PANOS London, November 23, 1998

"HIV is primarily transmitted through sex between men and women," says 'AIDS and Men: Taking Risks or Taking Responsibility?' published by the Panos Institute in London.

"But because men have more sexual partners than women, because men tend to control the frequency and form of intercourse and because women are physiologically more susceptible to HIV, it is men's behaviour which determines how quickly, and to whom, the virus is transmitted," it adds.

It is also because they are economically dependent on men, that many women are unable to convince their partners to change their behaviour, the report says. Surveys of sexual behaviour show that in every society men also have more sexual partners than women. This means more opportunity to contract and transmit HIV and other sexually transmitted infections.

The phenomenon is not restricted to one culture or region of the world. In a British survey, 24 percent of men but only seven percent of women claimed 10 or more partners in their lifetime.

And a World Health Organisation study showed that in Sri Lanka, three percent of women and four percent of men interviewed had had at least one casual sex partner in the previous twelve months.

In Guinea Bissau the figures were 38 percent men and 19 percent women, and in Rio de Janeiro, Brazil, 45 percent men and 10 percent women. In each of the 15 other countries in the survey, more men had casual sex partners than women. The Panos report argues that men's sexual behaviour is strongly influenced by perceptions of masculinity. Most cultures expect men to be sexually active, often with more than one partner. Men are also expected to take risks, which leads many to reject condoms as unmasculine and consider sexually transmitted infections as no more than an inconvenience.

"Surveys show that only a minority of men -- perhaps no more than one in three or one in four -- has sexual relationships with someone other than their long-term partner. But that figure represents several hundred million men worldwide," says Martin Foreman, Director of the Panos AIDS Programme.

Although men drive the epidemic, women are more vulnerable to HIV. This is because men often deny women the opportunity to protect themselves and because women are physiologically more susceptible to the virus than men.

A woman is at least twice as likely to contract HIV from a male partner with the virus than the other way around, and the risk for both sexes rises if either has another sexually-transmitted infection. Because they are often internal, women tend to be less aware than men of such infections, which further heightens their susceptibility.

When these factors are taken together it means that even though more men than women currently contract HIV worldwide, the rate at which women are infected is rising faster than that of men.

The report says that recognition of their vulnerability has led to women being the target of many HIV/AIDS prevention programmes, particularly through family planning programmes and ante-natal clinics.

"Such programmes have played a major role in raising awareness of the disease but in themselves they are insufficient: women cannot protect themselves unless men also do so," it says.

It is not only women who are vulnerable -- men themselves are at risk. But it is only recently that men who have sex with women have become the target of AIDS prevention campaigns. "Where these campaigns do more than simply give information -- where they help men understand the consequences of their sexual acts -- they are likely to encourage some change," the report says.

Men who have sex with men are also at risk. Although HIV is primarily spread through sex between men and women in the developing world, Panos says that sex between men is also a factor in HIV transmission in many countries. In some, particularly in Latin America, it may even be the primary means of transmission.

In particular, boys and men who are younger, poorer or physically or psychologically weaker may be forced into sexual or drug-taking situations where they contract the virus from other men. Men are raped -- and risk contracting HIV -- in prisons across the world.

But, according to the report, "widespread hostility and discrimination" prevent many men who have sex with men from admitting that they are at risk. This in turn leads governments to underestimate or ignore the problem. And because many men who have sex with men also have sex with women, lack of prevention campaigns places both these men and their women partners at risk.

It is not through sexual intercourse alone that men's behaviour drives the epidemic. Shared equipment in drug injection, common in countries from Russia to Brazil, is a major route of HIV transmission.

Men are four times more likely than women to inject drugs. According to Don Des Jarlais, an expert in global drug use, this is because "men are more likely than women to partake in all forms of socially deviant behaviour, from illicit drug use to bank robberies."

Male drug users are also more likely to share injecting equipment with others and to have sexual intercourse with partners who do not inject.

Drug injection currently affects several million men and women, but hundreds of millions are at risk of contracting HIV through sexual activity. Alternatives to condom use promoted by AIDS prevention organisations, particularly those which have a religious base, include abstinence and mutual fidelity. However, 'AIDS and Men' argues, these may be unreachable goals for those men most at risk.

"The question now is whether men can be persuaded to change and whether widely held concepts of masculinity will allow men to be responsible and protective," Foreman adds. "It may be that deeper changes, seeing masculinity as responsible rather than sexual prowess, are need before we can halt the epidemic."

Editor: Dipankar De Sarkar. Please credit Panos when using these features. Publishers are asked to send clippings of published features to Panos Features, 9 White Lion Street, London NI 9PD. Panos Features are also available on the Panos website http://www.oneworld.org/panos and by e-mail from Mark Covey, markc(at)panoslondon.org.uk.

(*) A Panos Briefing, 'AIDS and Men: Old Problem, New Angle', is now available from the Panos Institute, London. (END/PANOS/vz/dds/98)
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