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Thursday, April 2, 2009

Live from MenEngage Rio: Overcoming resistance to male involvement in health services

Posted by Eric Ramírez-Ferrero

One of the recurring themes at global symposium is the resistance to male involvement in reproductive and sexual health services that we’ve encountered around the world—resistance among individuals, in communities, and from governments. And it occurred to me yet again that this resistance may be due to simple lack of imagination: When people haven’t “seen” male involvement in practice, it’s hard to fathom what programs for men could look like. What resources are required to get men involved? What expertise is needed to start effective programs? And how would such programs affect current efforts that aim to improve women’s health and lives?

On Wednesday, I attended a training session on “Engaging Men and Boys in Clinic and Social Service Settings” in which we examined the nuts and bolts of programming and started to answer some of these questions.

The training, conducted in part by EngenderHealth’s own Manisha Mehta, started with a great activity where we were each put “in charge” of providing a health service focused on either men, or on couples, and asked to think about what our client, or clients, might need: Would it be counseling, clinical care (such as testing or treatment), health education, or would broader social marketing efforts be best? It got the room thinking about what we can easily offer from means within our reach.

My assignment was: “You are a nurse speaking with a couple in which one person is living with HIV, and the other does not have HIV. They want to know about their options for avoiding pregnancy and transmitting HIV.” (I decided this couple would need both health education and counseling—perhaps slightly more counseling.)

This activity led to enthusiastic conversations and demonstrated a diversity of what male involvement programming can look like, the huge range of services that are possible, that many services can be offered at low or no cost, and—perhaps best of all—that they actually could be integrated alongside existing services for women. In fact, there was a consensus that for reasons of ethics, equity, and sustainability, an integrated approach (rather than offering separate men’s services) really makes the most sense in settings like Tanzania, where there are is already a shortage of health services.

Next, we were divided into groups and given a case study. My group examined why young people in general—those between the ages of 15 and 24—and young men in particular are reluctant to use health services, even when they are designed to be “youth-friendly.”

We also had a larger discussion of why men are reluctant to use services ostensibly designed for them—so-called “male-friendly” services. We cited many reasons, but ultimately it seems like it’s a vicious cycle: Men don’t seek services, so health clinics become geared towards women, which means that they become “women’s” places, and then men won’t go to get care because clinics are “for women.” There’s also the reality that many health clinics aren’t open during hours that men have time to go.

I was lucky that my group included a senior member from Tanzania’s Ministry of Health. We talked very concretely about how CHAMPION and the Ministry could collaborate to provide male- and couple-friendly services. It was so encouraging to see the Ministry representative’s enthusiasm for integrating services—everything from prostrate cancer screenings, to counseling for sexual anxiety and dysfunction, to better vasectomy services, and improved treatment for sexually transmitted infections—as a start!

As importantly, we discussed how we might offer counseling to men—in a site outside of a clinic—that can help them examine and start to change behaviors (like having multiple sexual partners at the same time) that make them more likely to spread HIV.

This conversation cemented a key point of the training workshop: Male-friendly services cannot exist in a vacuum. Instead, they need to be an integral part of a continuum of care for whole families. This is what will make a difference in the lives of men, women and children.

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