title: When masculinity interferes with women's treatment of HIV infection: a qualitative study about adherence to antiretroviral therapy in Zimbabwe.
abstract: BACKGROUND
  Social constructions of masculinity have been shown to serve as an obstacle to men's access and adherence to antiretroviral therapies (ART). In the light of women's relative lack of power in many aspects of interpersonal relationships with men in many African settings, our objective is to explore how male denial of HIV/AIDS impacts on their female partners' ability to access and adhere to ART.
  
  
  METHODS
  We conducted a qualitative case study involving thematic analysis of 37 individual interviews and five focus groups with a total of 53 male and female antiretroviral drug users and 25 healthcare providers in rural eastern Zimbabwe.
  
  
  RESULTS
  Rooted in hegemonic notions of masculinity, men saw HIV/AIDS as a threat to their manhood and dignity and exhibited a profound fear of the disease. In the process of denying and avoiding their association with AIDS, many men undermine their wives' efforts to access and adhere to ART. Many women felt unable to disclose their HIV status to their husbands, forcing them to take their medication in secret, and act without a supportive treatment partner, which is widely accepted to be vitally important for adherence success. Some husbands, when discovering that their wives are on ART, deny them permission to take the drugs, or indeed steal the drugs for their own treatment. Men's avoidance of HIV also leaves many HIV-positive women feeling vulnerable to re-infection as their husbands, in an attempt to demonstrate their manhood, are believed to continue engaging in HIV-risky behaviours.
  
  
  CONCLUSIONS
  Hegemonic notions of masculinity can interfere with women's adherence to ART. It is important that those concerned with promoting effective treatment services recognise the gender and household dynamics that may prevent some women from successfully adhering to ART, and explore ways to work with both women and men to identify couples-based strategies to increase adherence to ART.
authors.affiliation: London School of Economics and Political Sciences, UK. m.skovdal@lse.ac.uk.
authors.forename: Morten
authors.initials: M
authors.lastname: Skovdal
authors.forename: Catherine
authors.initials: C
authors.lastname: Campbell
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D057228:Masculinity; D010349:Patient Compliance / Q000523:psychology; D036301:Qualitative Research; D012747:Sexual Partners / Q000523:psychology; D018454:Spouses / Q000523:psychology; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents