"A heart of the man is lighter than that of the woman…" exploring men's motivation and capability to access HIV services in Lusaka, Zambia: findings from the Yaba Guy Che study

Background
In southern Africa, men are less likely than women to access HIV services, including HIV testing, antiretroviral therapy (ART), and HIV prevention services. As a result, men living with HIV are less likely to be virally suppressed and more likely to transmit HIV than their female peers. Using the socio-ecological model as a framework, we explored factors that influence men’s motivation and capability to access available HIV services, including how social norms and social networks influence men’s engagement with services, in Lusaka, Zambia.

Methods
We conducted seven focus group discussions (FGDs) with men and women in an urban community in Lusaka. Five FGDs were conducted with men; two with young men aged 20–24; two with men aged 25–35 and one with men aged 20–35. We conducted two FGDs with women, stratified by age 18–24 and 25–35. The total number of participants was 70. Data were coded and analysed thematically.

Results
Pervasive negative community narratives around HIV, negative social and gender norms, the influence of men’s social networks, including stigma related to a positive HIV test result and fear of social isolation, were among the key factors influencing men’s access to HIV services. For HIV testing, the organization and delivery of services in health facilities, including location of HIV testing, waiting times, and likelihood of being seen accessing services, dissuaded men from testing for HIV. In general, health facilities were seen as women’s spaces and unresponsive to men’s needs. However, provider-initiated initiatives, including couples testing in antenatal care and an offer of HIV testing prior to medical male circumcision, and community-based HIV testing facilitated service use. Though condoms were the primary HIV prevention tool mentioned by study participants, norms of their use in marriage and sexual relations limited use.

Conclusions
Despite HIV having evolved to a chronic condition and various HIV prevention tools available, fear, social isolation, stigma, and harmful gender norms continue to negatively impact men’s motivation and capability to engage with available HIV services. Measures to facilitate men’s use of these services should consider how to increase social support alongside the delivery of services in spaces that meet men’s needs.