Bringing fear into focus: The intersections of HIV and masculine gender norms in Côte d’Ivoire

Abstract

This qualitative research study explored the role of masculinity in men’s engagement in the HIV care continuum in Côte d’Ivoire. The researchers conducted 73 in-depth interviews and 28 focus group discussions with 227 Ivoirian men between November and December 2016 across three urban sites. Participants in the study expressed that fear was the primary barrier to HIV testing and treatment. These men described five value domains–health, sexuality, work and financial success, family, and social status. Men saw HIV as a direct threat to their agency and strength with respect to each of these value domains, thus shedding light on their reluctance to discover their HIV status through HIV testing. With this data, the researchers created the Masculine Values Framework, a descriptive framework of masculine values that can be applied to better understand the behavior men exhibit in Côte d’Ivoire in the face of HIV. The Masculine Values Framework offers practical guidance for developing gender-sensitive HIV-focused social and behavior change programming in Côte d’Ivoire and similar contexts to reach the UNAIDS 90-90-90 targets.

Development, Implementation, and Scale Up of the National Furaha Yangu Campaign to Promote HIV Test and Treat Services Uptake Among Men in Tanzania

“…The audience consultation sessions revealed that fear of a positive result was one of the barriers for HIV testing, paralleling findings from other studies ( Conserve, Issango, et al, 2019 ; Ehiri et al, 2016 ; Naugle et al, 2019 ; Okal et al, 2020 ; Orr et al, 2017 ). For men in Tanzania and other countries, the fear of testing positive for HIV may stem from the perceived threat of HIV to their masculinity and ability to secure employment to provide for their families and serve as role models in their community ( Mburu et al, 2014 ; Nyamhanga et al, 2013 ; Siu et al, 2012 , 2013 ).…”

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

“…Of these, 81 studies were included in the meta‐analysis [33–113] and 29 studies were included in the meta‐synthesis [105,114–141]. Our updated searches identified 48 additional studies for the meta‐analysis [142–189] and 11 additional studies for the meta‐synthesis [190–200], most published in 2020.…”

“…In addition, participants described that HIV threatened men's ideals of strength, sexuality, livelihood, social standing and a fun lifestyle. HIV was “the end of your fun, the end of your joy,” imposing limitations on men's sexual choices because women will “run away” from a man who has HIV [ 192 ] (p. 6). Therefore, it was better not to know one's status.…”

“…Our updated searches identified 48 additional studies for the meta-analysis and 11 additional studies for the meta-synthesis [190][191][192][193][194][195][196][197][198][199][200], most published in 2020. Most studies reporting on knowledge of positive status asked participants about their status prior to testing in the study (33/47 [70.2%]), whereas some studies provided unclear details (7/47 [14.9%]) or used other methods (7/47 [14.9%]), including asking about knowledge of status after testing within the study.…”

“…. and respect" [192] (p. 7). Men worried that engaging in HIV care would take away from time socializing with other men and "men activities," leading them to feel "left behind, weak and incapable of fully being a man" [119] (p. 7).…”