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Cited by 56HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV/AIDS Impact and Responses

Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives

Open access
Katirayi, Leila, Chadambuka, Addmore, Muchedzi, Auxilia, Ahimbisibwe, Allan, Musarandega, Reuben, Woelk, Godfrey, Tylleskar, Thorkild, Moland, Karen Marie·2017·Reproductive Health
DOI 10.1186/s12978-017-0387-1PMC PMC5629810
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Abstract

BACKGROUND: With the introduction of 2016 World Health Organization guidelines recommending universal antiretroviral therapy (ART), there has been increased recognition of the lack of men engaging in HIV testing and treatment. Studies in sub-Saharan Africa indicate there have been challenges engaging men in HIV testing and HIV-positive men into treatment. METHODS: This qualitative study explored women's perspective of their male partner's attitudes towards HIV and ART and how it shapes woman's experience with ART. Data were collected through in-depth interviews and focus group discussions with HIV-positive pregnant and postpartum women on Option B+ and health care workers in Malawi and Zimbabwe. In Malawi, 19 in-depth interviews and 12 focus group discussions were conducted from September-December 2013. In Zimbabwe, 15 in-depth interviews and 21 focus-group discussions were conducted from July 2014-March 2014. RESULTS: The findings highlighted that many men discourage their partners from initiating or adhering to ART. One of the main findings indicated that despite the many advancements in HIV care and ART regimens, there are still many lingering negative beliefs about HIV and ART from the earlier days of the epidemic. In addition to existing theories explaining men's resistance to/absence in HIV testing and treatment as a threat to their masculinity or because of female-focused health facilities, this paper argues that men's aversion to HIV may be a result of old beliefs about HIV and ART which have not been addressed. CONCLUSIONS: Due to lack of accurate and up to date information about HIV and ART, many men discourage their female partners from initiating and adhering to ART. The effect of lingering and outdated beliefs about HIV and ART needs to be addressed through strengthened communication about developments in HIV care and treatment. Universal ART offers a unique opportunity to curb the epidemic, but successful implementation of these new guidelines is dependent on ART initiation and adherence by both women and men. Strengthening men's understanding about HIV and ART will greatly enhance women's ability to initiate and adhere to ART and improve men's health.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study in Malawi and Zimbabwe uses HIV-positive pregnant/postpartum women’s and health workers’ accounts to argue that men’s avoidance of HIV testing and treatment is driven not only by masculinity threats and female-centric clinics but also by outdated beliefs about HIV and ART. Men’s discouragement and lack of accurate ART information undermine women’s initiation and adherence, so universal ART success depends on better engaging men.

Key findings

  • Many men discouraged or prevented their female partners from initiating or adhering to ART, sometimes giving incorrect advice such as stopping medication after birth; some men were supportive and reminded partners to take ART.
  • Men avoided HIV testing even when ill, wanted to “test by proxy” based on their partner’s status, and if diagnosed often kept it secret or secretly took ART; the majority of women reported that men would still refuse ART after learning their status.
  • Lingering outdated beliefs persisted: HIV as a death sentence, ART only for the very ill, ART as a complicated multi-pill regimen, and fear of disfiguring side effects from older drugs such as stavudine.
  • Background figures cited: in sub-Saharan Africa only 45% [39–62%] of people living with HIV know their status, and 67% [65–68%] of men and 57% [55–60%] of women living with HIV are not receiving ART.

Methods

  • Descriptive qualitative study in Malawi (September–December 2013) and Zimbabwe (July 2014–March 2015), using in-depth interviews (IDIs) and focus group discussions (FGDs) with HIV-positive pregnant/postpartum women on Option B+ and health care workers (HCWs) providing PMTCT services.
  • Malawi: 19 IDIs with pregnant women and 20 with postpartum women; 12 FGDs (4 HCWs, 4 pregnant women, 4 postpartum women). Zimbabwe: 15 IDIs with pregnant women and 19 with postpartum women; 21 FGDs (4 HCWs, 8 pregnant women, 9 postpartum women). HCW participants: 43 in Malawi and 25 in Zimbabwe. Women’s mean age was 28.3 years in Malawi and 28.8 years in Zimbabwe; most were married.
  • Thematic analysis using MAXqda v.10, conducted separately by country and then combined; quotes were selected from both countries to illustrate themes.

