Masculine gender norms, male circumcision, and men’s engagement with health care in the Dominican Republic

ABSTRACT

Overall, adult men are less likely to seek and receive health care than women, but male circumcision for HIV prevention has been successful in engaging men in health services. The purpose of this paper is to examine the relationship between masculine norms and health care-seeking among men participating in a voluntary male medical circumcision (VMMC) programme in the Dominican Republic (DR). We employed a mixed methods approach integrating survey data collected 6–12 months post-circumcision (n = 293) and in-depth interviews with a sub-sample of these men (n = 30). In our qualitative analysis, we found that health care-seeking is connected to masculine norms among men in the DR, including the perceptions of medical facilities as feminine spaces. Participants’ narratives demonstrate that male circumcision programmes may facilitate men overcoming masculinity-related barriers to health care engagement. In quantitative analysis, we found that being concerned about being perceived as masculine was associated with health care-seeking behaviour in the past five years, though this association was not retained in multivariable analyses. Findings indicate that male circumcision programmes can familiarise men with the healthcare system and masculinise health care-seeking and utilisation, easing associated discomfort.

KEYWORDS:

• Masculinity
• gender
• circumcision
• HIV prevention

Acknowledgements

We would like to thank Martha Perez, Miriam Nova, Riqui Rosario, and Nicolas González for their assistance in recruitment and data collection. This project was supported by the National Centre for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000050. We are grateful to the Carolina Population Centre for training support (T32 HD007168) and for general support (R24 HD050924). P.J. Fleming was supported by the UNC STD/HIV training grant (T32AI007001). Fieldwork was generously supported by the Explorations in Global Health Award from the UNC Institute for Global Health and Infectious Disease, UNC Carolina Population Centre’s Research Residency Award, the Mellon Dissertation Fellowship from UNC’s Institute for the Study of the Americas, and the Koch Travel Award from the Gillings School of Global Public Health at UNC.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Paul J. Fleming http://orcid.org/0000-0001-9150-1254

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 Haitian communities living near and working on sugar cane farms.

Additional information

Funding

This work was supported by UNC Gillings School of Global Public Health [Koch Travel Award]; UNC Institute for Global Health and Infectious Disease [Explorations in Global Health Award]; Carolina Population Center [Research Residency Award]; UNC STD/HIV Training Grant from the National Institute of Allergy and Infectious Disease [grant number T32AI007001]; National Centre for Advancing Translational Sciences [grant number UL1TR000050]; Carolina Population Centre [grant numbers R24 HD050924,T32 HD007168]; UNC Institute for the Study of the Americas [Mellon Dissertation Fellowship].