This open-access paper looks at perceptions of men in South Africa around illness and HIV, and consequent fears about HIV counselling and testing.  

CITATION: Development of a National Campaign Addressing South African Men’s Fears About HIV Counseling and Testing and Antiretroviral Treatment

Orr N1, Hajiyiannis H, Myers L, et a. Journal of Acquired Immune Deficiency Syndromes (January 2017), 74 Suppl 6:S69-S73.

View Abstract: http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2017&issue=01011&article=00010&type=abstract

INTRODUCTION: South African men are less likely to get tested for HIV than women and are more likely to commence antiretroviral treatment (ART) at later stages of disease, default on treatment, and to die from AIDS compared with women. The purpose of this study was to conduct formative research into the ideational and behavioral factors that enable or create obstacles to mens’ uptake of HIV counseling and testing (HCT) and ART. The study consulted men with a goal of developing a communication campaign aimed at improving the uptake of HIV testing and ART initiation among men.

METHODS: Eleven focus groups and 9 in-depth interviews were conducted with 97 male participants in 6 priority districts in 4 South African provinces in rural, peri-urban, and urban localities.

RESULTS: Fears of compromised masculine pride and reputation, potential community rejection, and fear of loss of emotional control (“the stress of knowing”) dominated men’s rationales for avoiding HIV testing and treatment initiation.

CONCLUSIONS: A communication campaign was developed based on the findings. Creative treatments aimed at redefining a ‘strong’ man as someone who faces his fears and knows his HIV status. The resultant campaign concept was: “positive or negative-you are still the same person.”

SELECTED EXTRACTS:

Men’s work-related mobility, lower perceptions of HIV risk compared with women, fear of stigma, and rejection by communities because of being seen standing in queues at health centers, lack of trust in health workers (especially lack of confidentiality), and perceptions of demasculization by being attended to by female health workers4–6; and (3) The anticipated psychological burden of living with HIV, including inability to cope with an HIV positive result, an associated lack of will to live, perceptions that an HIV-positive status hastens death, and that HCT results in being perceived by others as having been sexually promiscuous.

For example, where masculinity is framed as being strong and not needing help, and where cultural beliefs associate weakness with illness, men are less likely to seek help at health facilities.

Stigma around HIV threatens masculine notions of respectability, independence and emotional control and can prevent men from admitting illness and making use of health services. The experience of being sick and taking treatment forces men to redefine their sense of identity and masculinity.

Men said they felt self-conscious and uncomfortable at public clinics because it was unusual to find young men there for reasons other than HIV, and other people would assume any man at the clinic would be HIV positive. Negative participant experiences at public sector clinics included being shouted at and judged by health professionals and confidentiality violations.

“We were raised with the mentality that a man … is this strong person so when people see a weakness I will be afraid because I won’t be seen as a man and I will be called a woman… Other men will say you are a woman and must wear panties” (rural male, 25–35 years, Gert Sibande, Mpumalanga).

“Nobody fears being sick (more) than a male person, we are more terrified of being sick than our female counterparts. So if I have to take medication, it’s the same as giving in” (admitting illness) (urban male, 18–24 years, Gert Sibande, Mpumalanga).

Some men stated that traditional healing practices influence late initiation of ART and nonadherence because traditional medicine is taken when one is ill, and stopped when one is cured.

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Best wishes, Neil

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