'If you are found taking medicine, you will be called names and considered less of a man': young men's engagement with HIV treatment and care during ulwaluko (traditional initiation and circumcision) in the Eastern Cape Province of South Africa.
'If you are found taking medicine, you will be called names and considered less of a man': young men's engagement with HIV treatment and care during ulwaluko (traditional initiation and circumcision) in the Eastern Cape Province of South Africa.
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DOI：
10.1080/17290376.2021.1894225
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Kom P
中科院分区：
文献类型：
--
作者：
Gittings L;Hodes R;Colvin C;Mbula S;Kom P
本文探讨了艾滋病毒阳性abakhwetha（年轻的男性开始）进行ulwaluko（传统的科萨启动和包皮环切术）与艾滋病毒相关的生物医学护理和治疗。2017年和2018年，对感染艾滋病毒的青少年和年轻男性（13-24岁）进行了以健康为重点的生活史叙述（n = 36）、半结构化访谈（n = 32）和卫生设施文件分析（n = 41），并对传统和生物医学保健医生进行了半结构化访谈（n = 14）。这项研究是Mzantsi Wakho研究的一部分，该研究是一项针对艾滋病毒感染青少年的纵向混合方法研究（n = 1060）。研究结果表明，ulwaluko规则不从事生物医学护理和治疗构成了挑战，谁是服用慢性药物的初始。担心无意中暴露其艾滋病毒呈阳性的状况，与成功完成ulwaluko以便作为男子合法化的压力相冲突。为了应对这一困境，他们采取了各种策略--包括把药藏起来秘密服药，让一个值得信任的人把药分开送，以及完全停止服药。ulwaluko之后的三个月也对获得生物医学治疗和护理提出了挑战。在这个高度监控的时期，amakrwala（新男子）不去卫生机构，因为担心被认为做了拙劣的包皮环切手术，或者违反了“成年规则”，在适当愈合之前离开了ulwaluko。为了解决这个问题，那些继续服用药物的人聘请了护理人员。除了建议ulwaluko是一个高风险的时间脱离生物医学治疗和护理，本文建立在一个强大的奖学金的重要性，地方和背景下的性别和健康研究。它记录了同修及其家庭的创造力、能动性和复原力，因为他们颠覆和重新象征了与健康有关的男性规范。
This paper explores how HIV-positive abakhwetha (young male initiates) undergoing ulwaluko (traditional Xhosa initiation and circumcision) engage with HIV-related biomedical care and treatment. Health-focused life history narratives (n = 36), semi-structured interviews (n = 32) and analysis of health facility files (n = 41) with adolescent boys and young men (ages 13–24) living with HIV, and semi-structured interviews with traditional and biomedical health practitioners (n = 14) were conducted in 2017 and 2018. This research was part of the Mzantsi Wakho study, a longitudinal, mixed methods study of adolescents living with HIV (n = 1060). Findings demonstrate that ulwaluko rules of not engaging with biomedical care and treatment pose a challenge for initiates who are taking chronic medicine. Fears of inadvertent disclosure of their HIV-positive status collide with the pressure to successfully complete ulwaluko in order to be legitimised as men. In response to this dilemma, they engage a variety of strategies – including taking medicine in secret by hiding them, having a trusted person deliver them discretely, and stopping medicine-taking altogether. The three months following ulwaluko also pose a challenge in accessing biomedical treatment and care. In this time of high surveillance, amakrwala (new men) do not present at health facilities for fear of being thought to have had a botched circumcision or to have contravened ‘manhood rules’ and left ulwaluko before having healed properly. To get around this, those who continued taking medicine engaged caregiver pick-ups. Beyond suggesting that ulwaluko is a high-risk time for disengagement from biomedical treatment and care, this paper builds on a robust scholarship on the importance of locality and context in gender and health research. It documents the creativity, agency and resilience of initiates and their families as they subvert and re-signify health-related masculine norms.
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