Addressing Gaps in Men's Health Literacy and Health Seeking in Mozambique: A Case for Differentiated Care for HIV and CVD

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As in other parts of the world, men are more likely to delay health care seeking and drop out of care than women in Southern Africa. There is evidence for men's gaps in health care for tuberculosis and HIV, and increasingly for non-communicable diseases (NCD) such as diabetes and hypertension which are on the rise in the region. However, due to emphasis on women and children in the global health agenda, men's health gaps have been neglected and there is limited regional data on their awareness, decision-making, and actions with regards to seeking health care. In this project, we focus on the case of cardiovascular disease (CVD) in HIV-positive men in Mozambique, a country where poverty, conflict, and migration for work have influenced men's health and their vulnerability to disease. Our project aims to contribute data for the development of 'differentiated' care strategies, that is models of care that are responsive to men's health needs and adapted to local systems processes and resource constraints. Mozambique has a high burden of infectious diseases (ID) as well as a growing burden of NCD, and men have lower levels of awareness, control, and uptake of treatment for both ID and NCD. Our project is based in a large urban district of Maputo and will use a range of qualitative and quantitative methods to explore aspects of men's health literacy and health-seeking. A literature review and mapping of men's health interventions in Mozambique will examine current approaches and assumptions. Facility-based observations and interviews with health providers and male patients with HIV and CVD will look at how their pathways to care are influenced by social, structural, and systems-related factors. A community-based survey and a nested qualitative study will use different measures to compare data on health literacy, self-perceived health and household influences on men's health seeking behaviour. Data from these different sources will be used to develop models of processes and pathways to care for men. Finally, we will consult with our project partners, researchers and stakeholders in the fields of health and gender to share findings and discuss how these can potentially inform strategies to strengthen men's engagement with HIV and CVD services. We expect to deliver timely insights for the systems response to HIV/CVD co-morbidity in men. Further, our partnership will provide a solid interdisciplinary platform for the development of a larger proposal that can implement and evaluate health systems strategies to address the chronic health needs of male migrants and mobility across borders in the Southern African region.