Limitations

  • Stated: no data were collected directly with men; all reports of men’s opinions and behaviors came from female participants and HCWs. Women were recruited from health facilities and had initiated ART, excluding more vulnerable women who did not access a facility, rejected Option B+, whose child did not live, or who were unable to breastfeed. Simultaneous transcription and translation was also noted as a limitation.
  • Evident from the text: the abstract reports 19 IDIs in Malawi and 15 in Zimbabwe, while the results report 39 and 34 total IDIs respectively when pregnant and postpartum women are combined, making exact IDI totals inconsistent. The study also combines findings across two countries and time periods, and its qualitative, perception-based design cannot establish causality.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12978-017-0387-1

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 59 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Despite advancements in HIV care and ART regimens, many lingering negative beliefs about HIV and ART from the earlier days of the epidemic persist in the study communities.

    “One of the main findings indicated that despite the many advancements in HIV care and ART regimens, there are still many lingering negative beliefs about HIV and ART from the earlier days of the epidemic.”
    • Also stated in: § Plain English summary · hedged
      “One of the main findings indicated that despite the many advancements in HIV care and ART regimens, there are still many lingering negative beliefs about HIV and ART from the earlier days of the epidemic.”
    • Also stated in: § Findings · plain
      “There were many lingering beliefs in the community about HIV being a death sentence and a lack of messages about the ability to live a long and healthy life on ART”
    Quote in the paperSubstantial claim
  • Findingown data

    It was commonly reported in both Zimbabwe and Malawi that men refused to get tested for HIV even when feeling ill.

    “It was commonly reported in both Zimbabwe and Malawi that men refused to get tested for HIV even when feeling ill.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.
  • Findingown data

    In Malawi and Zimbabwe, many HIV-positive pregnant and postpartum women on Option B+ reported that their male partners discouraged or prevented them from initiating or adhering to ART.

    “The findings highlighted that many men discourage their partners from initiating or adhering to ART.”
    • Also stated in: § Plain English summary · plain
      “The findings highlighted that across the study settings women commonly experience their male partners discouraging them from initiating and adhering to ART.”
    • Also stated in: § Findings · plain
      “Men often discouraged or prevented their partners from initiating or adhering to ART”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.
  • Findingown data

    In both Zimbabwe and Malawi, men's lack of knowledge about HIV was repeatedly mentioned as linked to fear of HIV testing.

    “In both Zimbabwe and Malawi, men’s lack of knowledge about HIV was repeatedly mentioned as linked to fear of HIV testing.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.
  • Findingown data

    Some women commented on the visual depictions at the facility indicating that ART is for the very ill.

    “Some women commented on the visual depictions at the facility indicating that ART is for the very ill.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 37
  • May combine two claims. 47

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Women in the study felt that the lack of men's knowledge about HIV and ART was a significant challenge and mentioned the need for men to be educated on HIV and ART.

    “Women felt that the lack of knowledge was a significant challenge and mentioned the need for the men to be educated on HIV and ART.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Study participants reported that their partners were often uneducated about HIV and ART, and participants wished the health care messages would target men or include men in the counseling.

    “Study participants reported that their partners were often uneducated about HIV and ART, and participants wished the health care messages would target men or include men in the counseling.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Study participants described beliefs they had heard in the community such as HIV is a death sentence, ART is only for very sick people, and ART is a complicated multi-drug regimen.

    “Study participants described beliefs they had heard in the community such as HIV is a death sentence, ART is only for very sick people, and ART is a complicated multi-drug regimen.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The shift of ART regimens under Option B+ from an ART regimen requiring multiple daily pills to a regimen with one daily pill has been encouraging for many.

    “The shift of ART regimens under Option B+ from an ART regimen requiring multiple daily pills to a regimen with one daily pill has been encouraging for many.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Study participants reported that men do not feel comfortable at the facility and feel that it is a woman's space.

    “Study participants reported that men do not feel comfortable at the facility and feel that it is a woman’s space.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants spoke frequently about the need to educate men about HIV and ART.

    “Participants spoke frequently about the need to educate men about HIV and ART.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    According to the women and HCWs interviewed, men want to avoid being tested for HIV and potentially receiving a HIV-positive diagnosis.

    “According to the women and HCWs interviewed, men want to avoid being tested for HIV and potentially receiving a HIV-positive diagnosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Study participants reported that men seemed fearful of HIV and ART and would refuse to be tested.

    “Study participants reported that men seemed fearful of HIV and ART and would refuse to be tested.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Study participants also discussed the need for a male friendly space.

