TB and HIV stigma compounded by threatened masculinity: implications for TB health-care seeking in Malawi.

SETTING: Urban Blantyre, Malawi. OBJECTIVE: To understand why men with tuberculosis (TB) in the community remain undiagnosed. DESIGN: A multi-method qualitative study applying a modified grounded theory approach. Data were gathered from March 2011 to March 2012 from 134 men and women taking part in 1) focus group discussions with community members (n = 6) and health care workers (n = 2), and 2) in-depth interviews with TB patients (n = 20, females n = 14) and chronic coughers (n = 20, women n = 8). Data were analysed inductively to identify, refine and consolidate, and verify emerging concepts and themes. RESULTS: Two emerging themes highlighting compound stigma in this high human immunodeficiency virus (HIV) prevalence, low-income setting are presented. First, cough or any illness that portended a 'serious' condition were accompanied by portrayals of cough, TB and HIV as being interchangeable. Chronic coughers and TB patients described their illness in ways that foregrounded bodily decimation and rupture of social life and masculine identity. Second, 'resistance strategies' entailed resisting classification as (seriously) ill by evading or ambivalently approaching health care, or acknowledging the 'ill' status then actively pursuing health-appropriate behaviours, including changing lifestyle or adopting non-normative gender roles. CONCLUSIONS: Managing patients requires 1) going beyond syndromic management based on vital signs and clinical indicators to recognising and intervening on health care-seeking related tensions to retain individuals in care, and 2) understanding and addressing TB stigma as it manifests and affects men and women differently in specific settings

Clients’ Perception of Quality of Multidrug-Resistant Tuberculosis Treatment and Care in Resource-Limited Setting: Experience from Nigeria

Background: Quality care is essential to the well-being and survival of people with multidrug-resistant tuberculosis (MDR-TB). The aim of this study is to explore how MDR- TB patients, who were voluntarily hospitalized, perceived care and treatment strategy and to assess the influence of psychosocial factors on their perception of care and treatment strategy in Nigeria. Methods: The study enrolled 98 MDR-TB patients on voluntary confinement in four MDR-TB hospitals in Nigeria. Patients’ perceptions of quality of care and treatment strategy were evaluated with 28-item and 6-item instruments, respectively. Bivariate analysis was used to test for an association and multivariate analysis for factors that might contribute to the perceived quality of care. Results: Seventy-eight per cent (78%) of the participating patients perceived the quality of care to be good. Patients with better psychosocial well-being had five times higher odds to report good quality of care. Conclusion: The majority of MDR-TB patients perceived the quality of inpatient care to be good in Nigerian hospitals; however, their psychological health influenced their perception significantly. Health care providers need to improve treatment strategies to encourage acceptance of care as poor perception to health care service delivery may deter treatment completion and also cause relapse among clients on treatment

Defining the research agenda to measure and reduce tuberculosis stigmas

This is an Open Access article, © 2017 International Union Against Tuberculosis and Lung Disease. Content in the UH Research Archive is made available for personal research, educational, and non-commercial purposes only. Unless otherwise stated, all content is protected by copyright, and in the absence of an open license, permissions for further re-use should be sought from the publisher, the author, or other copyright holder.Crucial to finding and treating the 4 million tuberculosis (TB) patients currently missed by National TB Programs, TB stigma is receiving well-deserved and long-delayed attention at the global level. However, the ability to measure and evaluate the success of TB stigma reduction efforts is limited by the need for additional tools. At a 2016 TB stigma measurement meeting held in The Hague, stigma experts discussed and proposed a research agenda around four themes: (1) Drivers: What are the main drivers and domains of TB stigma(s)?; (2) Consequences: How consequential are TB stigmas? How are negative impacts most felt?; (3) Burden: What is the global prevalence and distribution of TB stigma(s)? What explains any variation? (4): Intervention: What can be done to reduce the extent and impact of TB stigma(s)? Each theme was further subdivided into research topics to be addressed to move the agenda forward. These include more clarity on what causes TB stigmas to emerge and thrive, the difficulty of measuring the complexity of stigma, and the improbability of a universal stigma ‘cure’. Notwithstanding, these challenges should not hinder investments in TB stigma measurement and reduction. We believe it is time to focus on how and not whether the global community should measure and reduce TB stigma.Peer reviewedFinal Published versio

Masculinity and HIV

Paper presented at the Malawi-Liverpool Wellcome Trust Annual Scientifc Meeting, Makokola Retreat, Mangochi, Malawi, 13-16 Septembe

Abortion & contraceptive use: sites of struggle for African men

In examining men's perspectives of contraceptive use and abortion, JEREMIAH CHIKOVORE identifies contradictions and multiplicities within gender relations and dynamics that are influenced by, among other factors, colonial-era labour mobilisation practices and socio-political dynamics.

Men's perspectives of abortion and contraceptive use

Paper presented at the Men, Masculinities, and Family Planning in Africa Conference, UCLA, Los Angeles, 14-15 Octobe

AIDS related knowledge and sexual behaviour among commercial farm residents in Zimbabwe

Objective: To describe sexual behaviour among residents of commercial farms in Zimbabwe, their gender- specific differences; to examine implications of these for HIV/AIDS transmission. Design: A cross sectional descriptive study. Setting: Three commercial farming communities near Harare, Zimbabwe. Subjects: Convenience sample of 218 adult (age 18+, or ever married) farm residents. Main Outcome Measures: Number of sexual partners, secondary sexual relationships outside marriage, condom ever-use, first sexual partner, sexually transmitted disease (STD) experience, unprompted knowledge of HIV. Results: Knowledge of HIV transmission was high, with eight to 88% of respondents reporting various correct means of transmission. Males reported engaging in riskier behaviour than females, with 60% of currently married males (n=81) reporting extra marital affairs compared to 4% of currently married females (n=91) (OR: 4.02; 95% Cl: 1.8 to 9.04). Males were more likely than females to report a second or further marriage (OR: 37.9 ; 95% Cl: 16.01 to 92.1). Females were more likely than men to report first sexual partner as spouse. Fourteen percent of respondents had children of various ages outside their current union. Reported STD experiences under various circumstances were negligible with no differences by sex. Conclusion: While HIV/AIDS prevention measures largely rely on individual behavioural change, preventive efforts should also encompass differences in sexual behaviour between categories like male and female. Importantly, this will determine composition of preventive policy, but also allow a clearer determination of trends based on the gender-specific behaviours. There is also need for more research work that attends to determinants of reporting behaviour beyond aspects of reported behaviour per se.,Zimbabwe Public Health Associatio