Reaching Men: Addressing the Blind Spot in the HIV Response

Main Article Content

Laura Pascoe
Dean Peacock
Lara Stemple


men’s health; masculinity; health behaviour; social hierarchy, socioeconomic factors


Globally, men are less likely than women to access human immunodeficiency virus (HIV) testing, treatment, and care, and consequently experience disproportionate HIV-related mortality. To address men's underutilization of HIV services, efforts are needed on two fronts: challenging the regressive gender norms that discourage men from seeking health services, and developing improved health system policies, programs, and service delivery strategies to ensure better provision of HIV services to men. It has long been understood that harmful gender norms make women vulnerable to HIV, and this understanding should expand to include the way these norms also put men at risk. This paper presents the data concerning men and HIV, explores the impact of gender norms, examines national and international policy developments, and chronicles the evolution of men’s place in the HIV response. It does so in part by tracing the efforts of Sonke Gender Justice, a South African NGO working across Africa, as it promotes the engagement of men in the fight against the dual epidemics of gender inequality and HIV.

Abstract 287 | pdf Downloads 77


1. Cornell M, Schomaker M, Garone DB, et al. Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: A multicentre cohort study. PLoS Med 2012;9(9):e1001304.
2. Cornell M, McIntyre J, and Myer L. Men and antiretroviral therapy in Africa: Our blind spot. Trop Med Internat Health 2011;16(7):828–29.
3. Cornell M, Myer L, Kaplan R, et al. The impact of gender and income on survival and retention in a South African antiretroviral therapy programme. Tropical Medicine & International Health: TM & IH 2009; 14(7):722–31.
4. Greig A, Peacock D, Jewkes R, and Msimang S. Gender and AIDS: Time to act. AIDS 2008; 22(2):S35–S43.
5. Hawkes S and Buse K. Gender and global health: Evidence, policy, and inconvenient truths. Lancet 2013;381(9879):1783–87.
6. Flood M, Peacock D, Barker G, et al. Policy approaches to involving men and boys in achieving gender equality (Paper prepared by Sonke Gender Justice). Department of Gender, Women and Health, World Health Organization; 2010.
7. UNAIDS. AIDS by the numbers: 2015. Geneva: UNAIDS; 2015.
8. UNAIDS. Fast-track: Ending the AIDS epidemic by 2030. Joint United Nations Programme on HIV/AIDS (UNAIDS); 2014.
9. Ghanotakis E, Peacock D, and Wilcher R. The importance of addressing gender inequality in efforts to end vertical transmission of HIV. J Internat AIDS Soc 2012;15 Suppl 2:17385.
11. Gibbs A. Understandings of gender and HIV in the South African media. AIDS Care 2010;22(sup2):1620–28.
12. Gruskin S, Safreed-Harmon K, Moore CL, et al. HIV and gender-based violence: Welcome policies and programmes, but is the research keeping up? Reproduct Health Matt 2014;22(44):174–84.
13. Krishnan S, Dunbar MS, Minnis AM, et al. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. In Reducing the Impact of Poverty on Health and Human Development: Scientific Approaches 2008;1136:101–110). Retrieved from ://000257430500013.
14. UNAIDS. The gap report; 2014.
15. UNAIDS. Men, boys and AIDS: Reframing the conversation; 2015.
16. UNAIDS. (2016). Involving more men and boys in HIV and SRH programmes in ESA: A proposed regional framework for action (draft). UNAIDS Eastern and Southern Africa Regional Office, Sonke Gender Justice; 2016.
17. UNAIDS. Report of the Eastern and Southern Africa regional consultation on the UNAIDS strategy 2016 – 2021. UNAIDS; 2015.
18. Cornell M, Stern O, Thomson-de Boor, H, and Peacock D. Integrating into National AIDS plans strategies to prevent gender-based violence and engage men and boys to achieve gender equality: Meeting Report. Sonke Gender Justice, UNFPA, MenEngage, UNAIDS, UNDP; 2010.
19. Barker G, Contreras M, Heilman B, et al. Evolving men: Initial results from the International Men and Gender Equality Survey (IMAGES). International Center for Research on Women; 2011. Available at:
20. Foreman M. AIDS and men: Taking risks or taking responsibility? London, UK: Panos Institute; 1999.
21. Mane P and Aggleton P. Gender and HIV/AIDS: What do men have to do with it? Curr Sociol 2001;49(6).
22. Peacock D and Levack A. The Men as Partners program in South Africa: Reaching men to end gender-based violence and promote sexual and reproductive health. International J Men's Health 2004;3(3):173–88.
