Adjunct Associate Professor Christopher Colvin, the former Founding Head of the Division of Social and Behavioural Sciences (DSBS) in the School of Public Health and Family Medicine and PhD candidate Myrna Van Pinxteren from the same division, are co-authors on the paper, “Fostering a healthy public for men and HIV: a case study of the Movement for Change and Social Justice (MCSJ),” which was recently published in a special edition of Palgrave communications.

This investigation, to better understand what barriers men experience when seeking care for their health needs, spanned five years. The process, launched in Cape Town in 2015 which focused on retaining men in the HIV cascade, was referred to as iALARM. “This study aims to better understand the care needs for men by actively linking stakeholders from different parts of the health system together and sharing health information among a diverse group of people who live and/or work in Gugulethu or the larger Klipfontein Sub-district,” says Colvin. He adds, “The Movement for Change and Social Justice (MCSJ), emerged in relation to the iALARM project.” MCSJ is a health and social justice movement borne out of several health activists, who were linked to iALARM, recognising a need to collectively tackle longstanding health issues in their community.

MCSJ led a march in April 2019 to stress the importance of implementing the National Health Insurance (NHI) to create equal access to health services for all South Africans.

Gender norms are inescapable in this line of work. But it would be myopic to view the situation only through stereotypical and patriarchal gender norms – which situate men as holding power over women and children. Norms which legitimise violence and risky behaviour, norms which shun expressions of male vulnerability. Colvin says it’s important to recognise these gender norms as constantly evolving and multiple – there are many ways to “be a man”. He says, “A tricky balancing act in iALARM has been to acknowledge what type of behaviour is harmful and work towards ‘gender transformation’ without reducing the men we worked with to this stereotype. While acknowledging the diversity, fluidity and complexity of the gendered lives of men.”

Building a “healthy public” is the bedrock of MCSJ’s work. It is defined here as a necessary paradigm shift towards the appreciation of public struggles which sometimes hinder the awareness of health issues. This, while not casting blame on communities as “targets of intervention” but also in not overstating culture as a typical hinderance to required biomedical intervention. As a result, “MCSJ’s approach to health activism and understanding of health issues in the community are tackled within the complex social, economical and cultural contexts of Gugulethu,” says Colvin. “Most MCSJ members are born, and often still live in the community that they attempt to improve, which leads to buy-in from local residents and an understanding of the barriers that men (and women) face when trying to access care and link to treatment. It is within this context that campaigns are developed and shaped.”

The “healthy public” relies on role players like Mandla Majola, DSBS’s community engagement coordinator, who are well immersed in the cultural, social and economic contexts of their communities.  These role players also have contacts in the community. This expansive network that MCSJ’s members are linked to, coupled with their intimate knowledge of the pervasive health issues in the area means that the initiative is well-positioned to develop practicable strategies and apply effective solutions. In fact this was one of the team’s lessons learnt in both their engagements with iALARM and MCSJ. Van Pinxteren expands: “…it is important to develop context-specific and flexible interventions that are sustainable and scalable. When doing this, it is crucial to work with local organisations and representatives, as well as to listen to and understand the experiences and needs of both men and their support networks.”

Mandla Majola speaks to the crowd in front of Parliament during the NHI march in April 2019.

The relationship that has developed between this community engagement project and the academic institution did so in a complex environment. This included “persisting economic, racial and gendered divides” and socio-economic factors like high levels of poverty, unemployment, and crime. i And yet residents exhibit agency in developing community initiatives to improve their circumstances and generate their own opportunities. The paper offers some insight into how community engagement projects and academic institutions can straddle acute differences and difficulties while connecting over shared values for a sense of deep meaning and reward.

Van Pinxteren acknowledges that relationships between community health activists and researchers or scholars as part of community engagement are not novel. But she also speaks to how the one between UCT and MCSJ is particularly special: “…most of the executive members of MCSJ have worked with researchers in the past and know the benefits and challenges of working with academic partners.” She mentions the provision of resources and information, which can be distributed to the larger community.

iALARM is experimental in nature and exercises a flexible approach. This encourages a freedom to work with different organisations and initiatives that fall within the “men and HIV” ambit. Aware of how research can be double-edged with the ability to either benefit or harm the community, MCSJ uses this knowledge to create their own campaigns and strategies. “This means that the iALARM team was able to assist with the development of MCSJ’s frameworks and male-focused projects such as the Men’s Forum, the Men in Clinic Poster Project, and Soccer Coaches training,” says Van Pinxteren.

She says that another important outcome of this relationship is MCSJ being a part of the iALARM Task Team, a dedicated group of stakeholders who play different roles in the health system. “This has created opportunities for MCSJ members to connect with health system actors they normally would not interact with on a regular basis, including facility managers, sub-district managers and health promotors.”

It is apparent that although responding to and including men in ongoing efforts to address the HIV pandemic is complex, one of the ways to tackle this problem and help bridge the gap is by involving affected communities in collaborations where they are allowed the space to take the lead and deliver relevant, appropriate, and context-specific solutions.