"Deadly", "fierce", "shameful": Notions of Antiretroviral Therapy, Stigma and Masculinities Intersecting Men's Life-course in Blantyre, Malawi

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2021 Dec 11

PMID 34893060

Citations 5

Authors

Astrid Berner-Rodoreda

Esther Ngwira

Yussif Alhassan

Boniface Chione

Rosalia Dambe

Till Barnighausen

Sam Phiri

Miriam Taegtmeyer

Florian Neuhann

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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".

Citing Articles

Intersectional HIV stigma in Sub-Saharan Africa, Latin America and the Caribbean: Insights and pathways forward - A scoping review.

Malika N, Bogart L, Matovu J, Phaladze N, Mubiru K, Leon Rhandomy M PLOS Glob Public Health. 2025; 5(2):e0004240.

PMID: 39928642 PMC: 11809812. DOI: 10.1371/journal.pgph.0004240.

Stigma and discrimination faced by adolescents living with HIV and experiencing depression in Malawi.

Faidas M, Stockton M, Mphonda S, Sansbury G, Hedrick H, Devadas J BMC Glob Public Health. 2024; 2(1):39.

PMID: 39681956 PMC: 11622908. DOI: 10.1186/s44263-024-00072-3.

Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis.

Janek S, Hatoum S, Ledbetter L, Relf M AIDS Behav. 2024; 28(8):2500-2533.

PMID: 38777917 PMC: 11423389. DOI: 10.1007/s10461-024-04329-8.

Lived experiences of people living with HIV-A qualitative exploration on the manifestation, drivers, and effects of internalized HIV stigma within the Malawian context.

Kumwenda M, Kamkwamba D, Chirwa M, Kasoka K, Taegtmeyer M, Oraro-Lawrence T PLoS One. 2023; 18(4):e0284195.

PMID: 37104484 PMC: 10138249. DOI: 10.1371/journal.pone.0284195.

Cultural Repertoires and Situated Selections as an Alternative Framework to Hegemonic Masculinities: Findings From Eswatini.

Berner-Rodoreda A, Vandormael A, Barnighausen K, Mavuso M, Dlamini P, Matse S Am J Mens Health. 2023; 17(1):15579883231152110.

PMID: 36823951 PMC: 9969463. DOI: 10.1177/15579883231152110.

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