Unlike women, who may have regular access to HIV information and testing through antenatal clinics, and/or incentive to test for their children’s well-being, men have neither regular contact with clinics nor direct incentive to test.
Men and women unanimously characterized men as fearful of and resistant to HIV testing. Although most men reported having tested and received the result, the consensus was that most Basotho men avoid HIV testing.
According to a health survey carried out between 2018 and 2020, 35% of countries with available data, over 50% of people report having discriminatory attitudes towards going for HIV tests, whereby fear and lack of knowledge were the most commonly cited reasons for men’s avoidance of HIV testing.
Additionally, men and women explained the phenomenon of men using their wives’ HIV status as a proxy for their own, which allows men to avoid HIV testing while still feeling they have some indication of their HIV status.
Both men and women reported that a positive HIV test may be seen as confirmation of infidelity and that men may avoid testing because they do not want their wives to know about their extramarital activities.
Furthermore, men discussed how testing for HIV is often perceived as a life-changing event that will directly impact their relationships and behaviour, regardless of the test result.
Men reported feeling (or expecting to feel) obligated to change their behaviour once they learned their status, whether positive or negative, suggesting that men may consider HIV testing to be incongruous with their current lifestyles or may alter their lifestyle in undesirable ways.
“Men testing for HIV is something not common because once you get HIV tested and your friends discover that you are HIV-positive, you will feel isolated and it is something disappointing in life,” Part of the survey established.
According to the United Nations Program on HIV and AIDS survey in 2020, there has been good progress on HIV testing and treatment, driven by a strong and growing global commitment to achieve the 90–90–90 targets by 2020.
The 90–90–90 targets are that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people living with HIV will have access to antiretroviral therapy and 90% of all people on antiretroviral therapy will have viral suppression.
In 2017, an estimated 75% of people living with HIV knew their HIV status; among them, 79% were accessing antiretroviral therapy and 81% of people accessing treatment had suppressed viral loads. The largest gap remains at the first 90, people who know their HIV status with very few men coming out for tests.
Community-based HIV stigma and conflict within personal relationships were viewed as significant barriers to testing. Most importantly, many men described HIV as a ‘death sentence’, or people with HIV as ‘already dead’, indicating a strong basis for not only fear but also feelings of futility regarding HIV testing.
Men reported few opportunities for regular contact with health clinics or HIV testing sites, and commonly receive information about HIV from television, radio, or friends.
Because women have more opportunities for contact with health services and HIV prevention and may test for HIV during antenatal care, participants reported that men commonly perceive HIV testing to be something that women do.
Consequently, HIV itself has come to be seen as a disease that women bring into the relationship and are responsible for managing.
According to Dr Silas Ayunga who is the director of Medical Services in Nyamira, both men and women believed that because men are acutely aware of how their sexual behaviour may contribute to their HIV risk, they fear they are already infected, and consequently avoid HIV testing.
“Our actions tend to prevent us from [HIV testing] because you know what you have been doing outside and now you know that for you to have this thing, I could very well have it. I think you get frightened of knowing you have it,” says Dr Ayunga.