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

Figures & data

Table 1. Methods, samples, and data sources by region (baseline year of SEARCH).

Methods and samples/sources	Kenya	Uganda Southwest	Uganda East	Total n
IDIs with community member cohort	56	28	28	112
IDIs with community leader cohort	16	8	8	32
IDIs with healthcare provider cohort	28	12	10	50
FGDs with CHC participants (n = 8–12 per FGD)	4	2	2	8
PO at CHCs	8	12	8	28

IDI, in-depth interview; FGD, focus group discussion; CHC, community health campaign; PO, participant observation.

Table 2. Sex differences in HIV testing by mode of outreach.

	Enumerated stable population	CHC-based testing coverage	HBT coverage	Hybrid testing (CHC + HBT) coverage
Stable adult residents: total	149,906	104,635 (71%)	26,672 (18%)	131,307 (89%)
Men	66,726	42,622 (64%)	14,771 (22%)	57,393 (86%)
Women	80,180	62,013 (77%)	11,901 (15%)	73,914 (92%)

CHC, community health campaign; HBT, home-based testing.

Source: Chamie et al. (2016)

Table 3. Barriers to men’s participation in testing, among SEARCH study participants (illustrative quotes).

Structural barriers: Men’s livelihoods Fishermen who returned to shore at daybreak slept all day, and those who fished during the day were away from dawn to nightfall. As one participant noted, “many men leave at 6 a.m. for fishing … they would be back to the house at 7 p.m” (Male FGD participant, Tom Mboya). ‘He told me, “Most men are in the gardens harvesting millet, ground nuts and maize. Some of them just fear testing” (Participant Observation field notes, Kadama).

Narratives of entrenched gender norms

“Men are generally lazy … ‘I am already infected and still want to show my male ego without considering my family’ … many men as well are not ready to take up HIV test and would push their partners to go first and rely on their results” (Male youth Focus Group Discussion (FGD) participant, Sena). “As men we have a lot of fear … Men also like giving excuses, that they are ever busy in the name of searching for the family, even if they have gotten this food that they are ever looking for [laughter]” (Male adult FGD participant, Sena). “Many men believe that medical issues are women’s affairs” (Male adult FGD participant, Ongo). “Men are people with hardened hearts. They will hardly rush for any program. They can release their wives and children first to go, and for him, he assesses before going” (Female adult FGD participant, Kameke).

Debates and questioning surrounding gender norms

“Interviewer: You have mentioned that most people do not test as couples; please tell me more about this? A good percentage of men are not faithful. It is men who would even end up enrolling for HIV care at a very far facility. Men should change and be free to test as couples so as to build trust. They should stop frustrating their women as well. [Female adult participant] Gender based violence is real and rampant in this community. This is so because there is no family dialogue to discuss family issues. I do dialogue in my house but when I introduced the HIV topics, many started avoiding the dialogue” [Male adult participant], FGD Tom Mboya.

Chamie, G., Clark, T., Kabami, J., Kadede, K., Ssemmondo, E., Steinfeld, R., … Charlebois, E. D. (2016). A hybrid mobile HIV testing approach for population-wide HIV testing in rural East Africa: An observational study. Lancet HIV, 3(3), e111–e119. doi:10.1016/S2352-3018(15)00251-9. Epub 2016 Jan 26.

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