"If You Don't Take a Stand for Your Life, Who Will Help You?": A Qualitative Study of Men's Engagement with HIV/AIDS Care in Rural KwaZulu-Natal, South Africa

The needs of South African men with HIV are often overlooked in providing healthcare for people living with HIV/AIDS, leading to unique needs and experiences for men seeking HIV/AIDS healthcare. Compounding this phenomenon are norms of masculinity guiding these men's behaviors as they navigate health and healthcare systems. The aim of this study is to provide new insight on which components of masculinity interplay with healthcare access in South Africa. The study took place at one primary health care clinic in a peri-urban township in rural KwaZulu-Natal, South Africa. In-depth individual interviews were conducted with 21 HIV-positive men recruited from the clinic. Direct observations of the HIV clinic waiting area were also conducted. Data was analyzed using a grounded theory-informed memo-writing approach. Participants expressed a range of ways in which masculine ideals and identity both promoted and inhibited their willingness and ability to engage in HIV care. Notions of masculinity and social identity were often directly tied to behaviors influencing care engagement. Such engagement fostered the reshaping of identity around a novel sense of clinic advocacy in the face of HIV. Our findings suggested that masculinities are complex, and are subject to changes and reprioritization in the context of HIV. Interventions focusing on reframing hegemonic masculinities and initiating treatment early may have success in bringing more men to the clinic.