008. For the 25-49 age group it was 15% in 2004 declining by 7.2 percentage points in 2008

table 1: Multiple Partners [in the 12 Months Preceding Data collection] by age and Gender Demographic Variables Male (n= 649) Female (n= 662)

Percent of Respondents With Multiple Partners 61.5 16.8

15-24 years (n= 566) 25-49 years (n= 745 )

42.7 32.6

Total (n= 1,311)

38.9

Source: 2008 HIV/AIDS Knowledge Attitudes Behavior Survey, Jamaica

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Risky Behaviours in men

(cont’d...)

to 7.8. There has been a decline over the years, endorsed and practiced by men within a given in condom use with sex workers in both age- culture, it was sometimes undermined by the specific groups. realties the men faced on a daily basis in terms of not coming face-to-face, directly or indirectly, The findings in the KAB indicated that with the consequences of their actions. condom accessibility which was looked at in terms of the percentage of target populations By making men aware that risky behaviours surveyed, reported that the men could acquire a carry adverse consequences and had a probability condom if they needed one within a specific of negative outcomes; health providers in countime period (immediately); the base being the selling will have to go on to equip men with the sexually active population. necessary information in visual formats to make the association and reduce the consequences The factors which contributed to the infrequent associated with risky behaviours. It will become use of condoms among individuals, relates increasingly necessary for health providers to moderately to a relationship between their provide access to reproductive health informapartner’s attitude to condoms and the individual’s tion and services for men in a comfortable and level of preparedness which is evident when confidential environment; with emphasis being one of the partners carries a condom on their placed on counselling and the encouragement of person. A small but significant relationship was men to get the facts, for there to be a change in seen between a rejection of condoms because men’s attitudes and practices to sexual and rethey reduced pleasure, it was unlikely that there productive health issues. would be a condom on hand, loss of erection while putting on a condom and trust issues in Family planning should be presented to men as terms of partners intentions to pursue sex with more than just contraception but, their involveanother person by carrying condoms on their ment in decision making on the number of person. children, timing and spacing, contraceptive use and the potential impact of sexually transmitted Notwithstanding these present variables, Professor infections. The use of testimonials and visuals Chevannes disclosed that men being more to enlighten men to the consequences of risky visual, learned better via association and were behaviours should be a part of any initiative and more likely to change their behaviour if they programme to reach them. saw or unfortunately experienced the consequences of a risky behaviour first hand which The strategies to improve programmes and inirendered them unlucky, instead of lucky, on tiatives for behaviour change in men by health more than one occasion. providers may include: This underscores the fact that even though counselling was relevant to changing risky behaviours 4

Risky Behaviours in men ❖ Providing community-based reproductive health education and services for men enlisting the support of a community to change behaviours and attitudes in a composite setting.

(cont’d...)

protection from STIs and unwanted pregnancy as well as their fashionable functions for enhancing sexual performance by prolonging performance (retardants).

❖ The incorporation of family planning into STI service delivery as a means of target- These principles being enforced there should be a notable spin off in terms of partner benefits ing men. ❖ Providing educational materials on repro- (the female) and the removal of the concept that ductive health for men in its most basic, reproductive health services only cater to females. graphic and picturesque forms. ❖ Provider training on reproductive health Sources: KABP 2008-Ministry of Health issues for men to inculcate values to Family Health Manual-Ministry of Health enhance and promote couple communiThe National Family Planning Board expresses its appreciation to Professor Barry Chevannes for his cation. ❖ Providing the necessary information on a variety of condoms and their function in

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contribution to this article.

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Men Contraception Prepared and written by: Harriett M. clarke communications Officer (Writer)

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his article seeks to give health providers more information on male contraceptive methods and mechanisms of action in order for them to encourage males to become more involved in the reproductive health process. It will also explore techniques in couple communication and negotiation, and provide tips on how to make available opportunities for men to access knowledge of contraceptive methods for women, to influence the continuation of use by women.

nineteenth century which saw contraceptives promoted to the poorer classes for the first time, writers on contraception tended to prefer other methods of contraceptives rather than the condom. Feminists of this time period wanted contraceptives to be exclusively placed in the hands of women, and disapproved of male-controlled methods such as the condom, citing both the expense of these items and the contraceptive’s unreliability. However, they still pointed out that condoms were good options for a few, and were the only methods which also protected from disease.

