HIV this week

Burkina Faso / Gender-Access to Treatment: Gender asymmetry in healthcare-facility attendance of people living with HIV/AIDS in

15 Nov, 2009
By: Bila B, Egrot M.

Anthropological research in Burkina Faso indicates that more HIV-positive women than HIV-positive men are attending care facilities for people living with HIV and accessing antiretroviral medicine.

This article, situated in the field of study of interactions between gender and AIDS, offers a description of this asymmetry and an anthropological analysis of the socio-cultural determinants, through analysis of data from ethnographic research among people living with HIV and health actors.

Examining social representations of femininity and masculinity in Burkinabe society and the organisation of the healthcare system in connection with gender shed light on the decision-making processes of both sexes around therapeutic choices and the itinerary of care.

On the one hand, the social values attached to femininity, maternity and the status of wife create conditions for women that favour their attendance at care facilities for people living with HIV and encourage a widespread practice where wives take the place of their husbands in healthcare queues. Moreover, health policies and the effects of women’s empowerment within the healthcare system strengthen women’s access to health services. On the other hand, representations of masculinity are fully implicated in the cultural construction of men’s reluctance to attend care facilities for people living with HIV. The values associated with this masculinity cause men to run great health, economic and social risks, not only for themselves, but also for their wives and children.

By better understanding the interaction between gender, the experience of HIV and the institutional organisation of healthcare, we can identify ways to reduce men’s reluctance to attend care facilities for people living with HIV and improve both prevention and treatment-oriented programmes.

HIV this Week editors’ note:

This thoughtful article is an interesting read. Although the effects of gendered systems in sub-Saharan Africa create socioeconomic disadvantage and vulnerability for women compared to men, men are caught up in representations of masculinity that do not allow them to overcome their feelings of shame to seek care. These feelings centre both on having HIV infection and on needing external support for food, medicine and school supplies. In contrast, women’s feelings of obligation to be in good health so as to care for their children now and over the long-term motivate them to seek treatment, food, and school supply support readily at health care facilities. The result is that 2 men are followed clinically for every 3 to 6 women despite equivalent HIV prevalence. The solution is not separate service provision, although food support could be accessed at non-HIV care settings using vouchers, and is likely multi-faceted. Awareness raising focused on encouraging men living with HIV to value their social responsibility to their families and seek care might be a good start.