HIV/AIDS and Tuberculosis Global Program

Evaluating the Male Norms Initiative in Ethiopia and Namibia

An outreach poster used in the Male Norms Initiative.

An outreach tool promoting couples voluntary HIV counseling and testing that was used in the Male Norms Initiative. Image: PATH.

Inequitable gender norms—or social expectations about men’s roles, responsibilities, and rights compared to those of women—have been shown to promote HIV risk and related behaviors like gender-based violence. A growing evidence base reinforces both the importance and success of engaging men to recognize and address underlying gender dynamics to prevent HIV/AIDS and violence against women and girls.

In 2008, the US President’s Emergency Plan for AIDS Relief (PEPFAR) funded the two-year Male Norms Initiative (MNI) in Ethiopia, Namibia, and Tanzania to help address harmful gender norms among young men as a strategy to reduce HIV risk and violence behaviors. Working with local research partners, PATH designed and implemented an outcome evaluation of this behavior change communication project to measure changes in participants’ attitudes and behaviors.

PATH used qualitative, in-depth interviews with intervention participants, their romantic partners, and/or project partners to explore the process of behavior change and gain insight into the strengths and weaknesses of the intervention. These interviews applied the 24-item Gender Equitable Men (GEM) Scale to measure attitudes about gender roles related to domestic work, sexuality, relationships, and violence (Pulerwitz and Barker, 2008).

Ethiopia

In Ethiopia, PATH collaborated with Miz-Hasab Research Center to evaluate the MNI project in three low-income areas in the capital of Addis Ababa. The intervention was implemented by Hiwot Ethiopia, with technical assistance from EngenderHealth, and included group education sessions and community engagement activities designed to promote equitable gender norms and reduce the risk of HIV and violence among male youth group members.

Using a quasi-experimental study design, PATH and partners compared the impact of different sets of program activities over a six-month period among young men ages 15 to 24 years old. In one intervention group, participants received interactive group education along with community engagement activities. In a second group, young men received only community engagement activities. In the third, comparison group, participants only received intervention activities after the study period had ended.

Evaluation findings revealed that community-based interventions focused on combating inequitable and risk-supporting gender norms are associated with reduced partner violence and lower risk of HIV and other sexually transmitted infections—and can lead to healthier relationships by successfully influencing young men’s attitudes toward gender norms. They also suggested that combining group education sessions and community engagement efforts may be more effective in changing gender-related attitudes and reducing partner violence than using either strategy alone. Still, partners of most participants from both intervention groups reported positive changes in men’s behavior, including helping with household chores and having open discussions about HIV/AIDS, sex, and faithfulness.

Namibia

In Namibia, local nongovernmental organization (NGO) LifeLine/ChildLine led implementation of group activities to address gender norms and related behaviors that increase risk of negative health outcomes, especially around HIV, among adult male prison staff. MNI partners EngenderHealth and Promundo also provided targeted capacity strengthening and technical support to local NGOs on ways to address gender issues and engage men in HIV/AIDS prevention, care, and support. The project was evaluated by PATH, in collaboration with the Namibian research organization Survey Warehouse.

The PATH-led quasi-experimental study, which covered six prison sites in Namibia, focused on activities for guards and other staff from the Namibian Prison Service and evaluated the impact of gender-focused group education activities on attitudes and behaviors related to gender, violence, and HIV/AIDS. The intervention group, which included guards from three prisons, received interactive group education activities; the control group did not.

Findings from baseline and end line surveys and qualitative interviews revealed that the group education sessions led to positive changes in the lives and behaviors of participating Namibian prison staff. Many men, for example, reported that they had taken steps to reduce their HIV risk and supported more equitable relationships with their partners as a result of their participation in MNI group education activities. Local partner organizations involved in the intervention also reported improvements in gender sensitivity among their staff. Specific changes around partner violence, condom use, number of partners, and partner communication were harder to interpret from survey responses, in part due to challenges following up with study participants.

Additional resources

Promoting Gender Equity for HIV and Violence Prevention: Results from the PEPFAR Male Norms Initiative Evaluation in Ethiopia

Promoting Gender Equity for HIV and Violence Prevention: Results From the PEPFAR Male Norms Initiative Evaluation in Namibia

Pulerwitz J, Barker G. Measuring attitudes towards gender norms among young men in Brazil. Men and Masculinities. 2008;10(3):322–338 (79 KB PDF).