Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania

Abstract

BackgroundThis article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained.ObjectiveTo explore how masculinity norms limit men's access to ART in Dar es Salaam.DesignThis article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach.ResultsOverall, the study's findings revealed that men's hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards ‘hiding’, the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced.ConclusionThis study suggests that the superiority norm of masculinity affects men's access to ART. Societal expectations of a ‘real man’ to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one's status of living with HIV to at least one's spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions.

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?

“…Our findings on masculinity-related barriers to the HIV treatment cascade in this particular South African context are consistent with findings from other research in sub-Saharan Africa (Bila and Egrot 2009; Nyamhanga et al 2013; Siu et al 2013; Siu et al 2012; 2014a; Siu et al 2014b). Our results are novel, however, because they show how a gender-transformative intervention influences several key mechanisms that may improve men’s HIV testing and treatment outcomes.…”

“…Similarly, several qualitative studies of men living with HIV in other African settings showed that norms of masculinity related to self-reliance and strength were in conflict with the perceived expectations of a patient receiving HIV care (e.g. follow orders from medical personnel, refraining from risk-taking) (Bila and Egrot 2009; Nyamhanga et al 2013; Siu et al 2013; Skovdal et al 2011). Together, these findings emphasise that norms of masculinity are influential in men’s engagement in the HIV treatment cascade.…”

Stakeholders’ perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi

“…This finding remains consistent with Tanzanian and Ugandan studies where women could not ask their partners for HIV tests because they had no authority over them [39,55] and was also concluded as a limiting factor for MI in maternal health services in Mwanza, Malawi [66]. Superiority norms held by men led to men shunning of any HIV related clinics for fear of being regarded as weak [65] or less masculine [39]. Furthermore in this study, participants regarded a man who follows what his wife tells him, to have unknowingly taken a local herb called “Khuzumule” which renders him a “puppet”.…”

The incidence of oesophageal cancer in Eastern Africa: Identification of a new geographic hot spot?

“…Alternatively, short-term migration of cases from rural to urban areas for access to medical care in the setting of a suspected life-threatening illness could introduce bias, resulting in over-estimation of cases for the local urban population. Finally, gender bias in access to health care could be in part responsible for the higher ASRs amongst males; however, a previous finding that males in Tanzania are actually less likely to visit the care and treatment clinics due to perception that this signifies a display of weakness argues against this [31]. …”