Q&A – David Odali: Involving men to prevent HIV in women in Malawi

08 March 2016
Couple attending PMTCT services

Q&A with David Odali

David Odali, director of the Umunthu Foundation, AVERT’s partner in Malawi, offers insight into his experiences of working with men to help reduce local women’s vulnerability to HIV. A Q&A for International Women’s Day.

What makes women particularly vulnerable to HIV in Malawi?

Gender inequality and gender-based violence. It is the man who has the final decision as to whether they use condoms, and the women cannot negotiate for safer sex. The man has more strength over a woman, so they accept.

If a woman tests positive for HIV at the antenatal appointment, when she goes back to the husband, he may very quickly divorce her. He pushes the blame for bringing HIV into the home to her.

If the man does not divorce her, often that man does not go for HIV testing. He will go only when and if he gets sick.

We also have a problem that women are vulnerable to contracting HIV as they walk long distances to fetch firewood or water. They sometimes start off their journey early in the morning at dawn when walking becomes dangerous. They can either be attacked sexually – they can be raped – and some men also propose [approach] them.

How does this increased vulnerability affect women’s access to HIV services?

Number one, they lack the support which they need from men, from their husbands. Which in the first place, makes them vulnerable.

Number two, when a woman tests HIV-positive, men, instead of supporting them and confronting the challenge together, will sometimes place the blame on the women and [we see a] continuation of domestic violence at home.

We are talking about a lack of strong male involvement in HIV services that affects access to services.

What role can men play in reducing women's vulnerability to HIV?

We need that male involvement. How do we get it? By involving men themselves, and targeting men with awareness messages on the importance of supporting women and girls with regards to HIV.

We need to also come up with supportive attitudes about gender equality. We need men to stand up and go to the forest to get firewood, or to get water. If we have gender equality in our minds, we will be able to support our women and wives.                                      

I hear you were involved in the launch of the ‘He-for-She’ campaign in Malawi? How did that come about?

Yes, last week we launched the United Nations ‘He-For-She’ campaign, which calls upon men and boys to take a role in the promotion of social programmes which must benefit women and girls in gender equality in the areas of education, health, work, politics, identity etc.

We are part of a network called 'Men for Gender Equality Now' here in Malawi. This programme targets men, so that men can change their negative attitudes towards women and girls, and embed gender equality as the norm.

There is an African proverb that says - you have to send a thief, to catch a fellow thief.

That is why it is important to involve men, who are perceived to be the perpetrators of gender inequality and gender-based violence. We work with these men, so that they can change their negative attitudes towards women and girls. Men can also more easily convince their fellow men.

So how do you involve men in PMTCT?

We encourage the husband to give full support to their pregnant wife, by escorting them to any clinic appointment relating to the pregnancy. We also encourage men to be present on the day of the birth – even in the theatre. We try to popularise a policy of more male involvement.

We encourage men to be more loving throughout the period of the pregnancy, and to resist from committing physical violence against the wife.

If the wife tests HIV-positive, we also encourage the husband to be supportive, and to follow all tips that had been given, for example, the use of condoms, because it is now the wife that has the challenge of living with HIV.

How do you support expectant mothers when there may be a risk of domestic violence?

We work with the victim support unit of the police station. Through psychosocial counselling, the abusive husband can understand the wrongs of committing physical violence. Psychosocial counselling is also given to the victimised woman, so that she can restore her confidence after going through the violence. But when we see that that the husband has caused grievous bodily harm, then it will become a crime.

As well as HIV services, we provide legal support services. We have several cases in our offices, some have been taken to court and I am handling them.

Psychosocial counselling is very important because we have another very common domestic violence practice here – wife and children abandonment. A husband can abandon his wife, even with eight children, small ones, go to the next village and marry a young woman there.

We provide psychosocial counselling, both to the abandoned woman and also to the husband. But if the husband is not compromising, then we take this matter to the court, to secure maintenance for the children.

What is your message for International Women’s Day?

We should support proactive interventions that support male involvement in decreasing gender inequality. Because it is only by involving men that these new interventions can create more impact. But if we leave men out, men are perceived as active in gender inequality and gender-based violence, then the initiative will not be successful. My call is to try to, at all levels, involve men and support initiatives that involves men and boys.  

Photo credit:
© AVERT/ Corrie Wingate. Photos used for illustrative purposes only and do not imply the health status or behaviour on the part of the individuals in the photo.