Alain Damiba
2007-06-15 07:00:00.0
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BALTIMORE -

Each year, on the third Sunday of June, many of us take time to honor and celebrate our fathers or those who have served as fathers in our lives. Days like this are important, especially in today’s fast-paced society, because it’s often difficult to find uninterrupted time to connect with our spouses, children, extended family and friends.

Citing lack of time, we men often ignore our health-particularly our reproductive health. As a father and public health physician, I understand how important it is for us to take an active role in this aspect of our health. This includes knowing our status by undergoing screening for HIV and other sexually transmitted infections, finding out what we can do to protect ourselves and our partners through education and counseling about risk reduction and prevention, and seeking appropriate treatment.

In the U.S., we have access to medical services at a range of income levels. In many areas of Africa, parts of Asia, Latin America and the Caribbean, most men are not as fortunate.

In my role as vice president for Global Program Operations at JHPIEGO, an international health affiliate of the Johns Hopkins University, I travel the world educating government officials, doctors, nurses, midwives and other health professionals about the importance of ensuring safe, reliable and accessible health care for the communities they serve.

Although JHPIEGO primarily focuses on the health of mothers and newborns, men are an inextricable part of this picture. In most of the countries where we work, the main mode of HIV infection is through heterosexual contact: Many husbands or steady partners infect women at home.

This spring, I visited our staff in East and Southern Africa. According to the World Health Organization, the average life expectancy in that region is disturbingly less than 50 years of age. In 2006, the HIV prevalence rate among adults ranged from 10 to 30 percent-more than 10 to 30 times higher than in the U.S.

In many of the countries where we work, gender roles are very traditional, with men holding all of the decision-making power around their families’ health care. Based on deeply entrenched cultural norms, some families cannot seek health services without the consent of the man of the house. This means that even in countries with a high HIV prevalence, entire households may not be aware of their HIV status, do not know the steps they can take to protect themselves or their loved ones, and are not able to seek appropriate care and treatment when they become ill.

If a woman is infected with HIV by her husband or partner and then becomes pregnant, her baby is at considerable risk of also becoming infected and both mother and baby may become ill and die unless they receive timely access to care and treatment services.

JHPIEGO has been working in HIV/AIDS for more than 10 years. A major focus of our efforts in this area has been prevention, through counseling and testing for HIV and prevention of mother-to-child-transmission of HIV. Male involvement has always been an important component of our work in this area.

In March, a very important preventive step specific to men seized the attention of the global public health community. In response to the results of three clinical trials indicating that male circumcision reduces female-to-male HIV transmission by 60 percent, the World Health Organization and the Joint United Nations Programme on HIV/AIDS recommended that countries with high HIV prevalence begin offering free or subsidized male circumcision services.

JHPIEGO has been working to promote male circumcision services since 2003, when we started to work with the Zambian Ministry of Health on that issue. Male circumcision is a newfound entry point to other male reproductive health services including education and counseling around safer sex practices, and screening and treatment for HIV and other sexually transmitted infections. If we begin now, nearly 6 million new HIV infections could be averted in Africa over the next 20 years.

Let the struggles of our brothers around the world be lessons for us to take control of our reproductive health. Let the steps they are willing to take help us take a first step. Here, as is the case everywhere, that first step is knowledge. Get tested. Know your status. And remember, healthy men make healthy fathers and healthy families.

Alain Damiba, MD, MPH is Vice President for Global Program Operations JHPIEGO, an Affiliate of Johns Hopkins University.