Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes.
Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes.
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DOI：
10.1186/1471-2458-14-1061
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发表时间：
2014-10-11
影响因子：
4.5
通讯作者：
Holland P
中科院分区：
文献类型：
--
作者：
Mburu G;Ram M;Siu G;Bitira D;Skovdal M;Holland P
成见是社会和健康不平等的决定因素。此外，一些男子气概的概念可能使男子在健康结果方面处于不利地位。然而，很少有研究探讨社会不平等的这两个轴心交叉影响男子健康结果的程度。本文探讨艾滋病毒的耻辱和男性气概的交叉点，其对男性的参与和利用艾滋病毒服务在乌干达的影响。2010年6月至10月期间，在乌干达的姆巴莱和金贾地区进行了采访和焦点小组讨论。参与者是艾滋病毒感染者（n = 40），他们的家庭成员（n = 10）和医疗服务提供者（n = 15）。归纳分析被用来确定耻辱和男子气概之间的联系机制。我们的研究结果表明，艾滋病毒的耻辱感和男子气概并不存在作为孤立的变量，而是作为交叉现象，影响男子参与艾滋病毒服务。具体而言，艾滋病毒污名化威胁到男性关于受人尊敬、独立和情绪控制的观念，同时它扩大了男性的冒险行为。因此，大男子主义和艾滋病毒污名化的交叉点阻碍了一些男子：（一）寻求保健和接受“生病的角色”;（二）履行其家庭经济责任;（三）维护其声誉和体面;（四）披露其艾滋病毒状况;（五）参加同伴支助团体。参加一些同伴支持活动被认为是女性的特点，这也加剧了艾滋病毒的耻辱感，因为它含蓄地将艾滋病毒感染者挑出来。相比之下，将创收活动纳入同伴支助小组鼓励男子参与，因为这使他们能够养家糊口，使他们免受艾滋病毒的耻辱，并在此过程中为他们提供了一个挽回声誉和体面的机会。为了改善男子参与艾滋病毒服务的情况，应考虑艾滋病毒污名化和大男子主义之间的交叉关系。特别是，在艾滋病毒方案中，需要更好地整合和联系促进性别平等的干预措施和减少污名化的干预措施，前者支持男子重建其男性身份，拒绝阻止他们获得艾滋病毒服务的男性特征标志，后者针对污名化的社会和结构性驱动因素。
Stigma is a determinant of social and health inequalities. In addition, some notions of masculinity can disadvantage men in terms of health outcomes. However, few studies have explored the extent to which these two axes of social inequality intersect to influence men’s health outcomes. This paper investigates the intersection of HIV stigma and masculinity, and its perceived impact on men’s participation in and utilisation of HIV services in Uganda. Interviews and focus group discussions were conducted in Mbale and Jinja districts of Uganda between June and October 2010. Participants were men and women living with HIV (n = 40), their family members (n = 10) and health providers (n = 15). Inductive analysis was used to identify mechanisms through which stigma and masculinity were linked. Our findings showed that HIV stigma and masculinity did not exist as isolated variables, but as intersecting phenomena that influenced men’s participation in HIV services. Specifically, HIV stigma threatened masculine notions of respectability, independence and emotional control, while it amplified men’s risk-taking. As a result, the intersection of masculinity and HIV stigma prevented some men from i) seeking health care and accepting a ‘sick role’; ii) fulfilling their economic family responsibilities; iii) safeguarding their reputation and respectability; iv) disclosing their HIV status; and v) participating in peer support groups. Participation in some peer support activities was considered a female trait and it also exacerbated HIV stigma as it implicitly singled out those with HIV. In contrast, inclusion of income-generating activities in peer support groups encouraged men’s involvement as it enabled them to provide for their families, cushioned them from HIV stigma, and in the process, provided them with an opportunity to redeem their reputation and respectability. To improve men’s involvement in HIV services, the intersection between HIV stigma and masculinity should be considered. In particular, better integration of and linkage between gender transformative interventions that support men to reconstruct their male identities and reject signifiers of masculinity that prevent their access to HIV services, and stigma-reduction interventions that target social and structural drivers of stigma is required within HIV programmes.
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