The availability and use of acceptable male contraceptive methods could be the key in reducing the burden traditionally placed almost exclusively on the female, putting family planning back into the hands of both partners and allowing for greater partner support of the women by the men and increased involvement of men in the reproductive and decision-making process.

Men becoming more involved in the family planning process could help to increase access to contraceptives within the relationship and specifically methods that men can use. This could help to expand the couple’s range of contraceptive options and enhance couple communication.

There seems to be a need within the Reproductive Health sector to garner the appropriate information on contraceptives for men and use this information to drive programmes and initiatives for men. This would help in enabling the men to become more responsible users of contraceptives and to be more involved in the Reproductive Health process and in turn lead the women to choose contraceptive methods approved of by their male partners; helping them to maintain, sustain and implement Partners would be actively involved together in adequate and relevant family planning strategies choosing methods which cater to their lifestyle, needs and concerns. This would provide an throughout their reproductive lives. opportunity for dialogue between partners In ancient Egypt, Greece, and Rome, pregnancy including the male partner in the contraception prevention was generally seen as a woman's process, even when the primary responsibility responsibility, and the only well documented for actually using the contraceptive method may contraception methods were female-controlled still fall to one of the partners. devices such as pessaries. Even in the early

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Men & contraception

(cont’d...)

When using male methods such as condoms, the withdrawal method or vasectomy, the male partner has the primary responsibility. But even when the couple uses a female method such as oral contraceptives, IUCD or Norplant implants, the male partner can play an important role in their effective use in terms of partner support and encourage the use of the method by the female who may be experiencing side effects.

For example in some relationships men often remind their partners to take the pill and with the condom being the most popular contraceptive method for men, it can be suggested that the female places the condom on the male’s penis but she would have to have some knowledge of how to put a condom on. Similarly, with the female condom, the male partner could always offer to put the condom in the female providing that he is aware of how to insert the female condom. This would increase couple intimacy and encourage dialogue for continued use of the contraceptive method.

However, the more aware men are of the contraceptive options available, the better able they will be to interact with their partners and as a result become more involved in the contraceptive choices and decisions concerning the relationship.

Expense and a loss of sensation were considered some of the negative attributes for condom use even in the eighteenth – (18th) century with loss of sensation still being the most popular reason why there is reluctance by men to use the condom.The condom as a barrier method is very effective for dual protection which helps to prevent unplanned pregnancies and Sexually 7

Transmitted Infections (STIs) simultaneously.

Men may need information on a variety of condoms on the market which are designed, based on the materials used to manufacture these condoms, for more feeling and intimacy.

Men’s involvement in family planning would also impact on the transmission of STIs by the frequent and proper use of condoms and by seeking treatment for current STIs. Men need to understand that they must be treated for sexually transmitted infections because when their women are treated for an STI, they can easily re-infected their partners if they are not treated at the same time. In the prevention of STIs they must accept that condoms are the most suitable method of protection against STIs. The Family Health Manual outlines some crucial factors limiting men’s involvement which includes: • Services primarily target women and children and men are embarrassed to go to a clinic that serves mainly women and for which hours may be inconvenient.

• Providers’ bias – Providers need to be sensitised about male perspectives on sexuality and reproduction, in order to enable them to encourage male responsibility for sexual and reproductive behaviour.

• Providers need training in the promotion and counselling on condom use, voluntary abstinence and male methods of contraception.

• Providers’ attitudes also influence men’s perception of the appropriateness of

Men & contraception •

• •

•

•

(cont’d...)

service provision.

There is a limited number of male contraceptives available ; and it is unlikely that any new male methods will be approved for several years.

Myths and misinformation exist regarding pregnancy and STIs. Due to the lack of access to accurate information on male contraceptives, many men and women may not know how to use them correctly or may have misconceptions and fears that prevent them from using the methods.

Providers’ bias against certain methods result in not all contraceptives being discussed equally.