23. Dworkin SL, Colvin C, Hatcher A, and Peacock D. Men’s perceptions of women’s rights and changing gender relations in South Africa: Lessons for working with men and boys in HIV and antiviolence programs. Gender Soc 2012;26(1):97–120.
24. Ganle JK. Hegemonic masculinity, HIV/AIDS risk perception, and sexual behavior change among young people in Ghana. Qualitat Health Res 2015;1049732315573204.
25. Harrison A, O’Sullivan LF, Hoffman S, et al. Gender role and relationship norms among young adults in South Africa: Measuring the context of masculinity and HIV risk. J Urban Health 2006;83(4):709–22.
26. Hunter M. Love in the Time of AIDS: Inequality, gender, and rights in South Africa (1st Ed.). Bloomington, IN: Indiana University Press; 2010.
27. Jewkes R, Sikweyiya Y, Morrell R, and Dunkle K. Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: Findings of a cross-sectional study. PLoS ONE 2011;6(12):e29590.
28. Lindegger G and Quayle M. Masculinity and HIV/AIDS. In P. Rohleder, L. Swartz, S. C. Kalichman, & L. C. Simbayi (Eds.), HIV/AIDS in South Africa 25 Years On (pp. 41–54). Springer New York; 2009. Retrieved from
29. Peacock D, Stemple L, Sawires S, and Coates TJ. Men, HIV/AIDS, and human rights. J Acquire Immun Defic Synd 1999;51(Suppl 3):S119.
30. UN Population Fund (UNFPA). Report of the international conference on population and development. U.N. GA, U.N. Doc. A/Conf. 171/13 (1994) (hereinafter, Cairo Platform). Available at:
31. United Nations. Report of the fourth world conference on women. U.N. Doc. A/Conf. 177/20, U.N. Sales No. 96.IV.13 (1995) (hereinafter, Beijing Platform).
32. Stemple L and Karegeya P, and Gruskin S. Human rights, gender, and infectious disease: from HIV/AIDS to Ebola. Hum Rights Quart 2016;38(4):993–21. The Johns Hopkins University Press. Retrieved May 3, 2017, from Project MUSE database.
33. Stemple L. Health and human rights in today’s fight against HIV/AIDS. AIDS (London, England) 2008;22(Suppl 2), S113–S121.
34. Aniekwu NI. Gender and human rights dimensions of HIV/AIDS in Nigeria. Afr J Reproduct Health 2002;6(3):30–37.
35. Whelan D. Human rights approaches to an expanded response to address women’s vulnerability to HIV/AIDS. Health Hum Right 1998;3(1):20–36.
36. Bellamy C. Globalization and infectious diseases in women. Emerg Infect Dis 2004;10(11):2022–24.
37. UNAIDS. End review of UNAIDS agenda for accelerated country action for women, girls, gender equality and HIV. UNAIDS; 2015.
38. Global Fund to Fight AIDS, Tuberculosis and Malaria. The global fund strategy 2012-2016: Investing for Impact; 2011.
39. UNAIDS. Getting to Zero 2011-2015 strategy. Joint United Nations Program on HIV/AIDS (UNAIDS); 2010.
40. PEPFAR. Working together for an AIDS-free future for girls; 2014. Available at:
41. Dworkin SL, Fleming P, Colvin C. The promises and limitations of gender-transformative health programming with men: Critical reflections from the field. Cultur Health Sexualit 2015;17(S2):S128–S143.
42. UNAIDS. Agenda for accelerated country action for women, girls, gender equality and HIV: Operational plan for the UNAIDS action framework. Geneva: UNAIDS; 2009.
43. Stemple L. Male rape and human rights. Hastings Law J 2009; 60, 622–25.
44. Stemple L. Human rights, sex, and gender: limits in theory and practice. Pace Law Rev 2011;31:824–36.
45. Connell RW. The role of men and boys in achieving gender equality, prepared for expert group meeting on “The role of men and boys in achieving gender equality.” United Nations Division for the Advancement of Women (DAW) in collaboration with United Nations Development Programme (UNDP), International Labour Organization (ILO), and Joint United Nations Programmes on HIV/AIDS (UNAIDS). Brasilia, Brazil, 21 to 24 October; 2003.
46. Esplen E. Engaging men in gender equality: Positive strategies and approaches. Brighton: Institute of Development Studies; 2006.
47. Jewkes R, Flood M, and Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. Lancet 2015;385(9977):1580–89.
48. Ratele K. Working through resistance in engaging boys and men towards gender equality and progressive masculinities. Cultur Health Sexualit 2015;17(2):S144–58.
49. Barker G, Verma R, Crownover J, et al. Boys and education in the global south: Emerging vulnerabilities and new opportunities for promoting changes in gender norms. J Boyhood Stud 2012;6(2):137–50.
51. Keeton C. Changing men’s behaviour can improve women’s health. Bull World Health Org 2007;85(7).
50. Ghannam F. Live and die like a man: Gender dynamics in urban Egypt. Stanford University Press; 2013.
52. Morrell R. Changing men in Southern Africa. New York: Zed Books Ltd; 2001.
