Gender Norms and HIV Testing/Treatment Uptake: Evidence from a Large Population-Based Sample in South Africa

Abstract

How does the endorsement of different dimensions of gender norms by men and/or women influence their use of HIV testing and antiretroviral treatment? This question was examined using data from a 2014 population-based survey of 1053 women and 1004 men, ages 18–49, in rural South Africa. We used a global measure for views toward gender norms (the GEM Scale), plus four subsets of scale items (all reliabilities ≥ 0.7). In multivariate analyses using the global measure, endorsement of inequitable gender norms was associated with more testing (AOR 2.47, p < 0.01) and less treatment use (AOR 0.15, p < 0.01) among women but not men. When examining specific subsets of inequitable norms (e.g., endorsing men as the primary decision-maker), decreased odds of treatment use was found for men as well (AOR 0.18, p < 0.01). Careful attention to the role specific gender norms play in HIV service uptake can yield useful programmatic recommendations.

Gaining traction: Promising shifts in gender norms and intimate partner violence in the context of a community-based HIV prevention trial in South Africa

“…The scale was scored by taking the mean of non-missing items, and re-scaled for interpretability, with scores ranging from 0 to 10 and higher scores representing endorsement of more equitable gender norms. The composite scale as well as each sub-dimension had good internal reliability, with Ordinal Theta (similar to Cronbach's alpha [32]) of 0.88 for the composite score and �0.70 for each sub-dimension [18].…”

“…A ‘composite’ variable was created that included all items (23 items). Variables for four sub-dimensions conceptualized as being critical to uptake of HIV testing and treatment [ 18 ] were also constructed: norms condoning men’s violence and control over women (7 items; e.g., “A man is expected to discipline his woman”); norms around men as decision-maker in a couple (6 items, e.g., “A man should have the final word about decisions in his home”); norms around men’s toughness and avoidance of help-seeking (5 items, e.g., “For men, getting sick is a sign of weakness”); and norms around women’s primary responsibility as family caretaker (5 items, e.g., “A woman’s role is taking care of her home and family”).…”

“…Systematic reviews of these evaluations have concluded that the interventions hold promise in shifting gender norms and, in many cases behaviors, among men and women in the areas of IPV and HIV prevention as well as reproductive and child health [11][12][13]. Recently, interventions are also seeking to shift gender attitudes and norms as one pathway to reach the UNAIDS goals for HIV testing, treatment and viral suppression [14][15][16][17][18].…”

The HIV Epidemic in Colombia: Spatial and Temporal Trends Analysis

“…[28] In South Africa, ART coverage was lower among women who were in abusive relationships. [29] In the United States, women suffering from poverty stigma had lower ART adherence and lower frequency of HIV care visits than in others. [30] The high incidence of HIV/AIDS and AIDS mortality in the Caribbean and Andean regions is attributed to the status of these regions as main tourist destinations in Colombia.…”

Implementation Science: Helping to Accelerate Progress Toward Achieving the 90–90–90 Goal

“…In this era of effective HIV treatment, with PLHIV living longer and healthier lives, methods to measure resilience in the context of living with HIV is critical, as resilience has been shown to be associated with important HIV-related treatment outcomes. Gottert et al developed and validated a PLHIV resilience scale [23]. Previous resilience scales have not been specific to living with HIV.…”