    “Study participants also discussed the need for a male friendly space.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    This study found that if men do learn their HIV status they may attempt to keep it secret and they may also start treatment secretly to avoid admitting illness and therefore weakness.

    “This study found that if men do learn their HIV status they may attempt to keep it secret and they may also start treatment secretly to avoid admitting illness and therefore weakness.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Some women believed that their male partners had tested positive for HIV and had been secretly taking antiretroviral drugs (ARVs).

    “Some women believed that their male partners had tested positive for HIV and had been secretly taking antiretroviral drugs (ARVs).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.

  • May combine two claims.

    Findingown data

    Some women reported that their partner was supportive of them being on ART, provided emotional support and helped to remind them to take their medication.

    “some women reported that their partner was supportive of them being on ART, provided emotional support and helped to remind them to take their medication.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The results highlight many challenges with men accepting HIV testing and treatment and the powerful influence that men have on their partner's ability to initiate and adhere to ART.

    “The results highlight many challenges with men accepting HIV testing and treatment and the powerful influence that men have on their partner’s ability to initiate and adhere to ART.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women said that some men stated there was no need for them to be tested for HIV; they would determine their HIV status based on their partner's status.

    “Women said that some men had stated that there was no need for them to be tested for HIV; they would determine their HIV status based on their partner’s status.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.

  • May combine two claims.

    Findingreasoning

    Women often demonstrate a commitment to initiate and adhere to ART, but men may discourage or prevent their partners from initiating and adhering to ART.

    “Women often demonstrate a commitment to initiate and adhere to ART, but men may discourage or prevent their partners from initiating and adhering to ART.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.

  • May combine two claims.

    Findingown data

    The women in this study reported that not only did men not want to initiate ART themselves, they also discouraged or prevented their partner from taking ART.

    “The women in this study reported that not only did men not want to initiate ART themselves, they also discouraged or prevented their partner from taking ART.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some participants stated that there was the need for more "male friendly" services to engage and educate men.

    “Some participants stated that there was the need for more “male friendly” services to engage and educate men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    While there has been tremendous progress in the ability for one to live a long and healthy life on ART and significant developments in simplification of ART, data from this study demonstrates lack of information about these developments among men and the community at large.

    “While there has been tremendous progress in the ability for one to live a long and healthy life on ART and significant developments in simplification of ART, data from this study demonstrates lack of information about these developments among men and the community at large.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Fear of visible side effects from the earlier drug regimens (primarily stavudine) were documented in this study and have been seen in other literature.

    “Fear of visible side effects from the earlier drug regimens (primarily stavudine) were documented in this study and have been seen in other literature [42].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Finkelstein JL, Gala P, Rochford R, Glesby MJ, Mehta S. HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings. J Int AIDS Soc. 2015;18(1):19033. source

      Not checked in the free run.

    • Rests on an assumption: Stavudine was used in earlier ART regimens and caused disfiguration, and it is no longer in use.

  • May combine two claims.

    Findingown data

    Study participants indicated that men have only learned about the simplified drug regimen from others on ART and that this information has not been shared widely in the community.

    “Study participants indicated that men have only learned about the simplified drug regimen from others on ART and that this information has not been shared widely in the community.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A study in Canada found that 30.5% of HIV-positive patients opted to defer ART, with the most common reason for delaying among those with CD4 ≥ 500/mm3 being "no urgency" or "no need for treatment."

    “A study in Canada found that 30.5% of HIV-positive patients opted to defer ART, with the most common reason for delaying ART among those with CD4 ≥ 500/mm3 cited as “no urgency” or “no need for treatment” [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Hoehn N, Gill MJ, Krentz HB. Understanding the delay in starting antiretroviral therapy despite recent guidelines for HIV patients retained in care. AIDS Care. 2016;18:1–6. doi: 10.1080/09540121.2016.1234678 . source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Within sub-Saharan Africa, 67% of men and 57% of women living with HIV are not receiving antiretroviral therapy.

    “Within sub-Saharan Africa, 67% [65–68%] of men and 57% [55–60%] of women living with HIV are not receiving antiretroviral therapy [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] UNAIDS. Gap report. Geneva. http://files.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2014/UNAIDS_Gap_report_en.pdf Accessed on 22 Nov 16

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies have reported that men only access HIV services when in late stage disease.

