REPRODUCTIVE HEALTH AND AIDS-PREVENTION IN SUB-SAHARAN AFRICA - THE CASE FOR INCREASED MALE PARTICIPATION

Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessi ve child bearing, some responsibility for contraception, infertility i nvestigation and often undiagnosed sexually transmitted diseases (STDs ) including AIDS. Failure to target men in reproductive health interve ntions has weakened the impact of reproductive health care programmes. The paper proposes that sophisticated and dynamic strategies in Afric a and elsewhere which target women's reproductive health and research (such as control of STDs including AIDS, family planning, infertility investigation) require complementary linkage to the study and educatio n of men. Men's perceptions, as well as determinants of sexual behavio ural change and the socioeconomic context in which STDs, including AID S, become rife, should be reviewed. There is a need to study and foste r change to reduce or prevent poor reproductives health outcomes; to i dentify behaviours which could be adversely affecting women's reproduc tive health. Issues of gender, identity and tolerance as expressed thr ough sexuality and procreation need to be amplified in the context of present risks in reproductive health. Researchers and providers often ignore the social significance of men. This paper reviews the impact o f male dominance, as manifested through reproductive health and sexual decisions, against the background of present reproductive health prob lems. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outco mes. This should be followed up by well-developed causal models of the determinants of positive reproductive health-promoting behaviours. Be haviour specific influences in sexual partnership include the degree o f interpersonal support towards prevention, for example, of STDs, unwa nted pregnancy or maternal deaths. Perceived efficacy and situational variables influencing male compliance in, say, condom use, form part o f the wider study that addresses men. Thus preventive reproductive hea lth initiatives and information should move from the female alone to b oth sexes. Women need men as partners in reproductive health who under stand the risks they might be exposed to and strategies for their prev ention.