HIV/AIDS

Question 1

HIV IS NOT EQUITABLY DISTRIBUTED

Answer 1

• varies along range of lines; NOT only gender:
  1. wealth/poverty
  2. race
  3. settlement type (urban informal = highest; urban formal = lowest)
  4. age

Question 2

DOMINANT APPROACHES TO PSYCH & HIV

Answer 2

• theory of planned behs
• knowledge/attitudes/practices
  CAMPBELL (2003)
• shift towards focusing on identity/beh & how it shapes our understanding of HIV pandemic
  MURRAY & CAMPBELL (2003); WALDO & COATES (2000)
• implicitly focus on individual
• role of identities in shaping beh
  MCEACHEN ET AL. (2011)
• limited explanatory value to models (ie. TPB; safer sex/abstinence from drugs = poorly predicted (between 13.8-15.8% variance explained)
• short-run self-reported behs = better

Question 3

PSYCHOLOGY OF MASCULINITIES

Answer 3

CONNELL (1995)
- hegemonic masculinity (most valorised masculinity form) links identity/behs
- all other masculinities formed in relation/opposition to this:
1. complicit (exaggerated)
2. marginalised
3. subordinated
4. protest
VANDELLO & BOSSON (2013)
- masculinity = unstable; hard-won; must be constantly proven

Question 4

FLEMING ET AL. (2016)

Answer 4

• review of published research on masculinities/sexual risk beh
• assumption/norm of uncontrollable sex drive
• capacity to perform sexually
• power over others

Question 5

JACQUES-AVINO ET AL. (2019)

Answer 5

• separate research found ideology of masculinity associated w/:
  1. multiple partners
  2. heterosexual beh
  3. uncontrollable sexual desire thus justifying risk beh
  4. invulnerability to HIV/STIs

Question 6

LIMITED RESEARCH ON MASCULINITY

Answer 6

• multiplicity of masculinities & how this may impact such behs
• understanding where masculinities emerge from
• fluidity of masculinity; comes across as stereotypes

Question 7

UNAIDS SPECIAL ANALYSIS (2017)

Answer 7

• blind spot; reaching out to men/boys
• main focus of HIV in SSA has been on women; women = largest number of people living w/HIV
• men consistently less likely test for HIV/be on treatment/be virally suppressed)
• men who aren’t virally suppressed impacts their/their partners sexual health

Question 8

SILEO ET AL. (2019)

Answer 8

• summary of key findings on notions of masculinity that serve as barriers/facilitators to HIV care engagement; presented by stages of HIV care continuum
• linkage to care/art initation
• clinic attendance/retention
• art adherence

Question 9

SIKWEYIYA ET AL. (2015)

Answer 9

• 18 qualitative interviews w/men living w/HIV
• prior to HIV-diagnosis many had emphasised masculinity aka. youthful masculinity
• after HIV-diagnosis some men “grieved” loss of future (ie. whether they could have kids; failing to idealise notions of masculinity)
• diminished masculinity (particular concerns about being cared for)
• coping strategies (ie. not testing for HIV/not telling others)
• BUT some men used this as change for “re-birth” and responsible masculinity emerged

Question 10

DOVEL ET AL. (2015)

Answer 10

• contexts/health systems impact on men’s access to testing/treatment
• much of literature implicity blames men for poor use of testing/treatment focusing on role of masculinity as primary explanation
• BUT recent data raises doubt that masculinity is main culprit
• men = just as likely as non-pregnant women to initiate voluntary counseling/testing
• once tested positive men initiate ART at similar rates as women

Question 11

NGUYEN (2010)

Answer 11

• do health systems restructure people’s identities?
• technologies (HIV testing/treatment) did more than train people to produce illness narratives; equipped individuals to talk about themselves and get others to too
• self was made available as “substrate” that could be examined/prodded/discussed/worked upon; these incitements to disclose shaped social relations around those who mastered arts of asking/telling/listening
• conjured “self” into powerful life-giving force

Question 12

SUMMARY

Answer 12

• HIV = global issue; impacts dif countries/people differentially
• psych has been central to understanding HIV BUT oft in limited ways
• social identities on people’s risk of acquiring HIV on testing/treatment behs (focused on men’s masculinities)
• social contexts (health institutions) also impacy on people’s access to HIV prevention/treatment services
• institutions potentially impact on people’s identities