For some men practising contraception is contrary to their religion and /or opposition exists for certain methods.

It therefore cannot be stated enough that more information needs to be directed towards men for there to be a positive behaviour change and/or modification in the way men continue to

view the reproductive health issues which affect them as well as their partners.

Sources: Family Health Manual – Ministry of Health.

Image at: yourunion.wordpress.com

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Why Should Men be More Involved in Contraception?

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Contributed By: Dr. Karen Carpenter

his article seeks to explore how health providers can encourage men to be more informed and involved in contraceptive methods and mechanisms for both men and women. It also looks at techniques in couple communication and negotiation relating to opportunities for men to access knowledge of contraceptive methods for women, to influence the continuation of use by women. Today contraceptive devices and methods include sub-dermal implants, oral contraception, hormones as contraceptives, anti-pregnancy vaccines, male contraceptives, intrauterine, injectable, condoms and foams (barrier contraception) as well as surgical sterilisation.

Perhaps, precisely because contraceptive methods are so varied and particularly aimed at women, men sometimes find it difficult to fully understand what these options mean for their love life. Women on the other hand have a better understanding of reproduction, whether they have been formally schooled in the subject or have learned from their own body experiences.

Having to manage a monthly period puts women in the reproductive driver’s seat and makes them ultimately responsible for conception. Now the issue has been made more complex with the spread of sexually transmitted infections (STIs) and the HIV&AIDS pandemic.

Men and women need to both ensure that pregnancies are planned as well as to protect themselves from infection. This has called for greater involvement from men, with some interesting responses on the part of women, particularly in Jamaica.

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Image taken from: Family Planning and The Best Contraception your birth planning Methods and contraception guide – WordPress Entries (RSS) and Comments (RSS).

We sometimes argue that men should be more involved in family planning programmes, however involvement in family planning begins with the personal experience and the learning often takes place both vicariously and informally.

Men and women learn a great deal of their reproductive and contraceptive information by watching what others do and by talking with family and friends. Involving any group of people has to be based on their own self-interest.

In others words people need to know “What’s in it for me?” For women the challenge of physically bearing and then raising multiple offspring may be motivation enough to get them to become informed about the contraceptive choices available to them. The question now is “What will it take for men to become more involved in contraception?” in other words…

“What’s in it for men?”

Why Should Men be More One of the most obvious ways of including men is through women. If we begin in the home by talking to young men about the reproductive process as it takes place not just for them but for women too we will begin to dispel some of the myths. As men become sexual partners of women they need to be included in the discussion of what contraceptive method the woman or man should use and why. In this way men can take on some of the responsibility of making contraceptive decisions. In Jamaica, interestingly enough with the rise of HIV & AIDS, more research has been done into the Knowledge Attitude Behavior (KAB) study of young men and women. What the studies show is surprising as it is generally believed that women take on the burden of contraception more readily than men. This is not the case for those young people who responded to the KAPB study. Some 56 percent of young women and over 40 percent of young men in the 19-24 age range reported not using a condom on last intercourse (UNICEF, 2008). Anecdotally, young Jamaican men confirm that young women are more than willing to engage in intercourse without a condom and it is young men who sometimes have to insist on its use. So perhaps there is already a heightened involvement and awareness among men in the younger age groups. The issue is clearly not just one of contraception but also one that involves STI prevention. The young men who are sufficiently self-preserving that they insist on condom use need to be heard. It is rare that we in Jamaica publicly discuss how young men make responsible sexual choices and yet our marketing of condoms is directed at them.

Perhaps we have to give men and certainly younger men greater voice in the discussion of

(cont’d...)

contraception so that they can begin to understand that they struggle with the same issues as other men. There was a time when women’s voice were inaudible, now it seems we have to make a greater effort to bring men out from the margins of contraceptive health by letting them share their experiences.

What we take away from all this is that as caregivers we have to begin the four ( 4) conversation about how our reproductive capacities work with both boys and girls, young men and young women and that this conversation has to be about both male and female bodies. Second as partners of men, we as women also have to allow our male partners to be involved in the decision about the contraceptive choices that we make. Finally we have to encourage more men to speak out and speak about their own experiences as sexually responsible partners and how they came to understand the choices that were available to them and their partners.

