Global public health increasingly focuses on men and HIV, despite women bearing the majority of the burden. Men consistently experience poorer outcomes across the HIV prevention, treatment, and care cascade. While the 2017 UNAIDS report, 'Blind Spot,' and the subsequent MenStar Coalition highlighted this issue, the problem is not new. Research has long documented men's worse outcomes, attributable to factors such as masculine gender norms, gendered labor structures, and health service barriers. Although some researchers and activists had previously addressed this issue, it is only recently gaining significant attention and resources. This creates an opportunity to engage political, academic, and community actors, but also raises crucial questions: How should the 'problem' of men and HIV be framed to engage skeptics? How can we avoid blaming individual men while addressing social and structural factors? How can researchers promote coordinated and effective responses consistent with feminist and human rights principles? This paper examines a local-level effort in Cape Town to foster a healthy public regarding men and HIV, focusing on the emergence and lessons learned from the Movement for Change and Social Justice (MCSJ).

The paper draws upon existing literature highlighting men's poorer outcomes in HIV prevention, treatment, and care, citing studies demonstrating this disparity globally and particularly in sub-Saharan Africa. It references reports from UNAIDS and the MenStar Coalition as evidence of the growing global focus on this issue. Additionally, it acknowledges prior research that has identified various contributing factors, including gender norms, socio-economic structures, and barriers within healthcare systems. The introduction also mentions a body of work by public health researchers and activists that had previously addressed the issue but without widespread impact. The authors thus situate their case study within this broader context of existing research and the recent shift in global attention to men and HIV.

This qualitative case study employs a mixed-methods approach. Data sources include participant observation of MCSJ activities, qualitative process evaluations of MCSJ’s work, and reflections from the UCT-based research team. The iALARM project, a five-year NIH-funded research project focusing on men and HIV, served as the context for MCSJ’s emergence. iALARM employed a ‘Linkage and Retention in Care Task Team’ composed of clinic and NGO staff. This team reviewed health information and research to identify service gaps and develop service improvements. iALARM expanded to encompass the broader Gugulethu community and the Klipfontein health sub-district, incorporating a wider range of stakeholders into the Task Team. The study also included a retrospective cohort study on men’s performance in the HIV cascade and formative qualitative research to understand local factors. Qualitative and quantitative process evaluations assessed how local actors engaged with health information. The research received ethical approval from the UCT’s Faculty of Health Sciences Human Research Ethics Committee and obtained informed consent from participants.

The study details the emergence of MCSJ, highlighting its origins in a specific instance of delayed medication access for a community member. MCSJ is structured as a network of actors, including local NGOs, UCT’s DSBS, and Sonke Gender Justice, operating largely through campaigns addressing local health or social problems. These campaigns often involve information gathering, stakeholder consultation, engagement with public services, and advocacy for solutions. MCSJ has achieved improvements in various services in Gugulethu, including dental services, ARV access, condom distribution, and emergency room services. A key initiative is the 'Men's Forum,' focused on HIV-related activities such as community meetings, dialogues, support groups, and training for community leaders. The Men's Forum also facilitates networking and dissemination of findings from the iALARM project. The paper identifies several enabling conditions for MCSJ's success: sufficient funding and human resources (although mostly volunteer-based), the experience and local knowledge of key members (particularly Mandla Majola's long-standing AIDS activism experience), and the mobilization of diverse health information. The study also emphasizes the balancing acts MCSJ navigates: defining its scope and geographic reach, managing competing institutional and political identities, balancing academic and activist roles, and navigating gender-sensitive versus gender-transformative approaches. MCSJ employs strategies such as inclusive engagement with diverse community subgroups, working collaboratively with public health services, and leveraging academic partnerships and research knowledge for advocacy. Key research strategies include institutionalizing a long-term research cycle with annual community meetings, linking graduate students with local research needs, and providing capacity-building opportunities for community members.

The findings highlight the successful implementation of a community-based approach to address health inequities, particularly the significant role of community-university partnerships. MCSJ's model demonstrates the effectiveness of a locally rooted, flexible, and responsive approach. The study’s success underscores the importance of leveraging existing community networks and expertise, particularly in politically complex environments. The findings challenge conventional public health approaches by emphasizing the need for more responsive, inclusive, and locally owned interventions. The study's contribution lies in providing practical insights and lessons learned for fostering healthy publics that address complex health issues, particularly those involving men's health in the context of HIV.

MCSJ’s success demonstrates the potential of community-led initiatives to address health inequities. The flexible and responsive approach, leveraging local knowledge and partnerships, proves effective. However, the movement’s sustainability remains dependent on continued funding and leadership. Future research should investigate similar initiatives and explore the long-term impact of community-university partnerships in fostering sustainable and impactful interventions.

The study's focus on a single case study limits generalizability. The reliance on qualitative data, while rich in context, may not fully capture the quantitative aspects of MCSJ's impact. Future research could expand the scope to include a comparative analysis of similar initiatives in different contexts. Additionally, the study acknowledges that the long-term sustainability of MCSJ remains uncertain and its success is partly reliant on the contributions of key individual members.