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PSI and Gender Issues
• Engaging men
• Empowering at-risk populations to prevent HIV infection
• Discouraging cross-generational sex
• Integrating family planning with HIV prevention
Engaging Men |
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Reaching men through hotline services in the Congo
PSI/ASF (Association of Family Health) provides outreach programs in the Democratic Republic of Congo focused on reproductive health through a hotline to reach the general population. Created in 2005, the hotline consists of a telephone number that is a free call and can be used by any person seeking information on contraceptive methods and family planning issues. The goal is to reach for the entire country including parts of the population underserved by other programs. The hotline has had a considerable impact on the distribution of family planning messages; the toll-free number can be called by any person wishing to ask questions or learn more about family planning issues. The hotline receives on average of 100 calls per day, of which 70 to 80% are men, married and unmarried. These men, who timidly attend the women’s outreach meetings and learn of various strategies, use the hotline to further inform themselves about family planning. In addition, bordering countries (Republic of Congo, Angola, etc.) are also educated in family planning by the hotline.
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Central America
PSI’s affiliate PASMO has begun a comprehensive campaign called “Hombres de verdad” or “Real Men”. The campaign, a multiyear, multi-channel, multi-message media campaign, seeks to reframe gender concepts in Central America in the context of HIV preventive behavior. The objective of the campaign will be to give voice to existing ideas of masculinity that are consistent with safe behaviors for HIV (i.e. fidelity, partner reduction and condom use). PSI/PASMO conducted extensive qualitative research to define the barriers to fidelity, partner reduction and condom use among men, to discover new ideas about masculinity that might support these behaviors, and to identify effective spokespersons (male and female) for the campaign using new ideas of masculinity to support safe behaviors. |
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Male Clients of Sex Workers: No Longer a Neglected Demographic
PSI/India is implementing a multiyear STI/HIV prevention program as part of the Avahan: India AIDS Initiative, funded by the Bill & Melinda Gates Foundation. The program works with male clients of commercial sex workers in 100 high priority towns in Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. Contrary to popular theory, the majority of men who pay for sex in India are neither truckers nor migrants, but rather a cross section of the population. Recognizing men’s decision-making authority and the need for increased male- involvement in prevention activities, the program aims to reduce STI/HIV incidence by directly encouraging male clients to use condoms consistently with sex workers via integrated on-ground communication activities.
In May 2007, an evaluation found that consistent condom use with sex workers increased from 61% in 2006 to 81% in 2007. Consistent condom use was also significantly correlated with seeing a PSI communication activity in the previous 3 month. |
Empowering At-Risk Populations To Prevent HIV Infection |
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Empowering migrant populations: Working with sex workers in the Eastern Caribbean
PSI and its affiliate in the Caribbean, Society for Family Health (SFH), have been working with sex workers on a number of Caribbean islands for a year and a half. Often both the primary breadwinners and caregivers at home, these women are under enormous pressure to find any means possible to support their families and sex work abroad is often a higher-earning occupation than minimum wage or domestic work found in their home countries. PSI/SFH’s activities have focused on providing messages and information on self-efficacy, risk perception, consistent condom use, use of lubricant and condom negotiation skills, as well as referrals for sexual reproductive health services for this most-at-risk population (MARP). PSI/SFH’s methodologies were adapted from the Pan American Social Marketing Organization in Belize for use in the Caribbean context. Spanish-speaking sex workers are often very difficult to recruit for activities since many of them are illegal immigrants and are very secretive about their affairs to avoid arrest and deportation. This population also suffers from overt discrimination from nationals. PSI/SFH has been successful in identifying and training peer and health educators who are able to reach these most at-risk populations and to date has reached close to 18,000 sex workers (new and repeat participants), of which an estimated 25% were Spanish speaking. PSI/SFH is currently in negotiation with the Female Health Company and its regional distributors to try to increase the accessibility of the female condom in the Caribbean in the near future. |
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Reaching sex workers in El Salvador
PASMO, PSI’s partner in Central America, began providing mobile voluntary HIV counseling and testing (VCT) by training behavior change communications staff to conduct pre- and post-test counseling, in coordination with the El Salvador Ministry of Health. These trained counselors then hit the streets to seek out sex workers and their clients, men who have sex with men, and other high-risk groups in need of VCT services. Counseling takes place in locations such as brothels and nightclubs instead of traditional health clinics, where risk of lifestyle-related stigmatization is higher. HIV testing is conducted in an ongoing collaboration with the Ministry of Health. The initiative, supported by the U.S. Agency for International Development and KfW, is meeting a critical need among target groups for high quality counseling and support. |
