Uncertainty by Adolescent Boys and Young Men (ABYM) to seek Sexual and Reproductive Health (SRHR) services, lack of knowledge on services available at health facilities, lack of time, distrust of doctors and health providers as well as not being able to afford services related to sexual reproductive health have been underscored as some of the barriers to adolescent and young men accessing sexual and reproductive health Services.

This was highlighted during a meeting to share findings of a rapid situational assessment on the structural, social and behavioural drivers that facilitate or impede the uptake of Sexual and Reproductive Health (SRH) services on ABYM aged 18-34 years in selected sites in Lesotho, Malawi, Uganda, Zambia and Zimbabwe. The meeting was held in Maseru, Lesotho recently.

Speaking during the meeting, UNFPA, the United Nations Population Fund Officer in Charge in Lesotho Mr Richard Delate clarified that the study was prompted by the need for evidence and to understand what is going on regarding programming for men and boys in East and Southern Africa.

“This is because we do know that men and boys have particular SRH needs. We often think of men and boys purely as partners but actually they have their own health needs. HIV revealed this clearly. We saw a lot of men and boys dying from HIV in the region because they were not accessing treatment and not getting tested and knowing their status,” he stated.

Further enlightening participants on what prompted the assessment, Mr Delate specified that the issue was not new as there is a lot of international commitments from which programming on men and boys have been developed including the International Conference on Population and Development (ICPD) Program of Action where “we have specifically tried to program around the needs of men and boys in Southern Africa.”

However, he said programming around men and boys was very patchy in the region hence UNFPA East and Southern Africa Regional Office (ESARO) commissioned HEARD, a division of the University of KwaZulu-Natal, to undertake the formative assessment, which among others, was meant to assess the extent to which existing laws, policies, strategies and programmes meet the SRHR needs of adolescent boys and young men, and examine the extent to which an integrated package of SRHR services is being provided to meet the needs of adolescent boys and young men as clients through facility and community-based services, social and behavioral change programmes, including Comprehensive Sexuality Education (CSE), and the impact of COVID-19 on the continuation of services amongst adolescent boys and young men. 

“After this assessment, for the first time this region will have data around men and boys,” he emphasized.

Speaking at the same occasion, the Director of Gender in the Ministry of Gender, Youth, Sports, Arts, Culture and Social Development Ms ‘Matau Futho Letsatsi who was welcoming delegates to the meeting reiterated the need for Gender Based Violence to be included as one of the SRHR needs for men and boys. “We need to see how best we can use the men and boys’ study to better program for men and boys. Furthermore, we should always bear in mind that without seriously addressing the Sustainable Development Goal 5 (Gender Equality) we will not be able to attain all the other SDGs.”

 In the same vein, the acting United Nations Resident Coordinator to Lesotho who is also UNICEF Representative Mr Deepak Bhaskaran called for increased commitment as part of the 2030 Development Agenda, to leave no one behind, and to factor into the dialogues and discussions the needs of men and boys in all their diversity, both from a rights’ dimension and a public health prerogative.  “We will not make progress if we continue to deny some their rights at the expense of others, we have seen this particularly with the HIV response, and increasingly with other health outcomes too,” he added.

He continued, “we must recognize that underpinning the sexual and reproductive health of men and boys are social and gender norms. Social and gender norms hamper the uptake of services amongst men and boys, often to the detriment of their health and wellbeing and that of their families. Today, more adolescent boys and young men are dying from AIDS because they do not want to test for HIV or access treatment. Millions of men suffer in silence from STIs, fearful to seek services thereby placing their partners at risk and increasing their own risk of infertility.”

He further stated that men are dying from reproductive cancers such as prostate and testicular cancer as they lack information, adding that It is well known that when fathers are actively engaged in the birth of their children that it results in better outcomes for both the mother and the child.

One of the issues that came up during the meeting was that, based on evidence, the sexual and reproductive health needs of adolescent boys and young men are not well addressed in ESA, and that ABYM are not as severely affected by HIV and STIs as their female counterparts. Moreover, in the five countries, where the assessment study was undertaken there were approximately 43 200 new HIV infections in 2021 amongst men aged 15 years or older (UNAIDS, 2022) and approximately 4.5 million new STI infections among men aged 15-39 years old in 2019 (Institute for Health Metrics and Evaluation, 2019).

The study also revealed that there was a significant unmet need for SRHR services amongst ABYM, that PrEP services for victims of sexual violence; information, counselling and treatment on male cancers of the reproductive organs; and information and counselling on sexual dysfunction were the services with the greatest unmet needs.  It further showed that there was lack of information, education and communication materials, support and advocacy groups to create demand for SRH services and to improve access to SRH services while rural and younger ABYM need to be assisted to access SRH services.

At the validation meeting, besides reviewing findings of the study, participants also conceptualized them to their countries’ level and developed draft country action plans to strengthen SRHR programming for men and boys in their different countries.

The study was commissioned based on the premise that there is very little known about the extent to which existing policies, strategies or operational plans in the ESA region incorporate the involvement of men and boys, although the needs of this group may in some instances be integrated into national health policies and programmes.  Also that available programs, for good reasons, have largely focused on women of reproductive age and often men have been included to support their partners and thereby neglecting the role of men as end-users themselves and that SRHR programmes for men have been shown to reduce men’s risk-taking behaviour, reduce incidences of STIs and HIV and preventing unwanted pregnancies among other things.

Participants included government representatives, development partners and Civil Society Organisations.