Guest writer: Helen Farrer
There are an estimated three million people living with HIV in Nigeria, where high-risk groups such as female sex workers, men who have sexual relations with men and addicts who inject drugs, pose the highest risk for the development of new infections. The overall infection rate in the general population is relatively low, yet Nigeria is a vast country where HIV infection remains an issue of concern. To keep infection rates down, early diagnosis and treatment is key, yet sadly, social stigma stops many men from seeking the help they need.
A recent study by scientists at Binghamton University in New York has found that the extent to which males meet cultural ideals of masculinity in Nigeria, can impact the extent of stigma they experience. The study, led by Titilayo Okoror, a professor of African studies, involved extensive interviewing of 17 heterosexual men with HIV in Nigeria, all of whom were being treated with antiretroviral therapy. The researchers analysed the way participants’ experiences with stigma depended on their social circumstances when they were diagnosed with HIV, and on whether or not they met idealised standards of masculinity.
The findings showed that men who had become ill before being diagnosed with HIV, were more likely to feel isolated and stigmatised. Their idea of their own masculinity was also likely to be hampered. On the contrary, men with family members who had obtained an HIV diagnosis before they did, were less likely to feel the sting of stigma, and more likely to express an interest in increasing others’ awareness of the illness. In other words, when men felt that they met constructed ideals of manhood (which, in Nigeria, involved being healthy and strong and having gainful employment), they were less likely to report that they had been stigmatized. On the other hand, those who had felt ill for a long time before obtaining a diagnosis, perhaps staying home for various months because they did not have the strength or energy to work outside their homes, were more likely to feel that they were being ousted by their community.
Professor Okoror noted that HIV programmes in Nigeria need to take on a new focus. Early detection is key, since the sooner men are diagnosed and treated, the less likely they are to feel ill. Okoror noted that in Nigeria, married men are more likely to obtain an early diagnosis, than unmarried men. This may be because marriage bolsters the idea of the man being the strong, capable, stable individual, which comes close to idealised constructs of masculinity.
Early diagnosis and treatment does not only protect the person with HIV, of course; it also reduces the likelihood of the disease spreading. Men who are aware of their condition are less likely to indulge in risky behaviour, which may include having unprotected sex, sharing needles, etc. They are also less likely to suffer from depression and hopelessness, which in turn is linked to harmful activities such as substance abuse and alcoholism. Men can continue to feel healthy and energetic for many years if they start antiretroviral therapy early, since ART significantly reduces the likelihood of developing serious HIV-related infections. In 126 studies based on data obtained from almost 500,000 HIV patients, scientists found that there was a major reduction (between 57 and 91 per cent) in the likelihood of patients obtaining common HIV-related infections such as bacterial pneumonia, oral thrush, tuberculosis and shingles. The difference in infection rates was most dramatic in the first year of treatment.
Okoror hopes that new government programmes in Nigeria let men know that by getting tested sooner rather than later, they can avoid feeling sick at all. After they obtain their diagnosis, they can keep their medical information private, yet receive the treatment that will enable them to carry out a normal life, which includes work and social relationships. Men can also take important steps to ensure that the infection is not passed to third parties, and evade the mental anguish that can come with a diagnosis of late-stage HIV or AIDS. The study, entitled Social context surrounding HIV diagnosis and construction of masculinity: a qualitative study of stigma experiences of heterosexual HIV positive men in southwest Nigeria, can be read in the journal, BMC Public Health.