Despite government and civil society efforts to fight the spread of HIV, one of the main challenges that remain is men’s unwillingness to get tested and know their status.  In general, men reluctant to consult doctors. At the root of their aversion to seeking medical help — including testing for HIV — is their perceptions about manhood and themselves. 

The Human Sciences Research Council (HSRC) is currently conducting a study in four communities in Pietermaritzburg including Mpumelelo, an RDP community in the outskirts of the city. The study aims to “diagnose South African men and bring them into care”. Although the study is centred around men, getting them to test is still a problem.

The reason? Men don’t want to be seen as weak.

According to a research paper by a World Health Organization (WHO)  titled “The Men’s Health gap: men must be included in the global health equity agenda”, in most parts of the world, health outcomes among boys and men continue to be substantially worse than among girls and women. The research argues that men are more likely to die than women because of risky behaviours, such as alcohol abuse, which could be linked to masculinity. Even in cases when men consult doctors, they are likely not to report on the symptoms of disease or illnesses. 

HSRC principal investigator Professor Heidi van Rooyen says they have embarked on the research to try and understand reasons why men aren’t willing to get tested compared to their female counterparts.

“We already have a hypothesis to prove… men are generally not always available and sometimes impatient to wait in long queues. There’s still a huge stigma around HIV so we have tried to destigmatise our HIV testing services by offering other services, like TB screening, diabetes and on top of that we are offering an incentive to every man that get tested for everything,” she says. 

Deadly Masculinity

 Initiatives such as the Desmond Tutu Foundation’s Amajita Truck have been started to target and encourage men to test for HIV. The truck travels through townships in the Western Cape, offering men a free haircut with their HIV screening.

According to the latest HIV household survey, 1.2 million men between the ages of 15 and 49 years old are living with HIV in South Africa and only half of them are virally suppressed, meaning, the HIV in their blood is so low it’s undetectable which proves that ARVs are working.

Even with these strategies in place, it’s still difficult to get men older than 35 years to test for HIV in Mpumelelo.

According to HSRC community-based mobiliser Moeketsi Ramarobi, men see queueing at a clinic as not masculine. “Going to the clinic or any health institution symbolises weakness for men, who in general don’t want to be seen weak,” he explains.

It’s not just about manhood

 While the perception of masculinity and a fear of a positive result in an HIV test are the obvious culprits, these are not the only factors fuelling men’s reluctance to test for HIV or seek health services in general.

According to a 2015 report by Sonke Gender Justice, health policies and services don’t adequately integrate men’s health needs. Some of the sexual reproductive health (SRH) policies in countries such as Zambia and Zimbabwe don’t include men’s health. Instead, the policies cover SRH within the health of “women and children” or “maternal health”. This kind of categorisation of SRH as women-only services “limits spaces for men and perpetuates the expectation that sexual and reproductive health is the sole responsibility of women.

Men are not given enough priority in clinics and health programmes, says 37-year-old Thabani Makhathini who is a participant in the HSRC study.

 “We’re often labelled as oppressors, self-centred and disinterested instead of patients that need attention like any other patient. There is so much attention put on women they even have their own public clinics which only take women yet as men we need to pay private clinics like Men’s Clinic to have our health prioritised,” Makhathini adds.

The ripple effects

Heterosexual men are often the decision-makers over when and how sex happens. Their sexual partners — heterosexual women — often struggle to convince them to use condoms and this can be exacerbated in romantic relationships. According to a  2017 study published in the Global Health Action journal, although women reported negotiating safe sex in their relationships, they feared the possible consequences of insisting on using condoms with their partners.

This poses a threat not only to men but their partner’s life as well. Women living with HIV who are on antiretroviral (ARV) treatment in South Africa are two times more than men taking ARVs.

Some men have reported discontinuing treatment because clinics being far away, or they see an improvement in their health and see no need to continue.

“So, it is not that all men don’t want to get tested but there is an element of miseducation as well and finding solutions to keep men on ARVs,” says Sanele Funeka, project co-ordinator of the study.

In order to get men to test the HSRC has employed males who are aware of male-related health issues in order to make the programme much more interactive. The organisation also uses flexible hours to accommodate men that are normally busy during working hours or are only available during weekends. Another intervention involves outreach programmes aimed at men in taverns and bars.

Funeka says: “The aim of these interventions is to ensure we accommodate all types of men and we also address the differences between men and women.” – Health-e News