Keywords; Carpenter, Karen A. men’s contraception; women’s contraception; love life; STI’s; HIV&AIDS; Jamaica.

ReFeReNCeS GOJ-UNICeF Country Programme Action Plan 2007-2011 Ministry of Health, Jamaica, Knowledge Attitude Behaviour (KAB) 2008.

Segal SJ. Contraceptive innovations: needs and opportunities.

POPLINe Document Number: 051794. Unpublished] 1988.

Presented at the National Academy of Sciences, Committee on Population Conference on the Demographic and Programmatic Consequences of Contraceptive Innovations, Washington, D.C., October 6-7, 1988. 40, 9 p.

Family Health Matters – Ministry of Health.

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Reproductive Health Services Abstract: This article will give a listing of six (6) major stakeholders offering reproductive health services to men, while briefly describing and outlining the programmes and initiatives of each organisation.

Introduction All clients, irrespective of age or gender accessing family planning services must be registered and seen by a health provider. Therefore, stakeholders offering reproductive health services to men, play a very significant role in strengthening family planning issues especially as they relate to incorporating the male population into programmes primarily designed and implemented with a gender bias towards women.

These programmes, most of which provide family planning and maternal and child health services for women and mothers, inevitably overlook or neglect the role of men in fertility decision-making, contraceptive use as well as their reproductive health needs. Therefore, it is to be emphasised that family planning should involve both men and women.

Male issues should not be divorced from that of female issues but interwoven, where pertinent, into the whole fabric of family planning and incorporated into programmes targeting men. Health care providers must be cognizant that the acceptance of these issues by men is influenced by factors such as personal attitudes towards the clients acceptance of the concept of male responsibility and biases towards male methods.

The aim of this article is to look at the services offered by stakeholders of reproductive health that can assist men.

the National Family Planning Board (NFPB) Background: The 1994 United Nations International Conference on Population and Development (ICPD) effectively raised and essentially legitimized the profile of men on the global reproductive health agenda. This became the turning point in the life of the National Family Planning Board, and a concerted effort to reach the men of our Jamaican society became eminent. Consequently, the organisation began to refocus on educating and raising awareness in order to change some of the beliefs and attitudes of our men; making them more aware of their personal responsibility and to their partners, while strengthening the capacity of health care providers to offer services to men.

The programmes of the NFPB focusing on men are chanelled mainly through the training unit that either targets the men directly in their training seminars or by assisting the health providers via planned and scheduled workshops done within regions. These workshops assist the health providers to better understanding their role in the education of men on their sexual and reproductive health, while equipping them with updated information and methods of imparting the information to the target audience. Rap sessions are also done with young adult males, ages15-24, in secondary learning The primary objective of assessing male clients institutions based in or around the corporate area. prior to providing family planning services is to These rap sessions are usually hosted by the Marge determine their distinct reproductive health needs. Roper Counsellor.

Meeting these health needs may depend on availability of contraceptives; age and the type of health The Male Sexual and Reproductive Health Caucuses centre providing the service, their interest in having (South East and Southern) facilitated by the NFPB children, history of sexually transmitted infections, seek to address the issues of men as well, in order to further their mandate through strategic alliances lifestyles and sexual practices.

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Reproductive Health Services (cont’d...) with a number of government and non-government and community - based organisations. This is manifested in the Sexual and Reproductive Health Caucuses with membership including: The Jamaica AIDS Support for Life, Sistren Theatre Collective, the Women’s Centre of Jamaica Foundation, The Boys’ Brigade, the YMCA, Jamaica Foundation for Life Long Learning, New Testament Church of Jamaica to name a few.

the rural Family support Organization (ruFamsO) The Rural Family Support Organization (RuFamSO) is a registered non-governmental organisation located in May Pen, Clarendon. RuFamSo is dedicated to facilitating the best quality of life for families in central Jamaica. It originally started as the Teenage Mothers’ Project in 1986 addressing the plight of teenagers at “risk” because of early pregnancy. It later recast its outlook based on a study that was done on males at risk and teenage pregnancy. The programme known as the Male Adolescents’ Programme (MAP) offers skills in the areas of barbering, woodwork, garment construction, commercial food preparation as well as backyard gardening providing skills oriented education along with other developmental and social skills. At present only woodwork is being offered because of a lack of funding.

