Rural men keep silent on HIV for fear of rejection

Men in rural KwaZulu-Natal are still reluctant to disclose their HIV status, fearing public ridicule and rejection.

A study examining the health behaviours and experiences of HIV-positive men receiving antiretroviral treatment (ART) in rural districts, showed men preferred to keep their status secret as they didn't want to become the subject of gossip.

The senior author of the study, Victoria Hosegood of the University of KwaZulu-Natal's faculty of health sciences, said men felt as if they were failing in their roles as husbands, partners, fathers and breadwinners.

"Their identity is questioned and they find it difficult to be open about their HIV status. Men's reaction to telling other men was problematic, probably due to lack of trust with the information and being treated with disrespect. Disclosing information to the community was seen as extremely dangerous," said Hosegood.

In-depth interviews were conducted with 30 participants and their families at hospitals and clinics in the Umkhanyakude district - the northernmost area of KwaZulu-Natal - where 44% of men between the ages of 30 and 34 are HIV-positive.

Said Hosegood: "During interviews, men ... became less confident, (more) anxious and pensive. There is a great deal of concern about what will happen if that information is actually made public."

Instead of directly telling family members they were HIV-positive, the men would leave their medication on a table.

"For some, their experiences had already been quite negative just by being sick. Having the knowledge of being HIV-positive is something they cannot undo and they feel threatened, particularly by the men in their community."

Researchers also found that alcohol abuse in men made them believe that they were excluded from treatment programmes.

"Knowing that ART programmes discouraged alcohol use, they felt they were prohibited from entering the programme until they could stop or reduce alcohol use. Alcohol was described as an important coping mechanism."

Hosegood said men seemed to delay more in accessing healthcare than women.

However, the study showed men were interested in receiving help in disclosing information to their partners and family in the form of couples counselling - but women refused.