Impact of HIV on and the constructions of masculinities among HIV-positive men in South Africa: implications for secondary prevention programs

Abstract

BackgroundTo date, whilst there have been many published studies exploring the links between masculinity and HIV, not much work has been done to explore how an HIV-positive diagnosis impacts men's sense of masculinity and contextualizing the masculinities as fluid and changing.ObjectiveTo explore how human immunodeficiency virus (HIV) impacts the lives of men and their constructions of masculinity through interviews with 18 men living with HIV.DesignQualitative study involving conveniently and purposively selected black South African adult men who lived with HIV. In-depth interviews were conducted with 18 men who resided in Johannesburg and Mthatha, South Africa.ResultsOur analysis suggests that the performance of risky masculinity may influence the acquisition of HIV. Yet, it also reveals that HIV can have a significant effect on men and their masculinities. Men's constructions of harmful notions of hegemonic masculinity pre-HIV diagnosis negatively affected their help-seeking behavior and coping and adjustment to living with HIV, post-diagnosis. The dominant discourse that men are strong and healthy visibly presented challenges for men when faced with an HIV-positive status. They interpreted HIV diagnosis as a loss, a sign of failure as a man, and evidence of an inability to retain control. Being sick undermined their ability to perform roles expected of them, and this led to feelings of powerlessness, worthlessness, and distress.ConclusionsInterventions with men living with HIV need to provide safe spaces for men to critically explore gender and constructions of social identities and the pressures these place on men and implications for their health. With this approach, harmful constructions of masculinities may be challenged and mitigated, and this process may render men amenable to change.

What role can gender-transformative programming for men play in increasing men’s HIV testing and engagement in HIV care and treatment in South Africa?

“…In contrast, those same authors found evidence that masculine norms related to power, aggression, and sexual prowess discouraged men from receiving HIV care and treatment. In a study of black South African men living with HIV from Johannesburg and Mthatha, Sikweyiya et al (2014) found that men felt that HIV was a sign of failure as a man. Similarly, Hanass-Hancock et al (2015) found that men in KwaZulu-Natal who were living with HIV were concerned about a loss of work opportunities and inability to meet the masculine role of being a provider.…”

Masculinidades emergentes a través de la trayectoria del padecimiento: implicaciones para el cuidado de la salud de varones que viven con VIH

“…Antes del diagnóstico, se identifica una exposición al riesgo asociada con tener múltiples parejas sexuales, prácticas sexuales bajo el influjo del alcohol o drogas, así como el uso inconsistente del condón (Sikweyiya et al, 2014), pues la sexualidad masculina se construye como un deseo irrefrenable que requiere satisfacerse (Courtenay, 2000). Asimismo, la masculinidad se construye alrededor de la noción de fortaleza, negación del dolor o del cuidado de sí mismo (Lindegger & Quayle, 2009), condición que coadyuva al retraso del diagnóstico en varones hasta que los síntomas son demasiado graves como para ser silenciados.…”

“…Antes de vivir con VIH, los varones mantenían una relación de complicidad con las nociones hegemónicas de exposición al riesgo y centralidad de la sexualidad (Sikweyiya, Jewkes, & Dunkle, 2014), pues expresaban que su vida antes del diagnóstico estaba caracterizada por Vivir expuesto al riesgo. Esto se manifestaba al tener múltiples parejas sexuales, no utilizar condón en forma consistente o tener relaciones sexuales bajo el consumo de alcohol o drogas:…”

“…(Jorge, 2013, varón que se identifica como gay) Este malestar también podía manifestarse por medio de actos que implicaban riesgos para la salud, tal como el abandono del tratamiento o el consumo de alcohol, los cuales son considerados como estrategias de afrontamiento negativas en varones que perciben que su masculinidad se ha "deteriorado" por no cumplir con el ideal hegemónico (Sikweyiya et al, 2014).…”

"I was in the darkness but the group brought me light": Development, relevance and feasibility of the Sondela HIV adjustment and coping intervention

“…We drew from the findings of a Cochrane review [37, 38], and data from two formative studies that were conducted to explore the needs and coping strategies of HIV positive men [39, 40], and women [41]. Knowledge on barriers to coping and adjusting to new HIV status were also gained from these studies [39–41].…”