    “Previous studies have reported that men only access HIV services when in late stage disease [17–19].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [17] Skovdal M, Madenhire C, Mupambireyi Z, Nyamukapa C. Masculinity as a barrier to men’s use of HIV services in Zimbabwe. Glob Health. 2011;7:13. source

      Not checked in the free run.

    • cites [18] Orr N, Hajiyiannis H, Myers L, Makhubele M, Matekane T, Delate R, et al. Development of a national campaign addressing South African men’s fears about HIV counseling and testing and antiretroviral treatment. JAIDS. 2017;74(1):S69–73.

      Not checked in the free run.

    • cites [19] Chikovore J, Gillespie N, McGrath N, Orne-Glieman J, Zuma T, TasP study group. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa. AIDS Care. 2016;28(sup 3):74–82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In September 2015, the WHO recommended universal ART for everyone living with HIV regardless of CD4 cell count or clinical stage.

    “In September 2015, the WHO released new recommendations, referred to as “treatment for all” or “universal ART,” stating that ART should be initiated in everyone living with HIV regardless of CD4 cell count or clinical stage [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] World Health Organization. Guidelines on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva; 2015. http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf Accessed 12 Feb 16

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Universal ART offers a unique opportunity to curb the HIV epidemic, but successful implementation of these new guidelines is dependent on ART initiation and adherence by both women and men.

    “Universal ART offers a unique opportunity to curb the epidemic, but successful implementation of these new guidelines is dependent on ART initiation and adherence by both women and men.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Modelling studies have suggested that expansion of ART coverage could be effective in reducing HIV transmission at the population level.

    “Modelling studies have suggested that expansion of ART coverage could be effective in reducing transmission at the population level [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Vernooij E, Mehlo M, Hardon A, Reis R. Access for all: contextualizing HIV treatments as prevention in Swaziland. AIDS Care. 2016;28(3):7–13. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Strengthening men's understanding about HIV and ART will greatly enhance women's ability to initiate and adhere to ART and improve men's health.

    “Strengthening men’s understanding about HIV and ART will greatly enhance women’s ability to initiate and adhere to ART and improve men’s health.”
    • Also stated in: § Plain English summary · hedged
      “Hence, strengthening men’s understanding about HIV and ART may greatly enhance women’s ability to initiate and adhere to ART and at the same time improve men’s health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Men are generally initiating ART much later and have worse outcomes than women.

    “Men are generally initiating ART much later and have worse outcomes than women [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Mills E, Beyrer C, Birungi J, Dybul M. Engaging men in prevention and care for HIV/AIDS in Africa. PLoS Med. 2012;9(2):e1001167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    More men in sub-Saharan Africa die from AIDS than women, despite women having higher HIV prevalence than men.

    “More men in sub-Saharan Africa die from acquired immunodeficiency syndrome (AIDS) than women, despite women having higher HIV prevalence than men [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Dovel K, Yeatman S, Watkins S, Poulin M. Men’s heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies. AIDS. 2015;29(10):1123–5. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Previous studies have demonstrated challenges in getting men to access health facilities, test for HIV, and initiate and adhere to ART.

    “Previous studies have demonstrated the challenges of getting men to access health facilities, test for HIV and initiate and adhere to ART [10–12].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Dovel K, Yeatman S, Watkins S, Poulin M. Men’s heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies. AIDS. 2015;29(10):1123–5. source

      Not checked in the free run.

    • cites [11] Mambanga P, Sirwali R, Tshitangano T. Factors contributing to men’s reluctance to seek HIV counseling and testing at Primary Health Care facilities in Vhembe District of South Africa. Afr J Prm Health Care Fam Med. 2016;8(2):A996.

      Not checked in the free run.

    • cites [12] Shand T, Thomson-de Boor H, Van den Berg W, Peacock D, Pascoe L. The HIV Blind spot: Men and HIV testing, treatment and care in sub-Saharan Africa. IDS Bull. 2014;45:1. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a South African study, men had 4.4-higher odds of being untested, and HIV-positive men had 1.8 and 1.6-higher odds of being unaware of HIV status and untreated, respectively, compared to women.

    “One study from South Africa found that men had 4.4-higher odds of being untested, and HIV-positive men had 1.8 and 1.6-higher odds of being unaware of HIV status and untreated, respectively, compared to women [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Huerga H, Van Cutsem G, Farhat JB, Reid M, Bouhenia M, Maman D, et al. Who needs to be targeted for HIV testing and treatment in KwaZulu-Natal? Results from a population-based survey. JAIDS. 2016;73(4):411–8.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Premisecitation

    The second theory hypothesizes that health services have been designed for women, and men have been systematically left out.