s-corner clinic and community Development Organisation The name S-Corner came about because of the shape of the corner on which the institution is stationed and located at 18 St. Joseph Road, Waltham Park, Kingston 13. It has an income generating programme for the youth, conflict resolution workshops, and HIV awareness programmes. The facilitators are inclined to work with peace management initiatives and violence prevention alliances to provide talks and workshops especially for young men. At the clinic there has been an increase in the number of young men requesting condoms and counselling. Although the community is prone to outbreaks of violence, conflict resolution workshops and violence prevention alliances have been employed to target and reach young men. These offer counselling for families, partners and individuals. The programme maintains an outreach programme for gangs of the community and the facilitators work with The Peace Management Initiative & Violence Prevention Alliance.

Male community health workers assist the young men in matters concerning Reproductive Health and also in the distribution of condoms.

S-Corner Clinic and Community Development Organisation places an emphasis on income generation, as it tries to meet the needs of the environment in which it is situated. Men from in and around the community can visit the organisation for supplies of condoms and advice as it relates to issues affecting them and their sexual and The MAP programme also provides role play reproductive health. Men are encouraged to visit the activities for the boys, assisting them in developing clinic with their “baby mother’s,” becoming involved positive interactive and communication skills as a in the process and getting a hands-on feel of the responsibilities that come with parenting. stepping stone for developmental progress.

The young men enrolled in this programme are The men usually take this opportunity to seek out usually seventeen years and over and their academic any additional reproductive health information as it relates to contraception, parenting and STIs. competence should be that of grade nine level.

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Reproductive Health Services (cont’d...)

ously by these gender constructs.

These concerns are usually facilitated by the HIV Jamaica AIDs support for Life (JAs) Awareness programme which also expands on the issue of reproductive health by incorporating and The Jamaica AIDS Support for Life targets the encouraging condom use while informing the men following persons: about STIs. The aim of the programme is to encour• Men who have sex with men age them to get tested for HIV and to remain faithful • Men who have sex with women, to their partners. Workshops are generally arranged • Male commercial sex workers, those who by the organisation to encourage more awareness of work from the streets and those who work HIV/AIDS and other STIs. This is sometimes done from institutions such as massage parlours via the outreach programme which targets and • HIV positive men and boys approaches area leaders; and by meeting with the • HIV positive deaf men, young men in a bid to maintain peace and stability • HIV positive Children and within the area.

• Children orphaned by AIDS.

Youth Opportunities Unlimited (Y.O.U) Targeting the deaf in society actually came out of Youth Opportunities Unlimited caters to males through a mentoring programme that provides positive role models, in the absence of a father or other influential male.

the regular training programme which revealed that the deaf were among the most vulnerable persons in society but because of a communication barrier they were not being reached and as a result were easy prey to sex predators who more than likely forced their victims into having sex.

Y.O.U. also hosts adolescent cultural arts workshops and life skills seminars in schools.

All the programmes they engage in are designed to fit age, gender and sexual orientation of their A Peer Leadership Training programme, advocates clients. counselling for teens by their peers, and has reportedly impacted on youth and adult men in the Sexual orientation is differentiated because of those society. Many of the topics emerging in the clients who are transgender. Transgender is described workshop are based on Male Marginalization and and defined as: gender roles and constructs for example “date rape”, • Male to Female- persons who are born men sexual harassment at both work and school and but identify as women and society’s expectations for males. The programme tries to clarify various myths, which exist in society • Female to Male - women born female but about Sexuality and Reproductive Health as well as identify as men because of chemical gender constructs. These are deemed more harmful imbalances in the brain. than good and it addresses them with the hope of It is to be noted that Transgender and Gay persons creating change. are two different orientations.

