‘We need other men to stand up and start the journey’ engaging men as HIV community health workers - a gender transformative approach?

Abstract

The HIV epidemic is strongly gendered. Women and girls are more likely to contract HIV for biological and social reasons in Sub-Saharan Africa and men living with HIV are more likely to be lost to follow-up and die on antiretroviral therapy (ART) than women. Care work is also gendered, with women shouldering the burden of HIV care-related work. This paper considers the potential of male delivered community health work to improve men’s HIV-related health outcomes and shift gendered norms related to care work. It describes the experiences and perspectives of eight HIV community health workers and their clients from the Cape Town area, and reviews current evidence on male-focused HIV and sexual and reproductive health services, gender transformation and men and care. Findings suggest that meaningfully involving more men in HIV care work may be a way to shift damaging hegemonic masculine norms related to care and health, and that South Africa’s roll-out of National Health Insurance could be an opportunity to do so. Barriers to engaging men in this feminised profession are also explored.

Keywords:

• Masculinity
• gender transformation
• HIV
• community health care
• South Africa

Disclosure statement

No potential conflict of interest was reported by the author(s).

Acknowledgements

The authors are grateful to the research participants for so openly sharing their perspectives and experiences that formed the basis of this research. Special thanks to the CHW participants who also provided informal translation between their clients and myself during interviews. Thanks also to the following organizations and individuals: Kheth'Impilo for recruiting participants, logistically supporting the study and for their valuable input; Nicoli Nattrass, who supervised the dissertation research that formed the basis for this article for her support and guidance; Rebecca Hodes for reviewing this article and her continued support, guidance, and encouragement; Judith Head for supervising the proposal development and first stages of this study; and Thobani Ncapai and Sihle Tshabalala for providing their valuable insight into the data. Thank you also to the two anonymous reviewers for their excellent guidance which improved the content of this paper.

Notes

1 This case study was developed from the first author’s research notes.

2 Gender transformative approaches aim to change discriminatory and biased gender practices, policies, beliefs and ideas (Betron, Barker, Contrerasm, and Peacock 2012) and have the potential to create more gender equitable environments and change men’s beliefs and behaviours (Sen, Östlin, and George 2007).

3 The community health worker participants were employed by a South African not-for-profit organisation that specialises in health and community systems and services strengthening. Community health workers assist clients living with HIV and tuberculosis by assessing treatment readiness, conducting psychosocial assessments; identifying barriers to adherence, providing pre-treatment initiation education and providing support services through planned home visits, clinic support and follow-ups.

4 Racial identifiers are put within quotation marks (‘’) to denote that these categories are not essential qualities, but rather as indicators of relational positions and social constructs. Insofar as possible, this work aims to avoid reproducing these categories, while acknowledging these historical and on-going constructs as powerful organising factors.

5 Acknowledging the presence of multiple dominant masculine ideals, the concept was broadened to include multiple hegemonic masculinities within the South African context (Morrell, Jewkes and Lindegger 2012).

Additional information

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The AIDS and Society Research Unit of the University of Cape Town's Centre for Social Science Research provided financial assistance for this research. Support during the writing of this manuscript was provided by the University of Cape Town through the South National Research Foundation Innovation scheme and conference funding; the South African Social Science and HIV Programme, an initiative funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (Award #R24HD077976), and Evidence for HIV Prevention in Southern Africa (EHPSA), a DFID programme managed by Mott MacDonald (MM/EHPSA/UCT/05150014). The content is solely the responsibility of the author and does not necessarily represent the official views of the aforementioned funders, including the National Institutes of Health.