Projects > Amadoda Aqotho

Amadoda Aqotho

(Previously “Man to Man”)

Background

Responding to the dual epidemics of HIV/AIDS infection and cultural violence, especially against women and children, the Man to Man programme began in 2008. The programme was initiated by Dr. David Palmer, UVHAA Executive member, with assistance from our chairperson Rev. CMK Dlamini and peer educator Prince Khuluse. The teaching used in this programme was based on the Kenyan book “MMAK Manual – The Movement for Men against AIDS in Kenya”. Men act as a catalyst within rural communities by creating a forum for rural men to engage in dialogue about their roles as men, fathers and partners, and ways in which gender based attitudes negatively affect physical and mental well being in their communities, by increasing risk of HIV infection for both men and women, and leading to increased social and domestic violence.

The Cultural Health Programme for “Rural Men as Partners and Fathers” developed from this programme and in October 2009 was funded through the Aids Foundation of South Africa.

The Project has come of age with the new name “Amadoda Aqotho” developed at the Pennington workshop in April 2011.  The project is an intervention meant to engage men into dialogue and action culminating in the reduction of gender based domestic violence and men are leading the fight against the spread of STIs and HIV infection. It also serves as a platform for men to discuss men’s sexual and reproductive health.  OXFAM contributed to ensuring that the capacity of Amadoda Aqotho is built by funding training of the rural facilitators and Project Manager as HIV lay counsellors.

The project then took a new turn as part of growth and became part of the research study on the improvement of Family Health Care in Umdoni and Vulamehlo addressing Millennium Development Goals 4 and 5 in a programme developed by Aids Foundation South Africa in November 2011.  Recognising that long term behavioural change is unlikely to take place in a short period, and that positive changes in attitudes may revert to previous norms once the educational experience has ended it is difficult to make an assessment of the project as a whole.  However the structure of the programme was found to be very good, acceptable to rural communities and welcomed as being especially helpful for young people. The input from consultants, in particular Musa Ndlovu and Dr. Irwin Friedman, brought a welcome scientific approach to the programme. 

It has been a challenge for UVHAA to work with this programme and we are all the richer because of it.  We wish to record our thanks to the AFSA team, in particular Ms. Debbie Ewing and Moeti Lesotho, for their outstanding support and valuable advice, which contributed greatly to the success of the whole project.

During 2013 the project was funded directly by UVHAA in partnership with SANTA Scottburgh Branch.  During 2014 it is hoped to find a new sponsor for the programme under the guidance of our UVHAA Chairperson, Rev. CMK Dlamini. The request from all the communities is that the programme finds the means of continuing and is extended to other areas.

                                                                                   

Vision and Mission

The Vision of the project is “A dynamic Men’s project creating a conducive environment for influencing policies and cultural practices which lead to domestic and gender violence and vulnerability of women and children to HIV and AIDS infection, through promotion of sustainable development in specified localities in Umdoni, Umzumbe and Vulamehlo Municipalities.

The Mission of the project is “To strengthen Inter sectoral partnership with relevant stakeholders in reducing escalating HIV and AIDS infections, TB, STIs and gender based violence in the Umdoni and Vulamehlo Municipalities” by enhancing participation and providing information on men’s sexual health to boys and men in behaviour change stimulating activities which also addresses Men’s Wellness and wellbeing of families.

The goal and values are to improve the health status and well-being of culturally vulnerable and marginalized populations in rural areas through increased access to sexual health education and care services impacting to positive change in cultural attitudes and practices

Values to be upheld are respect of human rights; respect of diversity; non partisan; participatory; and observing of protocols.

Objectives

Reducing HIV infection rates and improving access to treatment in rural areas

Reducing unintended pregnancies, especially teenage pregnancies

Combating gender based violence

Fighting community stigma around HIV

Developing small income generating projects for men’s support groups

Implementation.

As with Home Based Care the facilitators for this programme were chosen because of previous work in their communities and also had to be resident in the areas where they worked.  They were trained on the basic MMAAK Manual and were also trained as HIV lay counsellors.  In addition they underwent short courses on Home Based Care and First Aid.

