title: Impact of HIV on and the constructions of masculinities among HIV-positive men in South Africa: implications for secondary prevention programs.
abstract: BACKGROUND
  To date, whilst there have been many published studies exploring the links between masculinity and HIV, not much work has been done to explore how an HIV-positive diagnosis impacts men's sense of masculinity and contextualizing the masculinities as fluid and changing.
  
  
  OBJECTIVE
  To explore how human immunodeficiency virus (HIV) impacts the lives of men and their constructions of masculinity through interviews with 18 men living with HIV.
  
  
  METHODS
  Qualitative study involving conveniently and purposively selected black South African adult men who lived with HIV. In-depth interviews were conducted with 18 men who resided in Johannesburg and Mthatha, South Africa.
  
  
  RESULTS
  Our analysis suggests that the performance of risky masculinity may influence the acquisition of HIV. Yet, it also reveals that HIV can have a significant effect on men and their masculinities. Men's constructions of harmful notions of hegemonic masculinity pre-HIV diagnosis negatively affected their help-seeking behavior and coping and adjustment to living with HIV, post-diagnosis. The dominant discourse that men are strong and healthy visibly presented challenges for men when faced with an HIV-positive status. They interpreted HIV diagnosis as a loss, a sign of failure as a man, and evidence of an inability to retain control. Being sick undermined their ability to perform roles expected of them, and this led to feelings of powerlessness, worthlessness, and distress.
  
  
  CONCLUSIONS
  Interventions with men living with HIV need to provide safe spaces for men to critically explore gender and constructions of social identities and the pressures these place on men and implications for their health. With this approach, harmful constructions of masculinities may be challenged and mitigated, and this process may render men amenable to change.
authors.affiliation: Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa; yandisa.sikweyiya@mrc.ac.za.
authors.forename: Yandisa M
authors.initials: YM
authors.lastname: Sikweyiya
authors.affiliation: Gender and Health Research Unit, Medical Research Council, Pretoria, South Africa.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jewkes
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Dunkle
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D015658:HIV Infections / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D008297:Male; D057228:Masculinity; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D036301:Qualitative Research; D055502:Secondary Prevention / Q000458:organization & administration*; D012725:Sexual Behavior / Q000523:psychology; D012959:Socioeconomic Factors; D013019:South Africa; D055815:Young Adult
keywords: HIV; Men; South Africa; coping and adjustment; masculinities