What Role Do Masculine Norms Play in Men’s HIV Testing in Sub-Saharan Africa?: A Scoping Review

Sileo, Katelyn M.; Fielding-Miller, Rebecca; Dworkin, Shari L.; Fleming, Paul J.

doi:10.1007/s10461-018-2160-z

Cited by 84 publications

(75 citation statements)

References 49 publications

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“…However, "fear" is not limited to HIVST technology, given that fear is also a barrier to conventional testing conducted in health services [59]. The fear of testing is well documented in many population groups, perhaps ampli ed here because of the implications for homosexuality [4,60,61]. Furthermore, although our data do not allow in-depth analysis of the meaning of fear as a reason for not using the test, we could argue that such fear is related to more general aspects found in other studies.…”

Section: Discussionmentioning

confidence: 99%

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Magno

Leal

Knauth

et al. 2020

Preprint

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Background : Brazil has a substantial population living with HIV (PLWH) who are still unaware of their serostatus and has recently added HIV self-test (HIVST) into its public health system for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and its associated factors among those who had never been tested or had a previous HIV negative result. Methods : Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM in 12 Brazilian cities in 2016. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results : We included 3,605 MSM who did not previously know they were PLWH. The acceptability of HIVST was 49.1%, lower among those had never tested compared to those who had a previous HIV negative test. In the subgroup of MSM who had never had an HIV test, those who reported discrimination and who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous HIV negative test, only those reporting condomless receptive anal sex had greater HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in LGBT nongovernmental organizations, and complete secondary or incomplete higher school were associated with greater acceptability in both groups. Conclusions : The findings highlight that it is necessary to improve information about HIVST among the most vulnerable MSM in Brazil. Given the acceptability of self-testing and its current promotion in Brazil, we can also point to the need for policies that build on this and enhance timely access to health services and prevention information.

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Section: Discussionmentioning

confidence: 99%

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Magno

Leal

Knauth

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…given that fear is also seen as a barrier to conventional testing conducted in health services [47]. This is about the fear of the stigma of taking the test since it might imply both homosexuality and the fact that discover that is a PWLH [4,48,49].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Magno

Leal

Knauth

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Brazil has a lot of people living with HIV (PLWH) that are still unaware of their own serostatus and has recently integrated HIV self-test (HIVST) into its public health system and offered to key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and its associated factors. Methods: Respondent-driven sampling (RDS) was used in behavioral and biological surveillance to recruit 4,176 MSM in 12 Brazilian cities in 2016. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted according to Gile’s estimator using RDS Analyst Software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or at least once in a lifetime). Results: We included 3,605 MSM who did not previously know they were PLWH. The HIVST acceptability was 49.1%, lower among those had done HIV test during lifetime compared to those who have never done it (42.7% vs 50.1%), especially among who are in a less vulnerable social context. In the subgroups of MSM who had never had an HIV test, those with complete secondary or incomplete higher school, who reported discrimination, who with a medical appointment in the last 12 months, with high levels of knowledge of HIV/AIDS and who took part in LGBT nongovernmental organization (LGBT-NGO) had higher HIVST acceptability. Among MSM who had taken an HIV test, those who took part in LGBT NGOs had greater HIVST acceptability. We observed a dose-response effect of schooling and knowledge of HIV/AIDS on HIVST acceptability: an increase in both levels was associated with greater acceptability. Conclusions: The findings highlight that it is necessary to improve information about HIVST among MSM more vulnerable in Brazil. Given the acceptability of self-testing and its current adoption in Brazil, we can also point to the need for policies that build on this and enhance timely access to health services and prevention information.

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“…Indeed, oppressive beliefs about masculinity, heteronormativity, and heterosexism have been found to be barriers to HIV testing, not only for gay and bisexual men, but also for heterosexual men (39,93). Gender norms within the Black Diaspora are strikingly similar and create both barriers and facilitators to HIV testing that could include: a man's fear of losing his marriage and ability to provide for his family with a positive HIV test result; fear of being blamed for the spread of HIV; internalized feelings of shame; the perception that clinics are a female space and that "real men" don't go to doctors because it highlights their weakness instead of stoicism and self-reliance; threats to masculinity due to fears that a positive HIV screen might curtail their sexual prowess; and/or being exposed for infidelities, or philandering behavior (94). Mburu et al argued that HIV stigma "threatened masculine notions of reputation and respectability, independence and emotional control, while it amplified men's risk-taking" and influenced men's participation in HIV services (95).…”

Section: Societal-level Factorsmentioning

confidence: 99%

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

Taylor

DeHovitz

Hirshfield

2020

Front. Public Health

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Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.

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What Role Do Masculine Norms Play in Men’s HIV Testing in Sub-Saharan Africa?: A Scoping Review

Cited by 84 publications

References 49 publications

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

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