Barriers to care: The influence of gang violence on heterosexual men’s initiation and adherence within the HIV/TB care cascade

ABSTRACT

South Africa is burdened by twin epidemics of HIV and tuberculosis (TB) in which men are less likely than their female counterparts to engage with prevention, treatment and care. In some Cape Flats communities in Cape Town, South Africa, the challenge to men is compounded by high levels of gang violence. This study investigates the role of gang violence as a barrier to men’s entry and retention in the HIV/TB care cascade. Data for this study drew from six weeks of participant observation and eleven in-depth interviews in Hanover Park, a largely Coloured township of Cape Town. Key findings concerned men’s restricted mobility due to gang violence as a result of conflict over gang territory. Men both inside and outside gangs are affected by this violence, with men in gangs, in most cases, being totally cut off from healthcare services. Men in gangs are a key risk population group for both HIV and TB programming. Community-based interventions that address the effects of violence on health services should be designed for the communities on the Cape Flats. Findings could potentially be extrapolated to other settings affected by gang violence, both within South Africa and abroad.

KEYWORDS:

• Violence
• gangs
• access to care
• HIV/TB care cascade
• gender

Acknowledgements

Our sincere gratitude to the amazing women at the Alcardo Andrews Foundation who were an incredible help in the execution of this project. This project was supported by the US National Institute of Mental Health and the South African Medical Research Council (SAMRC) (1R01 MH106600). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health or the SAMRC.

Disclosure statement

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

Notes

1 Written from perspective of first author

2 Pseudonym.

3 Pseudonym

4 Name altered for publication

Additional information

Funding

This work was supported by National Institute of Mental Health; South African Medical Research Council [grant number R01 MH106600].