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Title Gendered health institutions: examining the organization of health services and men's use of HIV testing in Malawi
Full text https://escholarship.org/uc/item/7gx412ps; https://escholarship.org/content/qt7gx412ps/qt7gx412ps.pdf
Date 2020
Author(s) Dovel, Kathryn; Dworkin, Shari L; Cornell, Morna; Coates, Thomas J; Yeatman, Sara
Abstract IntroductionMen in sub-Saharan Africa are less likely to use HIV testing services than their female counterparts. Norms of masculinity are frequently cited as the main barrier to men's use of HIV testing services, but very little is known about how health institutions are organized to facilitate or impede men's care. We examined the organization of health institutions in Malawi, and implications for men's use of HIV testing services.MethodsA mixed methods ethnography was conducted in Malawi between October 2013 and September 2014. National Ministry of Health guidelines from 2012 to 2014 were analysed, counting the frequency of recommended preventative services by sex. In-depth interviews were conducted with 18 healthcare workers and 11 national key informants (29 total). Five rural health facilities participated in direct observation and 52 observational journals were completed to document the structure and implementation of HIV services within local facilities. All data were analysed using the theory of gendered organization. Findings were grouped into one of the three theoretical levels of organization: (1) organizational policy; (2) organizational practice; and (3) structure of gendered expectations.ResultsHealth institutions were gendered across three levels. Organizational policy: National guidelines omitted young and adult men's health during reproductive years (176-433 recommended visits for women vs. 32 visits for men). Health education strategies focused on reproductive and child health services, with little education strategies targeting men. Organizational practice: HIV testing was primarily offered during reproductive and child health services and located near female-focused departments within health facilities. As these departments were women's spaces, others could easily tell that men were using HIV services. Structure of gendered expectations: Clients who successfully accessed HIV testing services were perceived as exemplifying characteristics that were traditionally considered feminine: compliance (obeying instructions without explanation); deference (respecting providers regardless of provider behaviour); and patience ("waiting like a woman").ConclusionsHealth institutions in Malawi were organized in ways that created substantial, multilevel barriers to men's HIV testing and reinforced perceptions of absent, difficult men. Future research should prioritize a gendered organization framework to understand and address the complex realities of men's constrained access to HIV services.
Subject(s) Biomedical and Clinical Sciences; Health Services and Systems; Public Health; Clinical Sciences; Health Sciences; HIV/AIDS; Prevention; Clinical Research; Sexually Transmitted Infections; Health Services; Women's Health; Infectious Diseases; Infection; Generic health relevance; Reproductive health and childbirth; Good Health and Well Being; Adolescent; Adult; Delivery of Health Care; Female; HIV Infections; HIV Testing; Health Education; Health Personnel; Humans; Malawi; Male; Masculinity; Men's Health; Patient Acceptance of Health Care; Rural Population; Young Adult; gender health disparities; health institution; HIV; HIV testing; men; sub-Saharan Africa; Public Health and Health Services; Other Medical and Health Sciences; Clinical sciences; Epidemiology; Public health
Coverage e25517
Publisher eScholarship, University of California
Type of publication article
Format application/pdf
Source Journal of the International AIDS Society, vol 23, iss Suppl 2
Rights public
Identifier qt7gx412ps; info:doi/10.1002/jia2.25517
Repository Berkeley - University of California
Added to C-A: 2024-08-26;09:36:18