What’s wrong with the men?

Dr. Kiyimba of the Infectious Diseases Institute (IDI) says the model has been tested and found effective in reaching out to men and youth in South Africa, Tanzania, and Zimbabwe and IDI has been using it privately.

“We want men to get their medicine from the nearest post. If they are stable on treatment they really don’t need to waste time in the queues. The model is designed in a rotational way that one will visit the facility once in six months to pick medicines for the colleagues. This is when he is reviewed,” he explains.

This model is divided into parts including putting testing services out of the clinic, health workers taking drugs to particular points in the community or choosing one patient in the group to pick supplies for colleagues.

The approach poses questions of safety of drugs and patients privacy. But experts The Independent spoke to are optimistic that such initiatives close the gap for those who shun health facilities and gives people a range of choices.

However, Angelo Kaggwa of AVAC, a global HIV organization, says even as new interventions are coming up to target men, old strategies like voluntary medical male circumcision must be rethought to ensure faster pace of their adoption.

Already preliminary UPHIA results indicate the proportion of men aged 15-49years that are circumcised has increased from 26% in 2011 to 43% which is good progress.

Behavioural change campaigns

But the Uganda AIDS Commission Ag. Director General, Dr. Nelson Musoba, warns against making conclusions out of the less detailed data so far released. He says high prevalence figures should not cause any scare as they communicate to the fact that people with HIV are now living longer. To him, men should embrace methods that have been scientifically confirmed for efficacy like circumcision and Pre- Exposure Prophylaxis (PrEP) that involves giving HIV drugs to negative people at high risk of infection as protection.

He says the behavioral change communication campaign – ABC for Abstinence, Faithfulness and Condom use was very instrumental in bringing down prevalence from the highs of 18% in the 90s, was a success. He says for years, the commission has aggressively invested in prevention messages since it’s the best strategy of handling a disease that has no cure. For him, almost every one now knows that HIV is here.

But, if they know what have they done about it? Why then is the prevalence among men still unacceptable high? What are healthcare managers not doing right?

To get these answers, the Ministry of Health got Amos Zikusooka; a health communication expert behind one of its biggest campaigns – `Obulamu’ to do a survey. The ministry wanted to know whether people actually see and act on their Obulamu messages.  The survey was conducted by IPSOS, the research organization and results were released in July.

The results indicated 85% of the people in the 60 districts they considered in the survey had ever heard or seen these messages on either radio, television or billboards but, only 15% had done something as a result of exposure to the message or what the message suggested.

Now Zikusooka is working on new ways of ensuring the HIV message goes to those who need it most; the men.

“The biggest number of positive people are men. They don’t like going to the health facility so they don’t test,” he says.

In his new campaign – ‘HIV testing for men’ to be launched soon, Zikusooka uses language that men usually use; their slung and their excuses, to draw their attention.

“Men say they don’t have time to go to the facility. They also say they are still strong and don’t need to start treatment. What we will do is give them information that they are familiar with so they can make behavioral decisions”, he says adding “Our approach now is to craft messages with the same idea used in making a shirt. We first measure you and make a fitting shirt. So if that message is not meant for you it will definitely not make sense to you. Only that person will understand that message”.

Armstrong Mukundane is also crafting new messages targeting men. When The Independent visited the Communication for Healthy Communities offices on Sept.08, he was working on a flyer reading,” Women are too many but I will choose one and only Sarah”. Another had, “It’s not that I don’t trust her, I use condoms to protect myself”.  Such strategies Zikusooka and Mukundane are taking have been for long rated high in tackling the public health concern.

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