HIV testing attitudes and practices amongst 'wealthy men': qualitative evidence from Tanzania

Abstract

Evidence from nationally representative surveys conducted in sub-Saharan Africa shows that significant proportions of men in the wealthiest quintile report never having tested for HIV. Despite high prevalence rates in this quintile, no research has been conducted on the HIV testing attitudes and practices of wealthier men. This article reports findings from qualitative research conducted with 23 wealthy men in Tanzania. Whilst wealthy men reported barriers to and enablers of HIV testing previously reported by the general population, concerns around loss of social status and community standing were amplified for members of this demographic. Furthermore, HIV stigma among members of this group remains high. However, enhanced access to HIV testing through private clinics, regular healthcare appointments, health insurance schemes and the means to travel to other countries enables wealthy men to avoid stigma. In settings such as the workplace, wealthy men were able to test in public in their roles as 'leaders' to encourage others to test. Future interventions to increase testing amongst men should target settings in which these leadership roles can be taken advantage of. HIV services also need integrating into the health system to remove the need for testing and treatment to be accessed at separate clinics.

Socioeconomic inequalities in the 90–90–90 target, among people living with HIV in 12 sub-Saharan African countries — Implications for achieving the 95–95–95 target — Analysis of population-based surveys

“… 22 In contrast, PLHIV from wealthy backgrounds may have faced barriers to accessing HIV testing and treatment, such as stigma and discrimination, lack of private clinics, and concerns about potential loss of social status and community standing if community members learned about their HIV positive status. 23 Another explanation for wealth disparities in attaining the 90s could be the World Health Organization (WHO) 2016 recommendation for universal HIV testing and treatment (UTT). 24 With this recommendation, WHO removed eligibility requirements for ART, improving access to HIV testing and same-day ART initiation.…”

Feasibility and Acceptability of Human Immunodeficiency Virus Self-Testing for Men of Middle-to-Upper Socioeconomic Status in Botswana: A Pilot Study at 4 Worksites in the Financial Sector

“…In accordance with gender role strain and hegemonic masculinity theories [ 17 , 18 ], qualitatively, men say that they worry that others will discover their serostatus if they test HIV positive, subjecting them to gossip, rejection, and shame—and loss of respect by their partner and others [ 9 , 19–22 ]. Moreover, men discuss being seen accessing healthcare (and testing) [ 23–25 ], as well as an HIV diagnosis [ 26 , 27 ], as a threat to masculinity—being stigmatized as weak and unable to provide for their family—with consequent loss of respect and status. Men have also said that an HIV diagnosis threatens their “respectability, independence and emotional stability” [ 28 ], their need to provide for others, and their ability to maintain a source of income [ 28 ] and higher social class [ 29 ].…”

“…Fears about stigma and other individual-level concerns are heightened by structural factors related to healthcare, including concerns about privacy in public healthcare facilities and fears that providers will not keep their results confidential and that people from their community will see them visiting a facility for testing. Such concerns may be heightened among men of higher socioeconomic status (SES), who may fear losing status and believe that they are more recognizable in public settings [ 23 ]. Owing to inconvenient clinic hours and locations, competing needs for work are also a barrier to testing [ 20 , 32 ].…”