The objective of the programme is that positive reaffirmation encourages more males to enter tertiary institutions and also helps promote behaviour modification in those who live vocifer13

JAS does individual and group counselling sessions which incorporate prevention, treatment (using the ARV drugs) and care of HIV persons by themselves or loved ones. A literacy programme was founded

Reproductive Health Services (cont’d...) as it was discovered that some of these persons were unable to complete their basic education because of their HIV status, sexual or gender orientation. There is also a clinic situated in a confidential environment.

A programme for street boys was recently launched because it was found that there were several of them who were commercial sex workers. Initially the programme places them in a home and provides a structured lifestyle. Boys in the programme have access to the clinic, which highlights issues concerning reproductive health and sexually transmitted infections. These boys engage in remedial education and skills training with the objective of eventually reintegrating them with families. JAS operates from a human rights based perspective and as a result human rights training and sensitisation are endorsed.

Practitioner has been trained in the syndromic management of STIs. The Type V health centres usually offer rapid HIV and syphilis testing (often the samples are sent to the main clinic/lab and results returned to the clinic within the week). At the main STI clinics in each parish there is usually same day testing (with results). At this time they do not routinely offer any tests for gonorrhoea, chlamydia, trichomonas or other STIs for men or women. Most of these centres also offer Voluntary Counselling for HIV/syphilis so they can come in even if they have no STI symptoms and just want to know their status.

Men diagnosed with syphilis and some genital ulcers and HIV are referred to a contact investigator and in most parishes they are stationed at the main STI clinic and other satellite STI centres. They are then confidentially interviewed and the partners are contacted in an equally confidential manner. The partners are advised that they may have been exposed to syphilis/HIV as the case may be and the Ministry of Health encouraged to come in for testing/treatment. At no time are names disclosed to index cases or partners.

The main reproductive health services to the male Partner notification is done either by the patient or population situated in the Ministry of Health are through a health provider as a means of controlling accessed via STI clinics which are located in the the spread of STIs. health centres in the parishes categorized as Type III or Type V health centres. Type III health centres When requested by their partners men are also serve densely populated urban areas. Type III offers advised to attend the clinic to benefit from advice curative services, mental health services, dental,

by Midwives/Registered Nurses/Public Health dermatology, STI services and health promotion and Nurses during client screening and management or education services. Type IV offers parish adminisif assessed as having an STI. trative services as well as those services offered by Type III health centres. Type V offers those services The Ministry of Health in analysing statistics from as Type III in addition to specialists STI services, reported cases noted that services were accessed higher lab services and other specialist services more by females. In 2006, 5,003 males accessed offered at some sites for example Child Guidance services compared to 16,477 females for genital Clinics. discharge syndrome. In 2007 5,038 males compared to 18,963 females accessed services relating to Type III and higher have a doctor and Family Nurse genital discharge syndrome. Data on reports on Practitioner one day a week (Type V every day) so genital ulcer discharge in 2006 saw 528 males versus men can attend any of these centres and be seen.

482 females accessing services and in 2007, 414 The Medical Officer of health and the Family Nurse 14

and electronic messages) targeting men have been developed specifically addressing multiple partnership males versus 521 females accessed services. This was and the need for HIV testing through these programmes for men. found in the age group 15-49 years.

Reproductive Health Services (cont’d...)

The preventative services included targeting these males with education at the STI clinics and this is conducted by the community peer educators. Outside of the clinic settings, the males are also provided with preventative service at the community level via targeted community interventions in high prevalence communities. The intervention includes a specific strategy to reach men via sports, community dances and via taxi drivers. The interactions at these settings focus on risk assessment and developing the skill of using a condom as well, promoting and encouraging men with problems relating to STIs and HIV contraction to seek help and get treated.

Voluntary counselling and testing (outreach testing) is also emphasized in all of the interactions. Media (print

By strengthening, the capacity of health providers to provide services to men this will bring about improved promotion of shared responsibility for family planning, assuming that women will be more likely to adopt and continue using a contraceptive method if they have their partners’ active support. This concept recognises that without male involvement, support and commitment to family planning; efforts to reach male clients will fall through the cracks.

The stakeholders highlighted in this article are dedicated to the cause of bring men back into the reproductive and contraception process where they belong.