Masculinity, resources, and retention in care: South African men's behaviors and experiences while engaged in TB care and treatment

Daniels, Joseph; Medina‐Marino, Andrew; Glockner, Katherine; Grew, Emily; Ngcelwane, Nondumiso; Kipp, Aaron M.

doi:10.1016/j.socscimed.2020.113639

Cited by 23 publications

(23 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Families also suffered socially, being isolated or shunned by friends and the wider family. In many cases, it was family members who ensured adherence to medication, and social and family support for patients has been previously shown as a key factor in therapy adherence [41,53,54]. Despite this, the impact of the TB diagnosis on the family and how family members can best be supported has been rarely investigated [47], and we identify this as an important area for further research.…”

Section: Discussionmentioning

confidence: 94%

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

et al. 2022

View full text Add to dashboard Cite

Background Although tuberculosis (TB) is a curable disease, treatment is complex and prolonged, requiring considerable commitment from patients. This study aimed to understand the common perspectives of TB patients across Brazil, Russia, India, China, and South Africa throughout their disease journey, including the emotional, psychological, and practical challenges that patients and their families face. Methods This qualitative market research study was conducted between July 2020 and February 2021. Eight TB patients from each country (n = 40) completed health questionnaires, video/telephone interviews, and diaries regarding their experiences of TB. Additionally, 52 household members were interviewed. Patients at different stages of their TB treatment journey, from a range of socioeconomic groups, with or without TB risk factors were sought. Anonymized data underwent triangulation and thematic analysis by iterative coding of statements. Results The sample included 23 men and 17 women aged 13–60 years old, with risk factors for TB reported by 23/40 patients. Although patients were from different countries and cultural backgrounds, experiencing diverse health system contexts, five themes emerged as common across the sample. 1) Economic hardship from loss of income and medical/travel expenses. 2) Widespread stigma, delaying presentation and deeply affecting patients’ emotional wellbeing. 3) TB and HIV co-infection was particularly challenging, but increased TB awareness and accelerated diagnosis. 4) Disruption to family life strained relationships and increased patients’ feelings of isolation and loneliness. 5) The COVID-19 pandemic made it easier for TB patients to keep their condition private, but disrupted access to services. Conclusions Despite disparate cultural, socio-economic, and systemic contexts across countries, TB patients experience common challenges. A robust examination of the needs of individual patients and their families is required to improve the patient experience, encourage adherence, and promote cure, given the limitations of current treatment.

show abstract

Section: Discussionmentioning

confidence: 94%

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

et al. 2022

View full text Add to dashboard Cite

show abstract

“…However, given the lack of baseline research to understand men's preferences for PrEP promotion and access, their uptake of PrEP services, and HIV prevention services in general, will continue to be limited (18,21,22). Masculinity norms and social expectations impact men's health behaviors, and have been linked to men's late clinic presentation when ill and limited use of preventative health services, including HIV prevention and PrEP initiation (23)(24)(25)(26). Structural barriers that further impede men's access to health and HIV services include limited resources (unemployment and poverty), the lack of male-friendly healthcare (unfriendly staff; the perception of clinics being female/ maternal-child spaces; female dominant healthcare staff), and inconvenient clinic operating hours (21,27,28).…”

Section: Introductionmentioning

confidence: 99%

“…These studies have emphasized differentiation of SRHS for men in limited resources settings in order to increase uptake of HIV services. Lastly, leveraging aspects of masculine identity, such fatherhood, may further motivate and increase men's engagement with HIV prevention services (24).…”

Section: Introductionmentioning

confidence: 99%

What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo City Municipality, South Africa

