Bringing fear into focus: The intersections of HIV and masculine gender norms in Côte d’Ivoire

Autoři: Danielle Amani Naugle aff001;  Natalie Jean Tibbels aff001;  Zoé Mistrale Hendrickson aff001;  Abdul Dosso aff002;  Lynn Van Lith aff001;  Elizabeth C. Mallalieu aff001;  Anne Marie Kouadio aff003;  Walter Kra aff004;  Diarra Kamara aff002;  Patricia Dailly-Ajavon aff002;  Adama Cissé aff002;  Kim Seifert-Ahanda aff005;  Sereen Thaddeus aff005;  Stella Babalola aff001;  Christopher J. Hoffmann aff006
Působiště autorů: Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff001;  Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire aff002;  Sociology Department, Félix Houphouët-Boigny University in Cocody, Abidjan, Côte d’Ivoire aff003;  Sociology Department, Alassane Ouattra University, Bouaké, Côte d’Ivoire aff004;  United States Agency for International Development, Washington, DC, United States of America aff005;  School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223414


This qualitative research study explored the role of masculinity in men’s engagement in the HIV care continuum in Côte d’Ivoire. The researchers conducted 73 in-depth interviews and 28 focus group discussions with 227 Ivoirian men between November and December 2016 across three urban sites. Participants in the study expressed that fear was the primary barrier to HIV testing and treatment. These men described five value domains–health, sexuality, work and financial success, family, and social status. Men saw HIV as a direct threat to their agency and strength with respect to each of these value domains, thus shedding light on their reluctance to discover their HIV status through HIV testing. With this data, the researchers created the Masculine Values Framework, a descriptive framework of masculine values that can be applied to better understand the behavior men exhibit in Côte d’Ivoire in the face of HIV. The Masculine Values Framework offers practical guidance for developing gender-sensitive HIV-focused social and behavior change programming in Côte d’Ivoire and similar contexts to reach the UNAIDS 90-90-90 targets.

Klíčová slova:

Antiretroviral therapy – Behavior – Fear – HIV – HIV diagnosis and management – Human families – Social status – Sense of agency


1. Joint United Nations Programme on HIV/AIDS. The Gap Report. Geneva: UNAIDS; 2014.

2. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016; 375(9): p. 830–839. doi: 10.1056/NEJMoa1600693 27424812

3. Joint United Nations Programme on HIV/AIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.

4. Population-based HIV Impact Assessment (PHIA) Project. Côte d'Ivoire Summary Sheet 2017–2018. [Online]. July, 2018 [cited 2019 July 20]. Available from:

5. Bila B, Egrot M. Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in Burkina Faso. Soc Sci Med. 2009; 69(6): p. 854–861. doi: 10.1016/j.socscimed.2009.05.035 19539415

6. Camlin CS, Ssemmondo E, Chamie G, El Ayadi AM, Kwarisiima D, Sang N, et al. Men "missing" from population-based HIV testing: insights from qualitative research. AIDS Care. 2016; 28(3): p. 67–73.

7. Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, et al. Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study. PLoS Med. 2012; 9(9): p. e1001304. doi: 10.1371/journal.pmed.1001304 22973181

8. Dovel K, Yeatman S, Watkins S, Poulin M. Men's heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies. AIDS (London, England). 2015; 29(10): p. 1123.

9. Druyts E, Dybul M, Kanters S, Nachega J, Birungi J, Ford N, et al. Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa: a systematic review and meta-analysis. AIDS. 2013; 27(3): p. 417–425. doi: 10.1097/QAD.0b013e328359b89b 22948271

10. Gari S, Martin-Hilber A, Malungo JRS, Musheke M, Merten S. Sex differentials in the uptake of antiretroviral treatment in Zambia. AIDS Care. 2014; 26(10): p. 1258–1262. doi: 10.1080/09540121.2014.897911 24666201

11. Govindasamy D, van Schaik N, Kranzer K, Wood R, Mathews C, Bekker LG. Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata. J Acquir Immune Defic Syndr (1999). 2011; 58(3): p. 344.