    “The second theory hypothesizes that health services have been designed for women, and men have been systematically left out [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Dovel K, Yeatman S, Watkins S, Poulin M. Men’s heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies. AIDS. 2015;29(10):1123–5. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The second main theory explaining men's aversion to HIV testing and treatment postulates that the health facility has been designed to care for women, and men's health care needs have been neglected.

    “The second main theory explaining men’s aversion to HIV testing and treatment postulates that the health facility has been designed to care for women, and men’s health care needs have been neglected.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Code lists were circulated among each study team, including in-country staff, to ensure that they accurately reflected the data, and were updated based on feedback.

    “The code lists were circulated among each study team, including the in-country staff to ensure that it accurately reflected the data. The code list was updated several times based on feedback.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    These kinds of beliefs were prevalent in both countries and deterred both women and men from initiating and adhering to treatment.

    “These kinds of beliefs were prevalent in both countries and deterred both women and men from initiating and adhering to treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Given men's lack of information about ART, men may be confused and advise their partner incorrectly.

    “Given men’s lack of information about ART, men may be confused and advise their partner incorrectly.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The first theory suggests that HIV testing and treatment threatens traditional norms of masculinity.

    “The first theory suggests that HIV testing and treatment threatens traditional norms of masculinity [19, 32].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Chikovore J, Gillespie N, McGrath N, Orne-Glieman J, Zuma T, TasP study group. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa. AIDS Care. 2016;28(sup 3):74–82. source

      Not checked in the free run.

    • cites [32] Skovdal M, Campbell C, Nyamukapa C, Gregson S. When masculinity interferes with women’s treatment of HIV infection: a qualitative study about adherence to antiretroviral therapy in Zimbabwe. J Int AIDS Soc. 2011;14:29. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous literature has discussed how men may seek to control their partner and their partner's actions (such as taking medication) as a means to assert power and therefore reinforce an image of masculinity.

    “Previous literature has discussed how men may seek to control their partner and their partner’s actions (such as taking medication) as a means to assert power and therefore reinforce an image of masculinity [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Skovdal M, Campbell C, Nyamukapa C, Gregson S. When masculinity interferes with women’s treatment of HIV infection: a qualitative study about adherence to antiretroviral therapy in Zimbabwe. J Int AIDS Soc. 2011;14:29. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    All in-depth interviews and focus group discussions were audio-recorded to ensure that the data were accurately captured without subjective filtering of information.

    “All IDIs and FGDs were audio-recorded to ensure that the data were accurately captured without subjective filtering of information.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    This theory hypothesizes that men's poor health and poor health seeking behaviors are a result of the female-centric health care system that has left men out.

    “This theory hypothesizes that men’s poor health and poor health seeking behaviors are a result of the female-centric health care system that has left men out [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Dovel K, Yeatman S, Watkins S, Poulin M. Men’s heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies. AIDS. 2015;29(10):1123–5. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Outdated beliefs such as HIV is a death sentence, ART is only for the very ill, ART is a complicated, multi-drug regimen with visible side-effects and the lack of knowledge that one can live a long healthy life on ART discourage men from initiating HIV testing and treatment and supporting their partners.

    “Outdated beliefs such as HIV is a death sentence, ART is only for the very ill, ART is a complicated, multi-drug regimen with visible side-effects and the lack of knowledge that one can live a long healthy life on ART discourage men from initiating HIV testing and treatment and supporting their partners.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Because men have the power in their household to determine women's health care, their lack of knowledge about HIV and ART greatly affects their partner's ability to initiate and adhere to ART.

    “Because men have the power in their household to determine women’s health care, their lack of knowledge about HIV and ART greatly affects their partner’s ability to initiate and adhere to ART.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study coordinator reviewed approximately 10% of the transcripts while listening to the audio-recording to ensure the translations were accurate.

    “The study coordinator reviewed approximately 10% of the transcripts while listening to the audio-recording to ensure the translations were accurate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Findings from Malawi and Zimbabwe were very similar and were therefore combined to strengthen the transferability of the results.

    “While the study was conducted in different contexts, findings were very similar and therefore have been combined in this paper to strengthen the transferability of the results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Those who are utilizing the facility, such as pregnant and postpartum women, have the opportunity to learn about advancements in HIV care and treatment.

