Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania

Figures & data

Table 1 Characteristics of the focus group discussions conducted

	Number of sessions		Number of participants
Category of FGD	Female	Male	Female	Male	Total
Unmarried, aged 15–24	1	–	6	–	6
Married, aged 25–45	3	2	19	13	32
Parent of under-5 child, aged 25–45	2	–	14	–	14
Widows and widowers	2	2	13	13	26
Total	8	4	52	26	78

Table 2 Analytical framework: pathways through which masculinity interferes with men's access to antiretroviral therapy (ART)

Codes	Descriptive themes	Analytical themes	Overarching theme
Men do not want to show up. ShameSuperiority Men are heads of family. Clinic is a women's space. Fear of degrading social status Embarrassment	Men consider themselves to have a higher social status. Men fear degrading the social status that they enjoy.	Social construction of masculinity	Masculinity interfering with men's access to ART
Fear of being recognized by family members as living with HIV Men fear disclosing. Men fear stigma and discrimination. Fear of desertion	Men fear that going to the care and treatment clinic (CTC) would make their status of living with HIV known to their family members. Men fear that disclosure of their status of living with HIV may cause family instability – given their leadership position. Men are afraid of being deserted by their wives.	HIV perceived as a threat to men's masculinity
Fewer men at CTCs More women at CTCs Men steal their wife's antiretroviral drugs (ARVs). Preference of intermittent treatment of opportunistic infections (OIs) Buying ARVs from female clients Late clinic attendance Hesitant men die.	Out of shame, men suffer silently and attempt to cope by stealing their wives’ ARVs; seeking treatment of OIs; using their partner's doses, and/or buying ARVs from female clients.Men lag behind women in availing themselves of treatment at the CTCs. Men surrender and go to the clinic at an advanced stage of HIV.	Shame Men take advantage of their powerful decision-making and economic position to informally access ART. Unwillingness to admit problems

Table 3 The trend of mortality among people living with HIV attending care and treatment clinics run by the Management and Development for Health (MDH) project, October 2004–December 2008

	Enrolment to care and treatment clinics		Number of deaths		Proportion of deaths against enrolment
Year	Female	Male	Female	Male	Female	Male
2004 (October–December)	323	164	1	0	0.03	0
2005	5,383	2,238	413	305	7.7	13.6
2006	8,346	3,432	1,374	852	16.5	24.8
2007	10,111	4,379	1,847	1,221	18.3	27.9
2008	10,276	4,442	446	280	4.3	6.3
Total	34,439	14,655	45,36	2,658	13.2	18.1

Source: MDH Project, 2009