title: Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes.
abstract: BACKGROUND
  Stigma is a determinant of social and health inequalities. In addition, some notions of masculinity can disadvantage men in terms of health outcomes. However, few studies have explored the extent to which these two axes of social inequality intersect to influence men's health outcomes. This paper investigates the intersection of HIV stigma and masculinity, and its perceived impact on men's participation in and utilisation of HIV services in Uganda.
  
  
  METHODS
  Interviews and focus group discussions were conducted in Mbale and Jinja districts of Uganda between June and October 2010. Participants were men and women living with HIV (n = 40), their family members (n = 10) and health providers (n = 15). Inductive analysis was used to identify mechanisms through which stigma and masculinity were linked.
  
  
  RESULTS
  Our findings showed that HIV stigma and masculinity did not exist as isolated variables, but as intersecting phenomena that influenced men's participation in HIV services. Specifically, HIV stigma threatened masculine notions of respectability, independence and emotional control, while it amplified men's risk-taking. As a result, the intersection of masculinity and HIV stigma prevented some men from i) seeking health care and accepting a 'sick role'; ii) fulfilling their economic family responsibilities; iii) safeguarding their reputation and respectability; iv) disclosing their HIV status; and v) participating in peer support groups. Participation in some peer support activities was considered a female trait and it also exacerbated HIV stigma as it implicitly singled out those with HIV. In contrast, inclusion of income-generating activities in peer support groups encouraged men's involvement as it enabled them to provide for their families, cushioned them from HIV stigma, and in the process, provided them with an opportunity to redeem their reputation and respectability.
  
  
  CONCLUSIONS
  To improve men's involvement in HIV services, the intersection between HIV stigma and masculinity should be considered. In particular, better integration of and linkage between gender transformative interventions that support men to reconstruct their male identities and reject signifiers of masculinity that prevent their access to HIV services, and stigma-reduction interventions that target social and structural drivers of stigma is required within HIV programmes.
authors.affiliation: International HIV/AIDS Alliance, 91-101 Davigdor Road, Hove BN3 1RE, UK. gmburu@aidsalliance.org.
authors.forename: Gitau
authors.initials: G
authors.lastname: Mburu
authors.forename: Mala
authors.initials: M
authors.lastname: Ram
authors.forename: Godfrey
authors.initials: G
authors.lastname: Siu
authors.forename: David
authors.initials: D
authors.lastname: Bitira
authors.forename: Morten
authors.initials: M
authors.lastname: Skovdal
authors.forename: Paula
authors.initials: P
authors.lastname: Holland
mesh_terms: D000293:Adolescent; D000328:Adult; D004644:Emotions; D005260:Female; D017144:Focus Groups; D005783:Gender Identity; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D057228:Masculinity; D008571:Men; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012309:Risk-Taking; D012657:Self-Help Groups; D057545:Social Stigma; D014454:Uganda; D055815:Young Adult