Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
BMC Public Health. 2021 Dec 11;21(1):2247. doi: 10.1186/s12889-021-12314-2.
Stigma and masculinity represent persistent barriers in delivering successful HIV interventions to men. Our study examined community perceptions of HIV and anti-retroviral therapy (ART) and their implications for men on ART across the life course in Blantyre, Malawi.
Our qualitative study is based on 72 face-to-face semi-structured interviews. Participants were selected purposively and included men on ART (with suppressed and unsuppressed viral loads), adult male community members irrespective of HIV status and other HIV stakeholders such as health personnel and program implementers. Interviews were conducted in Chichewa and English, transcribed verbatim and analyzed thematically in NVivo 12. We applied the socio-ecological model as our theoretical framework as well as a "life-course" perspective.
Our findings highlight lingering negative perceptions towards ART in general and towards PLHIV irrespective of viral load suppression. With intersecting notions of masculinity and stigma, men's descriptions of anticipated stigma in their relationships and when visiting health facilities dominated. Stigma was experienced at the personal, interpersonal, facility and community level. Yet, men living with HIV were perceived differently throughout the life-course, with young sexually active men seen as the most stigmatized group and older men seen as drawing resilience from a greater range of masculine norms. Some men of all ages displayed "transformative" masculinities independent of stigma and community expectations.
We propose the "life-course" as a useful concept for studies on masculinity, HIV and stigma. Considering gendered constructions of "respectable" midlife-older age vis-à-vis younger age, and how they influence stigma as well as uptake and adherence to ART might lead to more targeted services for men that build on "transformative masculinities".
污名化和男性气质是向男性提供成功的 HIV 干预措施的持久障碍。我们的研究考察了马拉维布兰太尔社区对 HIV 和抗逆转录病毒疗法 (ART) 的看法，以及这些看法对整个生命周期中接受 ART 的男性的影响。
我们的定性研究基于 72 次面对面半结构化访谈。参与者是有目的地选择的，包括接受 ART 的男性（病毒载量有抑制和无抑制）、无论 HIV 状况如何的成年男性社区成员以及其他 HIV 利益相关者，如卫生人员和方案执行者。访谈以奇契瓦语和英语进行，逐字记录，并在 NVivo 12 中进行主题分析。我们将社会生态模型作为我们的理论框架，并采用“生命历程”视角。
我们的研究结果突出了人们对 ART 的普遍负面看法，以及对无论病毒载量是否抑制的 PLHIV 的负面看法。由于男性气质和污名化的交叉概念，男性在描述他们在人际关系中和访问卫生机构时可能面临的预期污名时占据主导地位。污名化发生在个人、人际、机构和社区层面。然而，艾滋病毒感染者在整个生命周期中受到不同的对待，年轻活跃的性活跃男性被视为最受污名化的群体，而年长男性则从更广泛的男性规范中获得韧性。一些处于不同年龄段的男性都表现出了独立于污名和社区期望的“变革性”男性气质。
我们提出“生命历程”是研究男性气质、HIV 和污名化的一个有用概念。考虑到中老年人相对于年轻人的“有尊严”的性别建构，以及它们如何影响污名化以及对 ART 的接受和坚持，这可能会为那些建立在“变革性男性气质”基础上的男性提供更有针对性的服务。