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Reaching women through female condom promotion
In Mozambique, PSI works with the National AIDS Commission (NAC) and the Ministry of Health to train women to negotiate condom use, and promotion. Starting in 2007, PSI trained 26 women from local governmental and non-governmental institutions (AMODEFA, Kindlimuka, Mudjaxihi, Ministério do Interior, Organização da Mulher Moçambicana, AMDL, and AVIMAS). Following the training, each institution began to integrate female condom activities into its ongoing programs, and receives supervision support from PSI. Since the project began, 5,000 female condoms have been distributed. |
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Men who have Sex with Men: Reducing Gender Related Stigma and Providing Quality Sexual Health Services
Men who have Sex with Men (MSM) in Laos face harsh gender-based stigma and discrimination, often lack higher education resulting in fewer sustainable employment opportunities, and have limited access to sexual health information and services. With funding from USAID and the Global Fund, PSI/Laos implements comprehensive HIV/AIDS and STI programs for MSM using creative mass media campaigns, peer-to-peer outreach, and community building activities that promote healthy sexual behaviors and reduce gender-based stigma and discrimination. PSI/Laos reinforces outreach and mass media efforts with the targeted social marketing of high-quality affordable HIV prevention products including Number One Deluxe Plus condoms, lubricant and 1 STOP STI treatment kits. In 2006, PSI/Laos also opened the Peuan Mai, or New Friends, Centers, which provide a safe space, a zone free of gender based discrimination, ensuring MSM access to unbiased, quality health services and information, STI treatment, service referrals, and other risk reduction support.
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Discouraging Cross-Generational Sex |
| Cross-generational sex, defined as non-marital sexual relationships between young women and men who are 10 or more years older puts young women at higher risk for violence, unplanned pregnancies, HIV and other sexually-transmitted infections. |
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Uganda
PSI/Uganda’s pilot cross-generational sex campaign targeted young women, older men, and community members in an attempt to break the silence surrounding this major contributor to the African HIV epidemic. Supported by Uganda’s Office of the First Lady, the PSI advocacy campaign recruited influential country and community leaders as well as parents to speak out against these harmful social norms. Results from the program showed that young women with a high level of exposure to the program were more likely to: i) reject cross-generational sex as a socially accepted norm; ii) believe in their confidence and ability to refuse sex with older men; and iii) recognize the risks associated with cross-generational relationships than those with low or no campaign exposure. PSI/Uganda has launched a nationwide campaign against cross generational sex applying lessons learned from the pilot phase. |
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Trinidad and Tobago
Anecdotal evidence in Trinidad and Tobago suggests that cross-generational and transactional sex between young girls and older men is common, widely accepted, and largely responsible for the dramatically increasing incidence of HIV infection among young girls and young women. A recent study conducted by the Trinidad and Tobago National AIDS Coordinating Committee revealed that 90% of young women 15-24 years of age who have had sex in the last 12 months partnered with a man at least 10 years her senior. Filling a programmatic gap, PSI/SFH is developing a pilot project to target young women 15-24 years of age engaged in (or at risk from ) cross-generational and/or transactional sex. PSI/SFH will use mass media, interpersonal communication strategies and street theatre to promote consistent condom use, develop life skills to make healthier behavioral choices and improve personal HIV and STI risk perception. PSI/SFH will focus the pilot intervention in three of the most disadvantaged communities in Trinidad and Tobago. In an effort to reduce the issues around access, PSI/SFH is also working to decrease the price of the female condom in the commercial market as well as attain stock of free female condoms for trial use in the three pilot communities.
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Integrating Family Planning with HIV Prevention |
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Myanmar
PSI/Myanmar’s Sun Quality Health Clinics offer both FP and VCT services. In addition to increasing convenience and cost-effectiveness, integration allows PSI to reach audiences that might otherwise be overlooked by traditional family planning programs, such as men and young adults. Engaging men in family planning is important; research shows that female contraceptive use increases when their male partners are informed and support family planning. In addition, integrating family planning with VCT is important to reach out to HIV positive women and prevent vertical transmission of HIV. In 2006, PSI programs provided millions of couple years of protection against pregnancy, averting an estimated 250,000 unintended pregnancies.
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PSI works with at-risk populations, such as this group of sex workers in Central America, to educate and empower them.
The logo for Peuan Mai ("New Friends") centers. |
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