Gendered Access to HIV Testing and Treatment in Africa
By Fiorenzo Conte
One of the most important questions concerning the fight against HIV/AIDS is how can access to HIV testing and treatment be widened? A new study analyzes the role played by gender in incentivizing or discouraging the use of HIV services. One of the questions that the study seeks to answer is: why are women in Burkina Faso (as in other Western African countries) over-represented vis-à-vis men in health centers offering HIV related services (for example, of the people on ARV, 67% are women and only 32% men)?
Place yourself in the position of a woman in Ouagadougou, the capital of Burkina Faso. As a women you have more “points of access” to HIV services, for example the Prevention Mother To Child Transmission available at any ante-natal care facility. However, this is only part of the story, as other factors also play an important role. As a woman, you feel a moral obligation to be in good health because you bear the responsibility to look after your children. In a society where the position of women in the household is marginal, you see the care for children as the reason as a source of pride and social recognition and hence integration. The provision of nutritional support also plays a role. If you go to the center you can often find nutritional and material support for your children. Both factors help to overcome any fear of stigma by the community. In addition, as a woman you are more likely to go to a public hospital as opposed to traditional healers: if you were to visit a witchdoctor without the approval of your husband, you could in fact be accused of sourcellerie (witchcraft).
Now place yourself in the position of a man in Burkina Faso. Consider your role as a breadwinner ascribed by society, you feel the pressure to prioritize your job over your health. Hence, you do not have time to go to formal health facilities, as you must work during office hours. Also, as a man you are not as accustomed to health facilities as women are. The problem is that you do not know anything about how these health facilities function: you see them as extraneous places. You do not go on a daily basis so for example you don’t know that counseling services are limited to 15 people per day, and you need to get there early if you want to find a spot. Further, as you associate health facilities to women and children and given that very few men seek care, you are discouraged to go in what you consider an environment which is geared to cater to women rather than men.
As a man, you place a great value on your dignity and your strength. You think that if you go to the Voluntary Counseling and Testing (VCT), people will say that you have fear of the disease, while the man needs to face any challenge without asking any help or support outside your family. A man that seeks medical care is a man without dignity. You fear to be seen in “those” places and therefore stigmatized. You feel ashamed to be seen by other as HIV positive, hence you want to avoid any place associated with HIV/AIDS care services.
Such scenarios are taken by case studies from Burkina Faso and Cameroon, however they are not limited to this region. For example, in Kenya where I am currently working men utilize HIV test services offered by the VCT center as much as women do, yet they are considerably less likely to regularly visit the center to take their ARV or to join support groups. The reasons of such choices echoed those of men in Western Africa: fear of being considered by the society weak and defeated by the disease.
These cases invite us to rethink the position of vulnerability along gender lines, when it comes to evaluating the access to HIV testing and treatment services. Paradoxically, a position of superiority in society translates into the unwillingness to get associated with any service or behavior that could jeopardize your claim of physical superiority and health facilities offering HIV/AIDS care services are considered to be such places. The same values that secure men a dominant position in the society limit their access to medical care. Conversely, a position of material and social dependence make women less shy to seek external support. If this is the case, there is a need to conceive specific interventions directly targeting men. The initiatives taken by this clinic in Nakuru, Kenya (see page 9) offers an example of how it is possible to reach out to men.