I read an article recently on The Conversation website written by researchers who have a project in Malawi and have published on the feminisation of HIV testing and treatment. It starts off talking about the common site in Malawi of sick men being ‘wheelbarrowed’ into hospital and then sent to the “death ward” to die while women regularly walk to the clinic, have dedicated services for their children and during pregnancy.
They quote an interesting statistical comparison: although more women than men are infected with HIV, men account for more HIV related deaths—so, somewhere there is something that is missing.
A lot of HIV health programmes focus on women—for a lot of good reasons. Women tend to manage the burden of healthcare for the entire family. Women are more vulnerable to HIV infection biologically, culturally, socially and economically; men have the sexual power and privilege over women.
A logical conclusion accounting for the higher number of male deaths is that men simply refuse to get tested and get appropriate care. Sickness can be perceived as a sign of weakness, so men choose to hide their illness for as long as they can. There is some evidence that men also hide their illness to avoid their sexual behaviours becoming known and questioned. So, is the stubbornness of men to blame?
Somewhat, men are less likely to seek health care; this is linked to perceptions of masculinity which is associated with the same drivers for multiple partners, violence against women, substance abuse and homophobia.
The authors found in their research that how HIV testing and treatment is offered affects men’s engagement with services. Specifically, they found that in southern Malawi, there are limited options for testing and treatment.
Most public clinics where testing is available are geared to women, so they tend to be crowded by women. Men then have the perception that these are places for women and avoid them. Private clinics are an option but this involves paying for the service which few can afford.
There are examples of HIV prevention programmes that have focussed on men and these have had some success. There is some evidence that programmes targeted at the workplace that integrate prevention, testing and treatment may be successful in engaging men.
They suggest ideas like male specific outreach or male specific times at clinics. Whatever the case, funders, government and care providers need to engage men in testing and treatment services to ensure they live full, healthy lives. n