HC3 in Action: Engaging Men and Adolescent Boys

"Strategic health communication can help create an enabling environment for men to access the care and services they need as well as support their partners' and families' access to and uptake of services."

This brief includes examples, promising approaches, and resources for constructive male engagement: engaging men and boys as clients, partners, and agents of change. Part of the "HC3 in Action" series, it documents Health Communication Capacity Collaborative (HC3)'s experience in 34 countries around the world with engaging men and boys in their efforts to achieve and maintain an AIDS-free generation, increase demand for family planning, end preventable child and maternal deaths, and realise a malaria-free world.

Men as clients: "Gender-related factors tied to masculinity along with challenges in aligning information and services with the unique needs, interests and resource constraints experienced by men and boys often means many men and boys do not have access to or avoid seeking preventive and other services, and delay getting the care they need once conditions arise." Examples of HC3 approaches described in the document include:

• To address the gap in HIV health communication programming for men in Swaziland, HC3 developed an interactive, small-group intervention, Swazi Men4Health. The small-group format allows men to discuss and reflect on how gender and social norms and stigma influence behaviours related to uptake of key HIV prevention and care services, and how those behaviours impact their health as well as others.
• In 2013, HC3 began reaching groups of men in Côte d'Ivoire through Brothers for Life (BFL), modeled after the South African programme by the same name, to increase HIV prevention and testing behaviours. At the end of the last discussion group session, men are encouraged to take a free HIV test offered on-site. Men who do not wish to test at that time are invited to enroll in an interactive text message programme.
• In Swaziland, HC3 worked with community mobilisers and local organisations to reach men who have sex with men (MSM) with services and information about HIV and sexual health. HC3 together with the Swaziland National AIDS Program sensitised health care workers through sharing data related to HIV and key populations (KP) in Swaziland, KP "ambassadors" sharing their own and their peers' experiences with the health care system and how it deters KP from accessing services, and dialogue and discussions between the health care workers and KP ambassadors to better understand their needs and constraints.
• To gain a better understanding of whether voluntary medical male circumcision (VMMC) programmes are adequately meeting the needs of adolescent boys, HC3 conducted a mixed-methods assessment exploring client-provider counseling and communication in South Africa, Tanzania, and Zimbabwe. A journal supplement focused on this research will be published in March 2018. In Mozambique, HC3 used multiple approaches to increase VMMC uptake among young men ages 15 to 29 - e.g., HC3 shared satisfied client testimonials addressing barriers such as fear of pain and infertility using community radio, videos on community mobilisers' tablets, TVs in health facilities, and WhatsApp groups.

Promising approaches for engaging men as clients include:

• Structure activities to be compatible with men's lifestyles, and take programme activities directly to men.
• Facilitate service uptake by offering services as part of community-based activities.
• Invest in establishing and strengthening relationships with community leaders to assist with community mobilisation.
• Sensitise and train providers to be sensitive and competent in meeting the specific needs of certain audiences.
• Use research, monitoring, and evaluation to reveal communication gaps for certain audiences.
• Increase encounters for follow-up and facilitating access to services.

Men as partners: "Gender norms that discourage communication between partners or limit one's voice in negotiating sexual relations can increase the risk of violence, unwanted pregnancies and transmitting infection between partners." Examples of HC3 approaches described in the document include:

• In Nigeria, community dialogue meetings, recruiting primarily men, focus on the benefits of childbirth spacing for fathers, mothers, children, and the community as a whole.
• HC3 conducted qualitative research in Mozambique to understand: how men perceive their responsibility in ensuring their family's health; what influences their health-related decision-making, particularly related to malaria; and how they prioritise when to seek care. Incorporating results from this research, HC3 together with the National Malaria Control Program and malaria focal points at provincial and district levels, developed a guide for engaging men in discussion groups.
• In Nigeria, HC3 is testing the effectiveness of a mobile health (mHealth) tool called Smart Couple, which engages couples to become informed, empowered, and confident in communicating with one another, making decisions together, and talking with a health provider about family planning.

Promising approaches for engaging men as partners include:

• Frame activities and behaviours in a way that appeals to men, including direct benefits to men as well as their partners.
• Acknowledge men's influence in household decision-making, and reposition their role in the home as a source of change.
• Use mobile-based tools that provide flexibility, privacy, and interaction to engage couples and improve couples' communication.

Men as agents of change: "While men can benefit from receiving information and services directly, they often still face existing social and gender norms that make it challenging to practice and maintain healthier behaviors." Examples of HC3 approaches described in the document include:

• In Mozambique, HC3 is aiming to reduce community-level stigma toward people living with HIV (PLHIV) by engaging men. HC3 modified community tools from the Tchova Tchova programme to include more explicit messaging focused on stigma reduction and treatment; the community dialogue also includes an activity focused on men and women's vulnerabilities to HIV and leads men to consider how gender and social norms contribute to risk and harmful practices.
• In Nigeria, HC3 held advocacy meetings with senior religious leaders and trainings at religious leader forums; through their public pronouncements and sermons to men, religious leaders explain that childbirth spacing is supported in Islam and promote childbirth spacing as a means to prevent maternal and child deaths and improve the health and wellbeing of one's family.
• HC3 Nigeria has produced radio spots featuring testimonials by men who were previously unaware of or against childbirth spacing, but are now satisfied clients championing the benefits. Similarly, in Mozambique, radio segments reinforce community-level stigma reduction activities by featuring positive testimonials by men who have overcome stigma and are successfully on treatment. In Cote d'Ivoire, testimonials of men living with HIV are shared with men who have recently tested positive so that they can hear fellow male voices who are living with HIV.

Promising approaches for engaging men as agents of change include:

• Engage and support religious leaders to promote and champion messages.
• Use stories and testimonies by men who share similar challenges and desires as the intended audience to make it easier for men to relate and visualise change.

In conclusion: "Whether through segmenting a male audience to deliver tailored activities; working closely with community and religious leaders to build trust, promote positive and equitable behaviors and mobilize men in communities; or using mass media to stimulate conversations, address social norms and reinforce community-based activities, programmatic approaches within constructive male engagement are growing and strengthening."

Links to HC3 and other organisations' tools and resources are provided throughout.