    “Those who are utilizing the facility, such as pregnant and postpartum women, have the opportunity to learn about advancements in HIV care and treatment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A study in South Africa found that men felt that they did not belong at the health facility, and the study emphasized the need for men to learn about HIV in a 'safe space' in which men could talk with one another and listen to experiences of other men.

    “A study in South Africa found that men felt that that they did not belong at the health facility, and the study emphasized the need for men to learn about HIV in a “safe space” in which men could talk with one another and listen to experiences of other men [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Fleming P, Colvin C, Peacock D, Dworkin S. What role can gender-transformative programming for men play in increasing men’s HIV testing and engagement in HIV care and treatment in South Africa? Culture, Health & Sexuality. 18(11):1251–64. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Those who don't access the facility or have other means of becoming informed (such as having a partner in antenatal care) may not be aware of these new developments.

    “Those who don’t access the facility or have other means of becoming informed (such as having a partner in antenatal care) may not be aware of these new developments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Reflexivity was discussed during data collection training and research assistants were trained to reflect upon their pre-understanding of the study topic areas and how that could influence questioning, potentially introducing bias.

    “Reflexivity was discussed during the data collection training and RAs were trained to reflect upon their pre-understanding of the study topic areas and how that could influence how they asked questions and selected follow-up questions, potentially introducing bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    There are limitations to understanding one group's beliefs and attitudes through another group's interpretation.

    “There are limitations to understanding one group’s beliefs and attitudes through another group’s interpretation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Triangulating data from different types of study participants and comparing responses increases the validity of the results.

    “Triangulating data from different types of study participants and comparing responses increases the validity of the results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The population does not include more vulnerable populations of women who may not have access to a health facility, who rejected Option B+, whose child did not live or who were unable to breastfeed their child.

    “Thus, the population does not include more vulnerable populations of women who may not have access to a health facility, who rejected Option B+, whose child did not live or who were unable to breastfeed their child.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Similar findings from different country contexts increases the transferability of study results.

    “Similar findings from different country contexts increases the transferability of study results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    A final limitation was the simultaneous transcription and translation of the data, translating the data first and then transcribing reduces chances of interpretation errors.

    “A final limitation was the simultaneous transcription and translation of the data, translating the data first and then transcribing reduces chances of interpretation errors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Women's perspectives may provide more candor into men's fear of HIV and critical insight into how men influence women's ART initiation and adherence.

    “However, women's perspectives may provide more candor into men's fear of HIV and critical insight into how men influence women’s ART initiation and adherence.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Universal ART offers a unique opportunity to curb the epidemic, but successful implementation of these new guidelines is dependent on ART initiation and adherence by both women and men.

    “Universal ART offers a unique opportunity to curb the epidemic, but successful implementation of these new guidelines is dependent on ART initiation and adherence by both women and men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Strengthening men's acceptance of HIV testing and treatment will not only strengthen the men's health, but it will also address women's HIV vulnerability and enhance overall health outcomes in women.

    “Strengthening men’s acceptance of HIV testing and treatment will not only strengthen the men’s health, but it will also address women’s HIV vulnerability and enhance overall health outcomes in women [38].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] DiCarlo A, Mantell J, Reimen R, Zerbe A, Morris D, Pitt B, et al. ‘Men usually say that HIV testing is for women’: Gender dynamics & perceptions of HIV testing in Lesotho. Culture Health & Sexuality. 2014;16(8):867–82. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    While these two theories offer different perspectives, they are also highly interconnected, as utilizing a 'female space' may threaten a man's masculinity and deter him from utilizing the health facility.

    “While these two theories offer different perspectives, they are also highly interconnected, as utilizing a ‘female space’ may threaten a man’s masculinity and deter him from utilizing the health facility.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    New research has shown that testing at home with self-test kits is well accepted by men, however, this is a fairly new practice.

    “New research has shown that testing at home with self-test kits is well accepted by men, however, this is a fairly new practice [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Camlin C, Ssemmondo E, Chamie G, El Ayadi A, Kwarisiima D, Sang N, et al. Men “missing” from population-based HIV testing: insights from qualitative research. AIDS Care. 2016;28(3):67–73. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Old ideas of HIV as a death sentence continue to linger and beliefs such as these continue to discourage men from successfully engaging in HIV testing and treatment.

