Abstract
BackgroundSocial constructions of masculinity have been shown to serve as an obstacle to men's access and adherence to antiretroviral therapies (ART). In the light of women's relative lack of power in many aspects of interpersonal relationships with men in many African settings, our objective is to explore how male denial of HIV/AIDS impacts on their female partners' ability to access and adhere to ART.MethodsWe conducted a qualitative case study involving thematic analysis of 37 individual interviews and five focus groups with a total of 53 male and female antiretroviral drug users and 25 healthcare providers in rural eastern Zimbabwe.ResultsRooted in hegemonic notions of masculinity, men saw HIV/AIDS as a threat to their manhood and dignity and exhibited a profound fear of the disease. In the process of denying and avoiding their association with AIDS, many men undermine their wives' efforts to access and adhere to ART. Many women felt unable to disclose their HIV status to their husbands, forcing them to take their medication in secret, and act without a supportive treatment partner, which is widely accepted to be vitally important for adherence success. Some husbands, when discovering that their wives are on ART, deny them permission to take the drugs, or indeed steal the drugs for their own treatment. Men's avoidance of HIV also leave many HIV-positive women feeling vulnerable to re-infection as their husbands, in an attempt to demonstrate their manhood, are believed to continue engaging in HIV-risky behaviours.ConclusionsHegemonic notions of masculinity can interfere with women's adherence to ART. It is important that those concerned with promoting effective treatment services recognise the gender and household dynamics that may prevent some women from successfully adhering to ART, and explore ways to work with both women and men to identify couples-based strategies to increase adherence to ART
Highlights
Social constructions of masculinity have been shown to serve as an obstacle to men’s access and adherence to antiretroviral therapies (ART)
Antiretroviral programmes are expanding throughout sub-Saharan Africa, providing people living with HIV and AIDS (PLHIV) with glimpses of hope [1]
Men’s fear and denial of HIV To mediate the links between social constructions of masculinity and husbands’ interference with their wives’ ART adherence, we turn to examining the conflict that exists between masculinity and HIV and how this has led many men in this context to develop a profound fear of any association with HIV, preventing them from getting tested and disclosing their HIV status: There are people in this community who are not feeling well and know that they should go and get tested for HIV, yet they are afraid to
Summary
Social constructions of masculinity have been shown to serve as an obstacle to men’s access and adherence to antiretroviral therapies (ART). Antiretroviral therapy (ART) is complex, and treatment regimens must be carefully adhered to in order to avoid drug resistance [2] and improve survival [3] This requires consistent and meticulous monitoring [4,5], and user/service interface where men exhibited a profound fear of being associated with HIV/AIDS, and examine how gender constructs and couple relations influenced women’s ability to disclose their status and adhere to ART in this setting. We fully acknowledge that more women than men take an active role in accessing HIV services [14,15], and women have been observed to respond more positively to the adherence of ART than men [16,17] Such findings suggest that many women are able to take control of their health, more so than men. While no other study has previously explored the link between masculinity and women’s adherence to ART, an expanding number of studies have examined the negative impact of men’s disengagement with HIV services to the uptake of antenatal voluntary counselling and testing (VCT) and mother to child transmission [18,19]
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