Their work was carried out during house to house visits, and in monthly meetings convened at tribal courts and other rural meeting places.

Implementation of rural men realising Millennium Development Goals 4 and 5 (Reduction of Maternal and infant Mortality) project was added in September 2011 and gave much focus to training and discussions. This also encouraged closer working in the field with the area co-ordinators from the Home Based Care programme. It also brought on board a number of key knowledgeable and influential figures who included Dr. Irwin Friedman from Seed Trust, and Ms. Mpume Shibe and Ms. V Mkhize from the Department of Health.

HIV Counselling and Testing  HCT

The 10 facilitators were supported by a team with a professional nurse, enrolled nurse and two lay counsellors.  In some cases the pre counselling was carried out in groups with post test counselling being carried out individually.  In the last six months 236 people were tested for the first time. Every effort was made to provide privacy in difficult rural settings.  All blood specimens taken for CD4 from reactive clients were delivered on the same day to GJ Crookes Hospital Laboratory; results were delivered confidentially on the next week.  At these sessions and on meeting days condoms were available for distribution

Cultural Attitudes and Beliefs

The National Strategic Plan highlights the correlation between cultural attitudes and beliefs and risk of HIV infection as one of the areas under-researched. It does, however, draw attention to gender inequality as inherent element of patriarchy in that the patriarchal paradigm prescribes women’s lower status and therefore, impact significantly on the choices that women can make in their lives, especially with regards to when, with whom and how sexual intercourse takes place (NSP p31)   Similarly, the links between ‘sex related cultural beliefs and behavioural  practices such as virginity testing, rites of passage to adulthood (especially amongst male youth) polygamy and wife inheritance, as well as traditional healers’ health practices, such as the use of sterilized sharp instruments and recommending sex with a virgin as part of treatment for HIV are mentioned as risk for, and vulnerability to, HIV infection. Young women are prepared to preserve their virginity, but no young man is prepared and preserved for virgin girls.

Challenges

It took a long time to convince the Amakhosi, Councillors and other traditional leaders, but the advantage of the programme was that it was clearly set out, it was not politically linked and it was not depriving any authority of powers.

Women also wanted to be part of the workshops, and they did share some of the talks in different areas.  They were part of the Community Dialogues.  However there was a strong request for a similar programme for girls and women.

 

                                    Interviews with Community Members

The individual interviews were conducted by the two Zulu speaking male evaluators.  The objectives were to ascertain if the project as a whole was well accepted in the community and if those participating had a satisfactory understanding of the relevant issues around HIV, TB and gender violence, especially sexual violence.  Condom use was also a topic of discussion and male medical circumcision.  The Community Dialogues were used as the venue for some of the interviews.

The ages of those interviewed varied from 23 to 92, and included married men and bachelors. The 92 year old man had three wives and unnumbered children and when interviewed was found to be knowledgeable on all topics and have an understanding of issues which have been discussed over the months the project has been active!. It was noted that most of the young men were unmarried and have more than one girlfriend.  They are almost all in favour of HIV testing and understand the importance of knowing ones HIV status, using condoms and circumcision.  Some of the older people were against the use of condoms, but could not clearly state why this was the case.

In all interviews the value of the project was voiced out, and everyone felt the programme should be continued if possible.  It was generally felt that the information and discussions should have been made available to females, both separately and together.  This was seen as a way to reduce teenage pregnancies, make condom use more acceptable and enable family decisions to be taken together. Having more information empowers a man to discuss issues within the family and enable them to take decisions together.

What also came out in the evaluation is that men delay or avoid seeking medical advice because the health facilities are not user friendly to men: as an example a man with STI found it very difficult to talk to a female health worker about the problem which leads to a worse situation In the opinion of many there has been a reduction in family violence since the project started.  Men have also changed their attitudes in family matters and relationships.

Only Free Condoms at this Shop

From left to right: Ms R Cressy; Mr L MolefeL Mr P Khanyile