Gender, Health and Change in South Africa

Structured Summary Introduction: This article addresses the question of how to “think about” and to “do” gender change in the context of HIV and public health interventions in South Africa. The issue of gender has been closely intertwined with the HIV epidemic in Southern Africa since the beginning of the epidemic. The need for more gender equitable practices and relationships has been a central theme of the response to the crisis. While much of this work has focused on efforts to reduce the uneven impact of HIV has on women and girls, there have also been important interventions with men and boys around gender and HIV. This article synthesizes findings from research projects with three such interventions. Methods: The findings presented here are drawn from three separate research projects conducted in South Africa in the last 10 years. The first was an ethnographic research project with the Khululeka Men’s Support Group in Cape Town. The second was an independent program evaluation of the “One Man Can” campaign that was commissionned by Sonke Gender Justice, a gender transformation NGO in South Africa. The third project was a qualitative process evaluation of a trial that used male lay health workers to provide support and care to pregnant and postpartum women who were enrolled in a PMTCT program. Results: Gender and gender change were understood and promoted in contrasting ways across the three case studies. In the case of Khululeka, HIV-positive men were encouraged to become “better men” within the context of existing gender norms by doing things that would protect their health and allow them to achieve socially valued roles as strong family leaders and financial providers. They began with a conventional HIV support group model but adapted it to better suit local gender norms around masculinity. In Sonke’s One Man Can (OMC) campaign, the focus was on the ways men and women could address the underlying gender inequities in their families and communities. Participants were encouraged to raise their awareness and critical understandding of gender-related rights issues and mobilize for progressive gender change. Sonke staff struggled, however, to find ways of sustaining the changes they witnessed in OMC workshops and an ideological tension persisted between “culture talk” and “rights talk” about gender. Finally, in the PMTCT program, men were recruited to serve as lay counselors for HIV-positive pregnant women. By carefully training and supporting men in the daily practice of providing care for these women, male counselors developed trusting relationships, offered effective services, and in general, undertook a form of gender-transformed practice that exceeded much of what was observed in the other two case studies. Discussion: There are many potential paths to gender transformation, and the HIV epidemic in Southern Africa has operated as a powerful catalyst for exploring and pursuing some of these paths. In the process, however, a number of political and conceptual limitations of gender transformation work emerged. There is a need to find ways of thinking about and acting on gender that isn’t over-determined by the logics of public health and biomedicine. There is also a need to complement ideological arguments for “gender transformation” with more embodied opportunities for transformed gendered practice.