12. Johnson LF. Access to antiretroviral treatment in South Africa, 2004–2011. South Afr J HIV Med. 2012; 13(1).

13. McGrath N, Eaton JW, Newell ML, Hosegood V. Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa. Lancet HIV. 2015; 2(6): p. e252–e259. doi: 10.1016/S2352-3018(15)00045-4 26280016

14. Parrott FR, Mwafulirwa C, Ngwira B, Nkhwazi S, Floyd S, Houben RM, et al. Combining qualitative and quantitative evidence to determine factors leading to late presentation for antiretroviral therapy in Malawi. PLoS One. 2011; 6(11): p. e27917. doi: 10.1371/journal.pone.0027917 22114727

15. Shand T, Thomson-de Boor H, van den Berg W, Peacock D, Pascoe L. The HIV Blind Spot: Men and HIV Testing, Treatment and Care in Sub-Saharan Africa. IDS Bull. 2014; 45(1): p. 53–60.

16. Campbell C. Migrancy, masculine identities and AIDS: the psychosocial context of HIV transmission on the South African gold mines. Soc Sci Med. 1997; 45(2): p. 273–281. doi: 10.1016/s0277-9536(96)00343-7 9225414

17. Connell RW. Gender and power: Society, the person and sexual politics: John Wiley & Sons; 2014.

18. Skovdal M, Campbell C, Madanhire C, Mupambireyi Z, Nyamukapa C, Gregson S. Masculinity as a barrier to men's use of HIV services in Zimbabwe. Global Health. 2011; 7(1): p. 13.

19. Gottert A, Barrington C, McNaughton-Reyes HL, Maman S, MacPhail C, Lippman SA, et al. Measuring men's gender norms and gender role conflict/stress in a high hiv-prevalence South African setting. AIDS Behav. 2016; 20(8): p. 1785–1795. doi: 10.1007/s10461-016-1374-1 27209467

20. Gottert A, Barrington C, McNaughton-Reyes HL, Maman S, MacPhail C, Lippman SA, et al. Gender norms, gender role conflict/stress and HIV risk behaviors among men in Mpumalanga, South Africa. AIDS Behav. 2018; 22(6): p. 1858–1869. doi: 10.1007/s10461-017-1706-9 28161801

21. Connell RW, Messerschmidt JW. Hegemonic masculinity: Rethinking the concept. Gend Soc. 2005; 19(6): p. 829–859.

22. Kaufman MR, Shefer T, Crawford M, Simbayi LC, Kalichman SC. Gender attitudes, sexual power, HIV risk: a model for understanding HIV risk behavior of South African men. AIDS Care. 2008; 20(4): p. 434–441. doi: 10.1080/09540120701867057 18449820

23. Fleming PJ, DiClemente RJ, Barrington C. Masculinity and HIV: Dimensions of masculine norms that contribute to men's HIV-related sexual behaviors. AIDS Behav. 2016; 20(4): p. 788–798. doi: 10.1007/s10461-015-1264-y 26696261

24. Connell RW. Gender, health and theory: conceptualizing the issue, in local and world perspective. Soc Sci Med. 2012; 74(11): p. 1675–1683. doi: 10.1016/j.socscimed.2011.06.006 21764489

25. Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005; 49(6): p. 616–623. doi: 10.1111/j.1365-2648.2004.03331.x 15737222

26. Hossain M, Zimmerman C, Kiss L, Abramsky T, Kone D, Bakayoko-Topolska M, et al. Working with men to prevent intimate partner violence in a conflict-affected setting: a pilot cluster randomized controlled trial in rural Côte d'Ivoire. BMC Public Health. 2014; 14(1): p. 339.

27. Jewkes R, Morrell R, Hearn J, Lundqvist E, Blackbeard D, Lindegger G, et al. Hegemonic masculinity: combining theory and practice in gender interventions. Cult Health Sex. 2015; 17(2): p. 112–127.

28. Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. Lancet. 2015; 385(9977): p. 1580–1589. doi: 10.1016/S0140-6736(14)61683-4 25467578

29. Morrell R, Jewkes R, Lindegger G, Hamlall V. Hegemonic masculinity: Reviewing the gendered analysis of men's power in South Africa. S Afr Sociol Rev. 2013; 44(1): p. 3–21.

30. Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013; 13(1): p. 220.

31. Nyamhanga TM, Muhondwa EP, Shayo R. Masculine attituds of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania. Glob Health Action. 2013; 6(1): p. 21812.

32. Okoror TA, Falade CO, Walker EM, Olorunlana A, Anaele A. Social context surrounding HIV diagnosis and construction of masculinity: a qualitative study of stigma experiences of heterosexual HIV positive men in southwest Nigeria. BMC Public Health. 2016; 16(1): p. 507.