    “Old ideas of HIV as a death sentence continue to linger and beliefs such as these continue to discourage men from successfully engaging in HIV testing and treatment [11, 38].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Mambanga P, Sirwali R, Tshitangano T. Factors contributing to men’s reluctance to seek HIV counseling and testing at Primary Health Care facilities in Vhembe District of South Africa. Afr J Prm Health Care Fam Med. 2016;8(2):A996.

      Not checked in the free run.

    • cites [38] DiCarlo A, Mantell J, Reimen R, Zerbe A, Morris D, Pitt B, et al. ‘Men usually say that HIV testing is for women’: Gender dynamics & perceptions of HIV testing in Lesotho. Culture Health & Sexuality. 2014;16(8):867–82. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Providing HIV testing and treatment services in male friendly spaces or at home may encourage men to accept HIV testing and treatment.

    “Providing HIV testing and treatment services in male friendly spaces or at home may encourage men to accept HIV testing and treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Previous research has indicated men's interest in receiving information in a male dominated environment, from male HCWs, in the privacy of their homes and through information directed at them (not via their partners).

    “Previous research has indicated men’s interest in receiving information in a male dominated environment, from male HCWs, in the privacy of their homes and through information directed at them (not via their partners) [17, 18, 38].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [17] Skovdal M, Madenhire C, Mupambireyi Z, Nyamukapa C. Masculinity as a barrier to men’s use of HIV services in Zimbabwe. Glob Health. 2011;7:13. source

      Not checked in the free run.

    • cites [18] Orr N, Hajiyiannis H, Myers L, Makhubele M, Matekane T, Delate R, et al. Development of a national campaign addressing South African men’s fears about HIV counseling and testing and antiretroviral treatment. JAIDS. 2017;74(1):S69–73.

      Not checked in the free run.

    • cites [38] DiCarlo A, Mantell J, Reimen R, Zerbe A, Morris D, Pitt B, et al. ‘Men usually say that HIV testing is for women’: Gender dynamics & perceptions of HIV testing in Lesotho. Culture Health & Sexuality. 2014;16(8):867–82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The main strength of this study is the triangulation of the findings between different country contexts and different types of study participants.

    “The main strength of this study is the triangulation of the findings between different country contexts and different types of study participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Kurt Riezler argues that fear may be shaped by ignorance and this is particularly relevant in the context of HIV.

    “Kurt Riezler argues that fear may be shaped by ignorance [41] and this is particularly relevant in the context of HIV.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Riezler K. The Social Psychology of Fear. Am J Sociol. 1944;49(6):489–98. http://www.jstor.org/stable/2771546 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Throughout this study and the literature, men's fear of HIV is well documented.

    “Throughout this study and the literature, men’s fear of HIV is well documented.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    ART is also provided at the health facility, and again the female dominated space may discourage men from accessing treatment.

    “ART is also provided at the health facility, and again the female dominated space may discourage men from accessing treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Fear of loss of masculinity and challenges accessing a female-centric facility are key factors that contribute to men's aversion to engaging in HIV care and treatment.

    “Fear of loss of masculinity and challenges accessing a female-centric facility are key factors that contribute to men’s aversion to engaging in HIV care and treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Both theories contribute to understanding men's challenges engaging in HIV testing and treatment; however, they are insufficient to fully explain men's aversion to HIV and ART.

    “Both theories contribute to understanding men’s challenges engaging in HIV testing and treatment; however, they are insufficient to fully explain men’s aversion to HIV and ART.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The primary limitation is that no data were collected directly with men, all reports of men's opinions and behaviors were reported from female study participants and HCWs.

    “The primary limitation is that no data were collected directly with men, all reports of men’s opinions and behaviors were reported from female study participants and HCWs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    As Connell has contended there are different masculinities.

    “As Connell has contended there are different masculinities [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Connell RW. Hegemonic masculinity, rethinking the concept. Gender & Society. 2006;19(6):829–59. source

      Not checked in the free run.

69 of 69

  • The paper relies on this without support.

    Women’s reports about their male partners’ attitudes and behaviors accurately reflect those men’s attitudes and behaviors.

    “This qualitative study explored women’s perspective of their male partner’s attitudes towards HIV and ART and how it shapes woman’s experience with ART.”
    “HIV-positive women’s experiences with their male partners is used an entry point to understand the challenges of HIV testing and treatment and how men affect their partner’s ability to initiate and adhere to ART.”

  • The paper relies on this without support.

