Chikovore , J., Gillespie, N., McGrath, N., et al. AIDS Care (2016) 28:S3, 74–82, doi: 10.1080/09540121.2016.1178953.
This qualitative study examined how perceptions of masculinity affect men’s engagement in HIV care in the context of a test-and-treat trial in South Africa. The authors conducted 20 interviews (10 men, 10 women), 10 of them repeated three times, with participants recruited from households and a clinic. They also formed four focus groups—of younger individuals, older individuals, traditional healing practitioners, and mixed participants—that met four times. Findings showed that men avoided HIV testing due to fear of a positive diagnosis, preference for traditional medicine, and concern that health facilities are for women. Female partners who tested positive faced disclosure challenges, including blame and financial neglect; they sometimes relied on an antenatal care visit for support in disclosure. Men acknowledged their likely role in transmitting HIV to their partner, but still avoided the subject, and delayed testing and treatment. The literature indicates that for men, HIV is a threat to sexual capability, independence, and earning potential—all "masculine" traits. The authors concluded that to successfully promote test-and-treat approaches, policy and service delivery models must take into account family dynamics, including men’s concerns about masculinity; and also consider service delivery models that reach men in alternative settings.