33. Chikovore J, Gillespie N, McGrath N, Orne-Gliemann J, Zuma T, ANRS 12249 TasP Study Group. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa. AIDS Care. 2016; 28(3): p. 74–82.

34. Hanass-Hancock J, Myezwa H, Nixon SA, Gibbs A. "When I was no longer able to see and walk, that is when I was affected most": experiences of disability in people living with HIV in South Africa. Disabil Rehabil. 2015; 37(22): p. 2051–2060. doi: 10.3109/09638288.2014.993432 25524661

35. Mburu G, Ram M, Siu G, Bitira D, Skovdal M, Holland P. Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes. BMC Public Health. 2014 December; 14(1): p. 1061.

36. Sikweyiya YM, Jewkes R, Dunkle K. Impact of HIV on and the constructions of masculinities among HIV-positive men in South Africa: implications for secondary prevention programs. Glob Health Action. 2014; 7(1): p. 24631.

37. Siu GE, Wight D, Seeley JA. Masculinity, social context and HIV testing: an enthnographic study of men in Busia district, rural eastern Uganda. BMC Public Health. 2014; 14(1): p. 33.

38. Siu G, Seeley J, Wight D. Dividuality, masculine respectability and reputation: how masculinity affects men's uptake of HIV treatment in rural eastern Uganda. Soc Sci Med. 2013; 89: p. 45–52. doi: 10.1016/j.socscimed.2013.04.025 23726215

39. Mfecane S. Living with HIV as a man: Implications for masculinity. Psychology in Society. 2008; 36: p. 45–59.

40. Orr N, Hajiyiannis H, Myers L, Makhubele MB, Matekane T, Delate R, et al. Development of a National Campaign Addressing South African Men's Fears About HIV Counseling and Testing and Antiretroviral Treatment. J Acquir Immune Defic Syndr (1999). 2017; 74(Suppl 1): p. S69.

41. Siu G, Wight D, Seeley J. How a masculine work ethic and economic circumstances affect uptake of HIV treatment: experiences of men from an artisanal gold mining community in rural eastern Uganda. J Int AIDS Soc. 2012; 15: p. 17368.

42. Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. What role do masculine norms play in men's HIV testing in sub-Saharan Africa?: A scoping review. AIDS Behav. 2018; p. 1–12.

43. Wyrod R. Masculinity and the persistence of AIDS stigma. Cult Health Sex. 2011; 13(4): p. 443–456. doi: 10.1080/13691058.2010.542565 21246426

44. National Insititute of Statistics (INS) and ICF International. 2012. Enquête Démographique et de Santé et à Indicateurs Multiples de Côte d'Ivoire 2011–2012. INS and ICF International.

45. Courtenay WH. Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Soc Sci Med. 2000; 50(10): p. 1385–1401 doi: 10.1016/s0277-9536(99)00390-1 10741575

46. Fishbein M, Ajzen I. Predicting and changing behavior: The reasoned action approach: Psychology Press; 2011.

47. Kincaid DL. Mass media, ideation, and behavior: a longitudinal analysis of contraceptive change in the Philippines. Communic Res. 2000; 27(6): p. 723–763.

48. Sen A. Well-being, Agency and Freedom: The Dewy Lectures 1984. J Philos. 1985; 82(4): p. 169–221.

49. Brown J, Sorrell J, Raffaelli M. An exploratory study of constructions of masculinity, sexuality and HIV/AIDS in Namibia, Southern Africa. Cult Health Sex. 2005; 7(6): p. 585–598. doi: 10.1080/13691050500250198 16864224

50. Zissette S, Melissa WH, Prose NS, Mntambo N, Moshabela M. "If you don't take a stand for your life, who will help you?": Men's engagement in HIV care in Kwazulu-Natal, South Africa. Psychol Men Masc. 2016; 17(3): p. 265. doi: 10.1037/men0000025 27616937

51. Hendrickson ZM, Naugle DA, Tibbels N, Dosso A, Van Lith LM, Mallalieu EC, et al. “You Take Medications, You Live Normally”: The Role of Antiretroviral Therapy in Mitigating Men’s Perceived Threats of HIV in Côte d’Ivoire. AIDS and Behavior. 2019 Jul 31:1–0.

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2019 Číslo 10