53. hooks, b. The will to change: Men, masculinity, and love. New York, NY: Washington Square Press; 2004.
54. Barker G. This World AIDS Day, Let’s redefine what it means to be a man; 2015. Retrieved from
55. Möller-Leimkühler AM. The gender gap in suicide and premature death or: Why are men so vulnerable? Eur Arch Psychiatr Clin Neurosci 2003;253(1):1–8.
56. Jolly S, Cornwall A, and Hawkins K. (Eds.). Women, sexuality and the political power of pleasure. Chicago, IL: University of Chicago Press; 2013.
57. Bulled N and Green EC. Making voluntary medical male circumcision a viable HIV prevention strategy in high-prevalence countries by engaging the traditional sector. Crit Pub Health 2016;26(3):258–68.
58. Njeuhmeli E, Forsythe S, Reed J, et al. Voluntary medical male circumcision: Modeling the impact and cost of expanding male circumcision for HIV prevention in Eastern and Southern Africa. PLoS Med 2011;8(11):e1001132.
59. Padian NS, McCoy SI, Karim SSA, et al. HIV prevention transformed: The new prevention research agenda. Lancet 2011;378(9787):269–78.
60. Betron M, Barker G, Contreras J, and Peacock D. Men, masculinities and HIV/AIDS: Strategies for action. United Nations Development Programme (UNDP); 2011.
61. Aluisio A, Richardson BA, Bosire R, et al. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV free survival. J Acquir Immune Defic Synd 1999;56(1):76–82.
62. Sherr L and Croome N. Involving fathers in prevention of mother to child transmission initiatives – what the evidence suggests. Journal of the International AIDS Society 2012;15(4(Suppl 2)).
63. Van den Berg W, Brittain K, Mercer G, et al. Improving men’s participation in preventing mother-to-child transmission of HIV as a maternal, neonatal, and child health priority in South Africa. PLOS Medicine 2015;12(4):e1001811.
64. Shand T, Thomson-de Boor H, van den Berg W, et al. The HIV blind spot: Men and HIV testing, treatment and care in Sub-Saharan Africa. IDS Bull 2014;45(1):53–60.
65. Dworkin SL, Hatcher AM, Colvin C, and Peacock D. Examining the impact of a masculinities-based HIV prevention and anti-violence program in Limpopo and Eastern Cape, South Africa. In Women’s Empowerment and Global Health: A 21st Century Agenda. UC Press; 2015.
66. Epprecht M. Heterosexual Africa?: The history of an idea from the age of exploration to the age of AIDS. Athens, OH: Ohio University Press/Swallow Press; 2008.
67. Varga C. The forgotten fifty percent: A review of sexual and reproductive health research and programs focused on boys and young men in Sub-Saharan Africa. Afr J Reproduct Health 2001;5(3):175–95.
68. Dworkin S. Men at risk: Masculinity, heterosexuality, and HIV prevention. New York, NY: NYU Press; 2015.
69. Dworkin SL, Treves-Kagan S, and Lippman SA. Gender-transformative interventions to reduce HIV risks and violence with heterosexually-active men: A Review of the global evidence. AIDS Behav 2013;17(9):2845–63.
70. Peacock D. South Africa’s Sonke Gender Justice Network: Educating men for gender equality. Agenda 2013;27(1):128–40.
71. Van den Berg W, Peacock D, and Shand T. Mobilizing men and boys in HIV prevention and treatment: The Sonke Gender Justice experience in South Africa. In Global HIV/AIDS Politics, Policy, and Activism: Persistent Challenges and Emerging Issues: Persistent Challenges and Emerging Issues: Vol 3. Praeger Publishers; 2013.
72. Thomson-de Boor H, Cornell V, Kabamba V, et al. An analysis of how National Strategic Plans on HIV and AIDS in five global regions address the role of men and boys in achieving gender equality and reducing the spread and impact of HIV and AIDS. South Africa: Sonke Gender Justice; 2010.
73. ATHENA Network. Integrating strategies to address gender-based violence and engage men and boys to advance gender equality through National Strategic Plans on HIV and AIDS: Impact and needs-assessment overview of findings. ATHENA, UNAIDS, Sonke Gender Justice, MenEngage, UNDP, UNFPA, UN Women; 2012.
74. Peacock D, Stemple L, and Pascoe L. Men and boys in the HIV response: Rights, roles and responsibilities: A discussion paper to fast-track gender equality and the end of AIDS by 2030. Sonke Gender Justice, UNAIDS; 2015.
75. Pascoe L, Peacock D, and Dovel K. To get to zero we must also get to men: A literature review prepared for the UNAIDS Eastern and Southern Africa Regional Team. Sonke Gender Justice, UNAIDS; 2016.
76. Peacock D. What the death of two men teaches us about our blind spot in the AIDS response. The Conversation; 2015. Available at:
77. PEPFAR. DREAMS Innovation Challenge; 2016. Available at: