Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso

Abstract

Anthropological research in Burkina Faso indicates that more HIV-positive women than HIV-positive men are attending care facilities for people living with HIV/AIDS (PLWH) and accessing antiretroviral medicine. This article, situated in the field of study of interactions between gender and AIDS, offers a description of this asymmetry and an anthropological analysis of the socio-cultural determinants, through analysis of data from ethnographic research among PLWH and health actors. Examining social representations of femininity and masculinity in Burkinabe society and the organisation of the healthcare system in connection with gender shed light on the decision-making processes of both sexes around therapeutic choices and the itinerary of care. On the one hand, the social values attached to femininity, maternity and the status of wife create conditions for women that favour their attendance at care facilities for PLWH and encourage a widespread practice where wives take the place of their husbands in healthcare queues. Moreover, health policies and the effects of women's empowerment within the healthcare system strengthen women's access to health services. On the other hand, representations of masculinity are fully implicated in the cultural construction of men's reluctance to attend care facilities for PLWH. The values associated with this masculinity cause men to run great health, economic and social risks, not only for themselves, but also for their wives and children. By better understanding the interaction between gender, the experience of HIV and the institutional organisation of healthcare, we can identify ways to reduce men's reluctance to attend care facilities for PLWH and improve both prevention and treatment-oriented programmes.

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.…”

“…In large multi-site cohort studies of persons living with HIV in South Africa who had initiated ARV treatment, men were significantly more likely than women to be lost to follow-up (Cornell et al 2014), have a lower median CD4+ count, and higher crude and age-adjusted mortality (Cornell et al 2012). Researchers in other settings in sub-Saharan Africa have found similar differences between men and women (Bila and Egrot 2009; Gari et al 2014; Parrott et al 2011). To reduce HIV transmission through HIV testing/care/treatment, it is therefore essential to improve our understanding of the barriers that are unique to men and what programmes can do to ameliorate this gender difference.…”

“…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.…”

Antiretroviral Therapy Uptake, Attrition, Adherence and Outcomes among HIV-Infected Female Sex Workers: A Systematic Review and Meta-Analysis

“…Varied study periods, different follow-up times and different ART eligibility criteria across studies could all contribute to the variability in study estimates. Nevertheless, pooled estimates of current ART use among HIV-infected FSWs are similar to estimates of current ART use among HIV-infected women in Burkina Faso (27%) and among HIV-infected female IDUs in Canada (30%) [62], [63]. Likewise, in the one study in Rwanda that reported ART initiation among ART-eligible FSWs, the proportion of ART-eligible FSWs in HIV care initiating ART was similar to the proportion of ART-eligible individuals in the Rwandan general population initiating ART (71%) [42].…”

Parental HIV disclosure in Burkina Faso: Experiences and challenges in the era of HAART

“…Countless studies on gender and healthseeking behaviours already report the asymmetry between women and men. Regarding HIV and AIDS, solid evidence points to a gender specificity in voluntary counselling and testing (Le Coeur, Collins, Pannetier & Lelièvre 2009;Obermeyer & Osborn 2007), disclosure to partners (Ndiaye, Boileau, Zunzunegui, Koala, Aboubacrine, Niamba, et al 2008;Tijou, Querre, Brou, Leroy, Desclaux, & Desgrées-du-Loû 2009) and in access and use of HAART (Bila & Egrot 2009 The possible transmission of HIV from mother-to-child adds to the complexity of the gender dimension. Indeed, some children may be infected by HIV themselves.…”