Men "missing" from population-based HIV testing: insights from qualitative research

被引:133
作者
Camlin, Carol S. [1 ,2 ]
Ssemmondo, Emmanuel [3 ]
Chamie, Gabriel [4 ]
El Ayadi, Alison M. [1 ]
Kwarisiima, Dalsone [5 ]
Sang, Norton [6 ]
Kabami, Jane [3 ]
Charlebois, Edwin [2 ]
Petersen, Maya [7 ,8 ]
Clark, Tamara D. [4 ]
Bukusi, Elizabeth A. [6 ]
Cohen, Craig R. [1 ]
Kamya, Moses R. [3 ,9 ]
Havlir, Diane [4 ]
机构
[1] Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, Bixby Ctr Global Reprod Hlth, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Ctr AIDS Prevent Studies, San Francisco, CA 94143 USA
[3] Infect Dis Res Collaborat, Kampala, Uganda
[4] Univ Calif San Francisco, Dept HIV Infect Dis & Global Med, San Francisco, CA 94143 USA
[5] Makerere Univ Joint AIDS Program, Kampala, Uganda
[6] Kenya Govt Med Res Ctr, Ctr Microbiol Res, Nairobi, Kenya
[7] Univ Calif Berkeley, Sch Publ Hlth, Div Biostat, Berkeley, CA 94720 USA
[8] Univ Calif Berkeley, Sch Publ Hlth, Div Epidemiol, Berkeley, CA 94720 USA
[9] Makerere Univ Coll Hlth Sci, Kampala, Uganda
来源
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV | 2016年 / 28卷
关键词
HIV testing; antiretroviral therapy; ART; gender; men; sub-Saharan Africa; ANTIRETROVIRAL TREATMENT; GENDER; AFRICA; INTERVENTIONS; PROGRAMS; OUTCOMES; THERAPY;
D O I
10.1080/09540121.2016.1164806
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Men's uptake of HIV testing is critical to the success of test and treat strategies in generalized epidemics. This study sought to identify cultural factors and community processes that influence men's HIV testing uptake in the baseline year of an ongoing test-and-treat trial among 334,479 persons in eastern Africa (SEARCH, NCT#01864603). Data were collected using participant observation at mobile community health campaigns (CHCs) (n=28); focus group discussions (n=8 groups) with CHC participants; and in-depth interviews with care providers (n=50), leaders (n=32), and members (n=112) of eight communities in Kenya and Uganda. An 8-person research team defined analytical codes and iteratively refined them during data collection using grounded theoretical approaches, and textual data were coded using Atlas.ti software. Structural and cultural barriers, including men's mobility and gender norms valorizing risk-taking and discouraging health-seeking behavior, were observed, and contributed to men's lower participation in HIV testing relative to women. Men's labor opportunities often require extended absences from households: during planting season, men guarded fields from monkeys from dawn until nightfall; lake fishermen traveled long distances and circulated between beaches. Men often tested by proxy, believing their wives' HIV test results to be their status. Debates about HIV risks were vigorous, with many men questioning traditional masculine gender norms that enhanced risks. The promise of antiretroviral therapy (ART) to prolong health was a motivating factor for many men to participate in testing. Flexibility in operating hours of HIV testing including late evening and weekend times along with multiple convenient locations that moved were cited as facilitating factors enhancing male participating in HIV testing. Mobile testing reduced but did not eliminate barriers to men's participation in a large-scale test & treat effort. However, transformations in gender norms related to HIV testing and care-seeking are underway in eastern Africa and should be supported.
引用
收藏
页码:67 / 73
页数:7
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