Negotiating therapeutic citizenship and notions of masculinity in a South African village

Abstract

The article explores the idea of therapeutic citizenship in relation to the experiences of men who attend support groups for people living with HIV or AIDS (PLHIV). At a rural South African health facility offering free antiretroviral (ARV) medicines, support groups aim to empower HIV-positive clients through knowledge and skills that enable them to adhere to their ARV regimen. Members are exhorted to abandon their 'traditional' health and gender beliefs in favour of a biomedical understanding and approach to health; to embrace participation in a support group for PLHIV; and to actively challenge HIV stigma through the public disclosure of their HIV-test result. Fourteen months of ethnographic fieldwork conducted in Bushbuckridge, Mpumalanga Province, South Africa, investigated how men negotiated these efforts - normally characterised in the academic literature as 'therapeutic citizenship' - in relation to men's socio-cultural definitions of masculinity. The findings reveal that most of the men gained the knowledge and skills necessary to adhere to treatment. Although they generally behaved in a disciplined way, they remained doubtful about their commitment to the particular kind of 'HIV identity' that a support group conferred on them. Men who embrace this identity must abandon their previous masculine lifestyles and conform to the support group's messages concerning what it means to be a 'responsible' HIV patient. The research documents some of the challenges men experience in negotiating these conflicting demands. The discussion draws on personal accounts by the participants to illustrate the ambivalence of men towards their 'HIV identity' and to belonging to a support group.

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

“…The majority of the studies were conducted in the USA (n = 13 studies) 101,110,113,114,123,[128][129][130]136,208,213,217 and the UK (n = 11), 99,100,102,108,112,115,116,128,209,214,216 with the remainder in Australia (n = 5), 109,111,118,210,212 Canada (n = 5) 107,117,120,125,211 and the following: Denmark, 207 France, 218 South Africa 215 and Sweden…”

“…The majority of the 38 included studies had male-only samples (n = 26), 99,101,[108][109][110][111]113,116,117,119,121,123,125,127,130,134,135,[207][208][209][210][211][213][214][215]217 but 12 studies included mixed-sex samples. 100,102,103,107,113,115,122,128,136,212,216,218 Two of the mixed-sex studies reported separate male-only and female-only data.…”

“…[99][100][101][102][103][134][135][136][207][208][209][210][211][212][213][214][215][216][217][218] Three studies were reported across multiple papers that were individually eligible for inclusion. [118][119][120][121][124][125][126] An additional two papers that did not meet the eligibility criteria as they had female-only samples are included in the synthesis because they presented data about women that formed the basis of gender comparisons made by the authors of included studies reporting findings from male participants.…”

“…The most common disease area was cancer (n = 22), [99][100][101]107,109,111,116,122,125,128,130,136,[207][208][209][210][212][213][214]216,217 followed by HIV/acquired immunodeficiency syndrome (AIDS) (n = 7), 108,110,117,123,127,129,215 cardiac (n = 4: coronary artery disease n = 1, 134 heart failure n = 1, 135 myocardial infarction n = 2 102,211 ), mental health (n = 2: depression n = 1, 115 depression/anxiety n = 1 112 ), arthritis (n = 1), 118 type 2 diabetes (n = 1) 218 and multiple sclerosis (n = 1). 103 The majority of cancer studies focused on male sex-specific cancers (prostate n = 14, 100,101,109,111,121,125,128,136,[208][209][210]212,213 testicular n = 2 …”

Secrecy as embodied practice: beyond the confessional imperative

“…As the path of HIV treatment requires abstaining from drinking and unprotected sex, men delay visiting the clinic until they are very sick, literally unable to get out of bed. At the clinic, they must disclose to other HIV-positive individuals in support groups (Mfecane 2011). In his contribution to this special issue, Mfecane shows how his informants disclose outside of such support groups only when their medication had produced physical improvement, despite the fact that, paradoxically, they now have a greater ability to keep their HIV status concealed.…”