Abstract
Studies in sub-Saharan Africa show that masculine identities contribute to men’s relatively lower uptake of HIV services. Although useful, these studies pay less attention to men’s agency to negotiate and refashion masculine identities which better suit their lives as men living with HIV. In this article, I analyze the refashioning of masculine identities among men living with HIV in Uganda, adjustment processes which helped their self-management, and adherence to treatment. In-depth interviews with 18 men are thematically analyzed. Physical recovery was the embodiment of recovered masculinity and underpinned the men’s ability to refashion alternative, hybrid masculinities. Men negotiated and refashioned two forms of dominant masculinity already identified in this context, respectability and reputation, notably being a responsible father again and supporting other men with HIV, and being strong, resilient and an HIV survivor. Understanding men’s refashioning of masculinities can inform service providers’ approaches to reach more men with HIV treatment.
Highlights
Despite gender structures which offer men numerous material benefits and decision-making authority, studies in sub-Saharan Africa over the last 10 years, including studies in Uganda, show that men face greater challenges than women when it comes to accessing HIV treatment services, adhering to drugs and continuing on treatment and care (Cornell, McIntyre, & Myer, 2011; DiCarlo et al, 2014; Mills, Beyrer, Birungi, & Dybul, 2012; Muula et al, 2007; Siu, Seeley, & Wight, 2013), with resulting higher mortality rates (Alibhai et al, 2010; Birungi & Mills, 2010; Braitstein et al, 2008; Cornell, Myer, Kaplan, Bekker, & Wood, 2009)
Studies highlight a tension between widespread ideals and practices of masculine identity, such as physical strength, emotional and physical resilience, independence, authority over women and sexual prowess, and HIV service providers’ recommendations about what patients need to do and be to become “good” HIV patients and “therapeutic citizens” (Mfecane, 2011; Siu et al, 2013)
In 2011–2012, qualitative and quantitative data were collected for a study on the ways that people living with HIV (PLWH) on antiretroviral therapy (ART) in Wakiso District, Central Uganda, were coping with and self-managing the condition and adhering to treatment
Summary
Despite gender structures which offer men numerous material benefits and decision-making authority, studies in sub-Saharan Africa over the last 10 years, including studies in Uganda, show that men face greater challenges than women when it comes to accessing HIV treatment services, adhering to drugs and continuing on treatment and care (Cornell, McIntyre, & Myer, 2011; DiCarlo et al, 2014; Mills, Beyrer, Birungi, & Dybul, 2012; Muula et al, 2007; Siu, Seeley, & Wight, 2013), with resulting higher mortality rates (Alibhai et al, 2010; Birungi & Mills, 2010; Braitstein et al, 2008; Cornell, Myer, Kaplan, Bekker, & Wood, 2009).Masculinities and the related stigma affecting men living with HIV help explain these gender inequalities with service uptake (Camlin et al, 2016; Chikovore, Gillespie, McGrath, Orne-Gliemann, & Zuma, 2016; Fleming, Diclemente, & Barrington, 2016; Mburu et al, 2014; Nyamhanga, Muhondwa, & Shayo, 2013; Siu et al, 2013; Skovdal, Campbell, Madanhire, & Mupambireyi, 2011; Wyrod, 2011). Despite gender structures which offer men numerous material benefits and decision-making authority, studies in sub-Saharan Africa over the last 10 years, including studies in Uganda, show that men face greater challenges than women when it comes to accessing HIV treatment services, adhering to drugs and continuing on treatment and care (Cornell, McIntyre, & Myer, 2011; DiCarlo et al, 2014; Mills, Beyrer, Birungi, & Dybul, 2012; Muula et al, 2007; Siu, Seeley, & Wight, 2013), with resulting higher mortality rates (Alibhai et al, 2010; Birungi & Mills, 2010; Braitstein et al, 2008; Cornell, Myer, Kaplan, Bekker, & Wood, 2009). For example Siu et al (2013) identified two interrelated dominant masculine value systems among Itheso gold miners in Uganda which influenced men’s performances of masculinity in different settings, including their HIV testing and treatment behavior.
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