Evaluation of a male engagement intervention to transform gender norms and improve family planning and HIV service uptake in Kabale, Uganda

Abstract

Men's limited understanding of family planning (FP) and harmful cultural gender norms pose obstacles to women's FP use. Thirty-two model men called 'Emanzis' were recruited from the community in Kabale, Uganda to lead men from their peer group through a 10-session curriculum designed to transform gender norms and motivate men to engage in FP and HIV services. Cross-sectional surveys were conducted before (n = 1251) and after (n = 1122) implementation. The Gender Equitable Men (GEM) Scale was used to assess the effect on gender attitudes. The intervention achieved negligible changes in responses to GEM items. Improvements in some gender-influenced health-seeking behaviours and practices in men were noted, specifically in visiting health facilities, HIV testing, and condom use. For future application, the intervention should be adapted to require higher peer educator qualifications, longer intervention duration, and more frequent supervision. Practical guidance is needed on where to direct investments in gender-transformative approaches for maximum impact.

What Role Do Masculine Norms Play in Men’s HIV Testing in Sub-Saharan Africa?: A Scoping Review

“…Thus, men had less fear about the stigma associated with HIV testing and were more willing to communicate with female sexual partners about couples counseling and testing. Another recent study by Ghanotakis et al [55] in Uganda showed that using a 10-week curriculum with men focused on transforming gender norms improved men’s willingness to go to a health facility and willingness to test for HIV. Together, these findings suggest that gender transformative interventions may be a promising approach for addressing masculinity-related barriers and leveraging masculinity-related facilitators to increase men’s HIV testing.…”

The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services

“…In a study evaluating male engagement in integrated FP and HIV service use, health‐seeking practices improved for men, especially condom use, HIV testing, and health facilities visits (Ghanotakis et al. ). Integrated services also played a role in the prevention of mother‐to‐child transmission of HIV—specifically by promoting access to FP and by understanding key populations’ SRH needs (FHI360 ; Ippoliti in this issue).…”

“…Research on integrating HIV testing and counseling and family planning by community health workers indicated it is feasible and acceptable and provides an opportunity to increase HIV testing among family planning clients (Brunie et al 2016). In a study evaluating male engagement in integrated FP and HIV service use, health-seeking practices improved for men, especially condom use, HIV testing, and health facilities visits (Ghanotakis et al 2016). Integrated services also played a role in the prevention of motherto-child transmission of HIV-specifically by promoting access to FP and by understanding key populations' SRH needs (FHI360 2013; Ippoliti 2017 in this issue).…”

“…Men continue, however, to avoid HIV and SRH services because of the stigma associated with attending health services with mainly female providers, as well as their preference for traditional healers who are mainly male (Mak 2016). More research is required to understand how improved gender equity might be leveraged to increase access to HIV testing and treatment, contraceptive use, and other reproductive health outcomes (Hawkes and Buse 2013;Onono et al 2015;Ghanotakis et al 2016;Newmann et al 2016;Pascoe, Peacock, and Dovel 2016).…”

Health education programs for improving men’s engagement with health services in low- to middle-income countries: a scoping review protocol

“…Ensuring healthy lives and promoting well-being for all at all ages is one of the key agendas adopted by the UN General Assembly for 2030 [12]. Gender-specific strategies for care delivery, health education, and research are key to achieving these goals, particularly in disease-burdened LMICs [9,[13][14][15]. A 2007 World Health Organization (WHO) review of interventions designed to involve men and boys in achieving gender equality and better health concluded that well-designed male involvement interventions would be more effective at improving men's attitudes and behaviors toward sexual and reproductive health and other health conditions [16].…”