Mburu Gitau, Ram Mala, Siu Godfrey, Bitira David, Skovdal Morten, Holland Paula
International HIV/AIDS Alliance, 91-101 Davigdor Road, Hove BN3 1RE, UK.
BMC Public Health. 2014 Oct 11;14:1061. doi: 10.1186/1471-2458-14-1061.
Stigma is a determinant of social and health inequalities. In addition, some notions of masculinity can disadvantage men in terms of health outcomes. However, few studies have explored the extent to which these two axes of social inequality intersect to influence men's health outcomes. This paper investigates the intersection of HIV stigma and masculinity, and its perceived impact on men's participation in and utilisation of HIV services in Uganda.
Interviews and focus group discussions were conducted in Mbale and Jinja districts of Uganda between June and October 2010. Participants were men and women living with HIV (n = 40), their family members (n = 10) and health providers (n = 15). Inductive analysis was used to identify mechanisms through which stigma and masculinity were linked.
Our findings showed that HIV stigma and masculinity did not exist as isolated variables, but as intersecting phenomena that influenced men's participation in HIV services. Specifically, HIV stigma threatened masculine notions of respectability, independence and emotional control, while it amplified men's risk-taking. As a result, the intersection of masculinity and HIV stigma prevented some men from i) seeking health care and accepting a 'sick role'; ii) fulfilling their economic family responsibilities; iii) safeguarding their reputation and respectability; iv) disclosing their HIV status; and v) participating in peer support groups. Participation in some peer support activities was considered a female trait and it also exacerbated HIV stigma as it implicitly singled out those with HIV. In contrast, inclusion of income-generating activities in peer support groups encouraged men's involvement as it enabled them to provide for their families, cushioned them from HIV stigma, and in the process, provided them with an opportunity to redeem their reputation and respectability.
To improve men's involvement in HIV services, the intersection between HIV stigma and masculinity should be considered. In particular, better integration of and linkage between gender transformative interventions that support men to reconstruct their male identities and reject signifiers of masculinity that prevent their access to HIV services, and stigma-reduction interventions that target social and structural drivers of stigma is required within HIV programmes.
污名是社会和健康不平等的一个决定因素。此外，一些男性气质观念在健康结果方面可能对男性不利。然而，很少有研究探讨这两个社会不平等轴相交在多大程度上影响男性的健康结果。本文调查了乌干达艾滋病毒污名与男性气质的交叉点，以及其对男性参与和利用艾滋病毒服务的感知影响。
2010年6月至10月期间，在乌干达的姆巴莱和金贾地区进行了访谈和焦点小组讨论。参与者包括艾滋病毒感染者（男、女，共40人）、他们的家庭成员（10人）和医疗服务提供者（15人）。采用归纳分析法确定污名与男性气质相联系的机制。
我们的研究结果表明，艾滋病毒污名和男性气质并非孤立存在的变量，而是作为相互交叉的现象影响男性参与艾滋病毒服务。具体而言，艾滋病毒污名威胁到男性关于体面、独立和情绪控制的观念，同时放大了男性的冒险行为。因此，男性气质与艾滋病毒污名的交叉使一些男性无法做到：一、寻求医疗保健并接受“病人角色”；二、履行其家庭经济责任；三、维护其声誉和体面；四、披露其艾滋病毒感染状况；五、参与同伴支持小组。参与一些同伴支持活动被视为女性特质，这也加剧了艾滋病毒污名，因为它含蓄地将艾滋病毒感染者挑了出来。相反，在同伴支持小组中纳入创收活动鼓励男性参与，因为这使他们能够供养家庭，使他们免受艾滋病毒污名的影响，并且在此过程中，为他们提供了一个挽回声誉和体面的机会。
为了提高男性对艾滋病毒服务的参与度，应考虑艾滋病毒污名与男性气质的交叉点。特别是，在艾滋病毒项目中，需要更好地整合和联系性别变革性干预措施与减少污名干预措施，前者支持男性重构其男性身份并摒弃阻碍他们获得艾滋病毒服务的男性气质标志，后者针对污名的社会和结构驱动因素。