    Lessons learned from implementation of lifelong ART under Option B+ are applicable to scaling up universal ART.

    “Hence, focusing on the role of men, this paper aims to identify the lessons learned from implementation of lifelong ART under Option B+ to inform the scaling up of universal ART.”

  • The paper relies on this without support.

    Stavudine was used in earlier ART regimens and caused disfiguration, and it is no longer in use.

    “Stavudine was a drug used in earlier ART regimens which caused disfiguration; however, it has not been communicated widely to the public that this drug is no longer in use.”

  • The paper relies on this without support.

    Reduction of HIV transmission on a population level requires successful acceptance of ART by the communities to which the new guidelines are targeted.

    “Reduction of HIV transmission on a population level requires successful acceptance of ART by the communities to which these new guidelines are targeted.”

  • The paper relies on this without support.

    WHO guidelines recommend that all people diagnosed as HIV-positive initiate ART.

    “While WHO guidelines recommend that all people diagnosed as HIV-positive initiate ART, there are many challenges that need to be overcome first.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Zimbabwe data-collection end date conflicts

    Minor

    The abstract says data collection ran through March 2014, before its stated July 2014 start; the methods instead give March 2015 as the end date.

  • Malawi interview count differs between the abstract and results

    Minor

    The abstract reports 19 in-depth interviews in Malawi, but the results report 19 with pregnant women plus 20 with postpartum women, for 39 in total.

  • Malawi postpartum married percentage is incorrect

    Minor

    Table 1 lists 74 married or cohabitating Malawi postpartum women out of 94, which is about 79%, not 89%.

    Reported 89 · recomputed 78.723404

  • Malawi postpartum single/divorced/widowed percentage is incorrect

    Minor

    Table 1 lists 20 single, divorced, or widowed Malawi postpartum women out of 94, which is about 21%, not 11%.

    Reported 11 · recomputed 21.276596

  • Zimbabwe interview count differs between the abstract and results

    Minor

    The abstract reports 15 in-depth interviews in Zimbabwe, but the results report 15 with pregnant women plus 19 with postpartum women, for 34 in total.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. World Population Review Zimbabwe. (2016). Accessed 19 Mar 2017, from http://worldpopulationreview.com/countries/zimbabwe-population/
  2. World Population Review, Malawi. (2016). Accessed 19 Mar 2017, from http://worldpopulationreview.com/countries/malawi-population/
  3. Ministry of Health (MoH), Zimbabwe. Zimbabwe national survey of HIV and syphilis prevalence among women attending antenatal clinics in Zimbabwe, 2012. Harare: AIDS & TB Programme; 2013. http://catalogue.safaids.net/sites/default/files/publications/ANC%20sero-surveillance%202013.pdf%20national%20survey%20of%20HIV%20AND%20SYPHILIS.pdf Accessed on 19 Feb 2017

Cited by

Sorted by citations

Authors
Katirayi, L., Chadambuka, A., Muchedzi, A., Ahimbisibwe, A., Musarandega, R., Woelk, G., Tylleskar, T., & Moland, K. M.
Affiliations
  • Elizabeth Glaser Pediatric AIDS Foundation (US)
  • University of Bergen (NO)
Corresponding author
Katirayi, Leila
ORCID
Venue
Reproductive Health
Publisher
Springer Science and Business Media LLC
Published
2017-10-05
Volume
14
Issue
1
Pages
124-124
ISSN
1742-4755 (ISSN-L)
DOI
10.1186/s12978-017-0387-1
PMC
PMC5629810
OpenAlex
W2761986408
Semantic Scholar
8fb1edd94f9789b0f9c40672e83d866f62bc5c42
Cited by
56
References
34
Citations by year
2026: 1 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 4 · 2021: 13 · 2020: 14 · 2019: 3 · 2018: 1
FWCI
3.79
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Reproductive Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Elizabeth Glaser Pediatric AIDS Foundation
  • Children's Investment Fund Foundation
  • University of California, Los Angeles
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
HIV testing, antiretroviral therapy, women's perspectives, HIV stigma, Option B+, pregnant women, postpartum women, healthcare workers, masculinity, antiretroviral therapy adherence, gender and HIV, Malawi, Zimbabwe
MeSH terms
Adult, Attitude to Health, Female, Humans, Male, Mass Screening, Men, Sexual Partners, Zimbabwe, HIV-1, HIV Infections, Focus Groups, Antiretroviral Therapy, Highly Active, Qualitative Research

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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