Men “missing” from population-based HIV testing: insights from qualitative research

Camlin, Carol S.; Ssemmondo, Emmanuel; Chamie, Gabriel; El Ayadi, Alison M.; Kwarisiima, Dalsone; Sang, Norton; Kabami, Jane; Charlebois, Edwin; Petersen, Maya; Clark, Tamara D.; Bukusi, Elizabeth A.; Cohen, Craig R.; R. Kamya, Moses; Havlir, Diane; the SEARCH Collaboration

doi:10.1080/09540121.2016.1164806

Cited by 181HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV/AIDS Impact and Responses

Men “missing” from population-based HIV testing: insights from qualitative research

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Camlin, Carol S., Ssemmondo, Emmanuel, Chamie, Gabriel, El Ayadi, Alison M., Kwarisiima, Dalsone, Sang, Norton, Kabami, Jane, Charlebois, Edwin +7 more·2016·AIDS Care

DOI 10.1080/09540121.2016.1164806PMC PMC5749410

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Abstract

Men's uptake of HIV testing is critical to the success of "test and treat" strategies in generalized epidemics. This study sought to identify cultural factors and community processes that influence men's HIV testing uptake in the baseline year of an ongoing test-and-treat trial among 334,479 persons in eastern Africa (SEARCH, NCT#01864603). Data were collected using participant observation at mobile community health campaigns (CHCs) (n = 28); focus group discussions (n = 8 groups) with CHC participants; and in-depth interviews with care providers (n = 50), leaders (n = 32), and members (n = 112) of eight communities in Kenya and Uganda. An 8-person research team defined analytical codes and iteratively refined them during data collection using grounded theoretical approaches, and textual data were coded using Atlas.ti software. Structural and cultural barriers, including men's mobility and gender norms valorizing risk-taking and discouraging health-seeking behavior, were observed, and contributed to men's lower participation in HIV testing relative to women. Men's labor opportunities often require extended absences from households: during planting season, men guarded fields from monkeys from dawn until nightfall; lake fishermen traveled long distances and circulated between beaches. Men often tested "by proxy", believing their wives' HIV test results to be their status. Debates about HIV risks were vigorous, with many men questioning "traditional" masculine gender norms that enhanced risks. The promise of antiretroviral therapy (ART) to prolong health was a motivating factor for many men to participate in testing. Flexibility in operating hours of HIV testing including late evening and weekend times along with multiple convenient locations that moved were cited as facilitating factors enhancing male participating in HIV testing. Mobile testing reduced but did not eliminate barriers to men's participation in a large-scale "test & treat" effort. However, transformations in gender norms related to HIV testing and care-seeking are underway in eastern Africa and should be supported.

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As a result, men often wait to access the health facility until they are very ill.
“As a result, men often wait to access the health facility until they are very ill [37].”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [37]
Diagnosis by 'proxy' is well documented in the literature.
“Diagnosis by “proxy” is well documented in the literature [19, 37].”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [37]
Local notions of masculinity disfavor seeking help because it is thought to be a sign of weakness.
“Local notions of masculinity disfavor seeking help because it is thought to be a sign of weakness [36, 37].”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [37]
Clinics are seen to be 'female spaces'.
“Clinics are seen to be “female spaces” [17, 37].”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [37]
One study in South Africa found that mobile, population wide testing via community health campaigns and home-based HIV testing reduced but did not eliminate barriers to male engagement in mobile community HIV testing.
“One study in South Africa found that mobile, population wide testing via community health campaigns and home-based HIV testing reduced but did not eliminate barriers to male engagement in mobile community HIV testing [37].”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [37]

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“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya
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Authors: Camlin, C. S., Ssemmondo, E., Chamie, G., El Ayadi, A. M., Kwarisiima, D., Sang, N., Kabami, J., Charlebois, E., Petersen, M., Clark, T. D., Bukusi, E. A., Cohen, C. R., R. Kamya, M., Havlir, D., & the SEARCH Collaboration
Affiliations: University of California, San Francisco (US)
Infectious Diseases Research Collaboration (UG)
Makerere University (UG)
Kenya Medical Research Institute (KE)
University of California, Berkeley (US)
Corresponding author: Camlin, Carol S.
ORCID: Camlin, Carol S.
Ssemmondo, Emmanuel
Chamie, Gabriel
Kwarisiima, Dalsone
Sang, Norton
Kabami, Jane
Charlebois, Edwin
Petersen, Maya
Clark, Tamara D.
Bukusi, Elizabeth A.
Cohen, Craig R.
Havlir, Diane
Venue: AIDS Care
Publisher: Informa UK Limited
Published: 2016-06-02
Volume: 28
Issue: sup3
Pages: 67-73
ISSN: 0954-0121 (ISSN-L)
1360-0451
DOI: 10.1080/09540121.2016.1164806
PMC: PMC5749410
OpenAlex: W2470451908
Cited by: 181
References: 19
Citations by year: 2026: 7 · 2025: 12 · 2024: 20 · 2023: 17 · 2022: 16 · 2021: 33 · 2020: 32 · 2019: 22 · 2018: 13 · 2017: 6 · 2016: 1
FWCI: 12.93
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: AIDS Care (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
PubMed Central (acceptedVersion, cc-by-nc-nd)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institute of Allergy and Infectious Diseases
United States President's Emergency Plan for AIDS Relief (PEPFAR)
Government of Kenya
Government of Uganda
World Bank Group
World Health Organization
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
Keywords: gender norms, masculinity, test and treat, barriers to HIV testing, antiretroviral therapy, care-seeking behavior, HIV risk perception, East Africa, Kenya, Uganda
MeSH terms: Adult, Cultural Characteristics, Health Services Accessibility, Humans, Interviews as Topic, Kenya, Longitudinal Studies, Male, Mass Screening, Men, Motivation, Patient Acceptance of Health Care, Risk-Taking, Rural Population, Sexual Behavior, Uganda, Health Behavior, HIV Infections, Focus Groups, Qualitative Research, Young Adult, Masculinity

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Men “missing” from population-based HIV testing: insights from qualitative research

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