Abstract
BackgroundA growing number of studies highlight men's disinclination to make use of HIV services. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality that determine men's acceptance or rejection of HIV services.MethodsDrawing on the perspectives of 53 antiretroviral drug users and 25 healthcare providers, we examine qualitatively how local constructions of masculinity in rural Zimbabwe impact on men's use of HIV services.ResultsInformants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. However, once men had been counselled and had the opportunity to reflect upon the impact of ART on their productivity and social value, it was possible for some to construct new and more ART-friendly versions of masculinity.ConclusionWe urge HIV service providers to consider the obstacles that prevent many men from accessing their services and argue for community-based and driven initiatives that facilitate safe and supportive social spaces for men to openly discuss social constructions of masculinity as well as renegotiate more health-enabling masculinities.
Highlights
The World Health Organisation [1] states that gender differences must be acknowledged and addressed if HIV and AIDS programmes are to be effective
Differences in HIV servicei uptake have been identified, with a growing number of studies highlighting that men are significantly less likely to get tested for HIV [2,3,4] or to enroll and adhere to antiretroviral treatment (ART) services [5,6,7,8]
This review found that, in the majority of studies, 60% more women enrolled onto ART compared to their male counterparts - a trend which they argue is not explained by the higher HIV prevalence amongst women compared to men, but an indicator of gendered health seeking behaviours [7]
Summary
The World Health Organisation [1] states that gender differences must be acknowledged and addressed if HIV and AIDS programmes are to be effective. A study in South Africa found that 70% of those who managed to stay on and adhere to HIV treatment were women [5] and in Uganda, just over twice as many women managed to keep viral suppression high after six months of treatment [8] These differences, coupled with the fact that men get infected at an older age and thereby experience disease progression faster than women, may help us understand why the rate of AIDS-related mortality in men is higher than in women in many places in Africa [11,12], underlining the need to explore the causes of men’s relative disadvantage. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality that determine men’s acceptance or rejection of HIV services
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