Smith

Daniels

Bekker

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background Compared to women, South African men are less likely to know their HIV status (78% vs 89%), have suppressed viral loads (82% vs 90%), or access HIV prevention services. To achieve epidemic control where heterosexual sexual behavior drives transmission, interventions to improve the uptake of HIV testing services (HTS) and prevention services must also target cis-gendered, heterosexual men. There is limited understanding of these men’s needs and wants with regards to accessing pre-exposure prophylaxis (PrEP). Methods Adult men (≥ 18 years) from a peri-urban community in Buffalo City Municipality were offered community-based HTS. Those who received a negative HIV test result were offered community-based, same-day oral PrEP initiation. Men initiating PrEP were invited to participate in a study exploring men’s HIV prevention needs and reasons for initiating PrEP. An in-depth interview guide, developed using the Network-Individual-Resources model (NIRM), explored men’s perceived HIV acquisition risk, prevention needs, and preferences for PrEP initiation. Interviews were conducted by a trained interviewer in isiXhosa or English, audio-recorded and transcribed. Thematic analysis was used, guided by the NIRM to generate findings. Results Twenty-two men (age range 18–57 years) initiated PrEP and consented to study participation. Men reported elevated HIV acquisition risk associated with alcohol use and condom-less sex with multiple partners as facilitators driving PrEP initiation. They anticipated social support from family members, their main sexual partner and close friends for their PrEP use, and discussed other men as important sources of support for PrEP initiation. Nearly all men expressed positive views of people using PrEP. Participants believed HIV testing would be a barrier for men interested in accessing PrEP. Men recommended that access to PrEP be convenient, rapid, and community-based (i.e., not clinic-based). Discussion Self-perceived risk for HIV acquisition was a major facilitator for men’s PrEP initiation. Although men expressed positive perceptions of PrEP users, they noted that HIV testing may be a barrier to PrEP initiation. Finally, men recommended convenient access points to facilitate PrEP initiation and sustained use. Gender-responsive interventions tailored to men’s needs, wants, and voices will facilitate their uptake of HIV prevention services, and help to end the HIV epidemic.

show abstract

“…These findings contradict common preconceptions that men are difficult clients who do not want to be reached, or who want a “hands‐off approach” to HIV treatment [ 34 ]. Such stereotypes harm men by justifying little to no tailored services for men as clients, resulting in insufficient support for men to engage in care [ 35 , 36 , 37 , 38 ]. On the other hand, there is also extensive literature showing that men (and women) do not want to be “forced” or coerced into using HIV services––HCWs must engage men as equals and agents of their own healthcare [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study

Hubbard

Mphande²,

Phiri³

et al. 2022

J Int AIDS Soc.

Self Cite

View full text Add to dashboard Cite

Introduction: HIV self-testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, and what ART-related interventions men desire. Methods: We conducted semi-structured in-depth interviews with cisgender men (≥15 years) in Malawi who tested HIV positive using HIVST between 2018 and 2020, as well as interviews with their female partners (≥15 years) who distributed the HIVST kits. Medical records from seven facilities were used to identify respondents. We included men who received HIVST from a health facility (primary distribution) and from sexual partners (secondary distribution). Interview guides focused on unique barriers to ART initiation following HIVST and desired interventions to improve linkage and initiation. Interviews were audio recorded, translated and transcribed to English, and analysed using constant comparison methods in Atlas.ti v.8.4. Themes were compared by HIVST distribution strategy. Data were collected between 2019 and 2020. Results: Twenty-seven respondents were interviewed: eight male/female dyads (16 respondents), eight men without a female partner and three women who represented men who did not participate in the study. Among the 19 men represented (16 men interviewed in person, three represented by secondary report from female partners), seven received HIVST through primary distribution, 12 through secondary distribution. Six men never initiated ART (all secondary HIVST distribution). Barriers to ART initiation centred on the absence of healthcare workers at the time of diagnosis and included lack of external motivation for linkage to care (men had to motivate themselves) and lack of counselling before and after testing (leaving ART-related fears and misconceptions unaddressed)--the latter was especially true for secondary HIVST distribution. Desired interventions were similar across distribution strategies and included ongoing peer mentorship for normalizing treatment adherence, counselling messages tailored to men, outside-facility services for convenience and privacy, and facility navigation to help men understand how to navigate ART clinics. Conclusions: Male HIVST users face unique challenges to ART initiation, especially those receiving HIVST through secondary distribution. Male-tailored interventions are desired by men and may help overcome barriers to care.

show abstract

Masculinity, resources, and retention in care: South African men's behaviors and experiences while engaged in TB care and treatment

Cited by 23 publications

References 33 publications

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo City Municipality, South Africa

Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study

Contact Info

Product

Resources

About