Alleviating the Burden of Responsibility: Men as Providers of Community-Based HIV/AIDS Care and Support in Lesotho

This six-page report presents the results of a study done by the Capacity Project that looked at the role of men as providers of HIV/AIDS care in an effort to alleviate the burden of HIV/AIDS care and support carried by women. The goal of the study was to strengthen the capacity of Lesotho's health system to address the HIV/AIDS pandemic at the community level by increasing the active engagement of men as providers of community home-based health care (CHBC), alleviating the burden of care on women, and providing a model for employment alternatives to men who had lost their jobs in the mining industry.

Data were collected during February and March 2008 in villages, health clinics, and hospitals across three districts chosen to represent two ecological zones, as well as urban and rural sites. The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators, and 31 focus groups with community health workers, community men and women, miners, and people living with HIV.

The study found that CHBC providers themselves noted that it took a great deal of time to care for the sick, leaving little time to earn money or provide for their own families. There was recognition that changing times require a change in caring practices. In terms of engaging men as providers, the study revealed a number of gender stereotypes and status beliefs related to caregiving. For example, beliefs about the essential male and female traits reinforced the inequitable division of HIV/AIDS caregiving labour. The expectation that men be money-earners served as a barrier to men's participation in CHBC, even in times of unemployment. According to the research, people hold the view that while women may work for free, men will not, and voluntary caregiving is to be avoided, as it is inconsistent with the conception of men as breadwinners.

Research also suggested that voluntary HIV/AIDS caregiving is associated with undesirable tasks that lower the status of women's unpaid domestic labour. However, first aid constituted a form of men's caregiving that was perceived by men as superior to women's family caregiving, as it requires technical skill, and is associated with saving lives, and with masculine traits such as courage, bravery, dignity, and discretion.

The authors state that while much of the data reflected men's and women's perceptions that men are capable of doing various CHBC tasks and would accept the caregiver role under certain conditions, there was a widely held perception that men would not necessarily always be accepted as caregivers due to traditional and culturally defined roles. For example, men are traditionally prohibited from entering the room of a nursing mother, providing care to a daughter-in-law, or entering the place of women's traditional dance. Both male and female respondents also appear to mistrust men's motives.

While respondents cited numerous hindrances to men's involvement, they also identified training, supervisory support, and financial incentives as the main factors that would facilitate men's participation. Training can mitigate negative stereotypes of men and increase their skills. The authors recommend that training for male and female caregivers should involve critical reflection on gender stereotypes, roles, and responsibilities.

The report includes a number of other recommendations:

• To reduce occupational segregation by gender, policies for national health, HIV/AIDS and CHBC, and human resources should be gender redistributive and explicitly promote a more equal division of responsibilities.
• The national CHBC curriculum should include skills training, reflection on gender roles and equality in caregiving, communication, HIV/AIDS education, service ethics, gender-based violence, and an introduction to male role models already engaged in CHBC.
• Organisations should adopt a "Volunteer Charter" for community health workers (CHWs) and home-based caregivers to address working conditions.
• CHBC programmes operating at district or village levels should be redesigned to be gender redistributive and explicitly promote equal sharing of responsibilities. Recruitment and compensation strategies should not be based on assumptions about the division of labour in families or reinforce masculine stereotypes.
• Government and civil society should make men's participation in CHBC a priority to reduce transmission of HIV/AIDS by altering personal, social, and cultural views surrounding HIV/AIDS care and support. HIV/AIDS and domestic caregiving should be made more attractive to boys through early childhood education and public campaigns that communicate the value of HIV/AIDS and all domestic caregiving to society.