Amsterdam 2015
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| Abstract #2387 - Comorbidity - double jeopardy | ||||
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Session: 23.3: Comorbidity - double jeopardy (Parallel) on Wednesday @ 16.30-18.00 in 202 Chaired by Margalit Lorber, Simon Rackstraw Authors: Presenting Author: Dr Jeremiah Chikovore - Human Sciences Research Council, South Africa |
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| Aim: Men delay seeking healthcare resulting in their higher mortality while on HIV or tuberculosis (TB) treatment, and contributing to on-going community-level disease transmission before going on treatment. This study aimed to generate understandings into the basis for men’s delay in seeking healthcare for TB. The study drew on Connell’s conception of masculinities as being patterns of practice by which both men and women, though predominantly men, engage the position of men in a gender order. | ||||
| Method / Issue: A qualitative design was employed and chronic cough was used as a proxy for TB. Data were gathered from community members (8 focus group discussions [FGD] that were either mixed or segregated by sex) healthcare workers (2 mixed-sex FGDs) TB patients (20 in-depth interviews [IDI], 8 women), un-investigated chronic coughers (20 IDIs, 13 women), and health stakeholder representatives (three-day participatory workshop with 27 participants). The research process made use of grounded theory principles as espoused by Strauss and Corbin and also Charmaz. | ||||
| Results / Comments: Two themes describing perspectives and experiences of men with respect to chronic cough are presented. Firstly, in a context of high HIV prevalence, any prolonged cough generates immense anxieties over perceptions that it may be connected to disease considered serious. The anxieties, together with actual experiences of seeking care, interact with masculinity notions in ways that deter early or even late stage healthcare-seeking. Secondly, contrary to common masculinity representations, during healthcare seeking and if a serious diagnosis is imminent, men assume a vulnerable posture, turning to close family for psychosocial and material support. When confirmed as having a serious diagnosis, they equally assume more subordinate roles in their families and relationships. Linked to this, they embrace their diagnosis along with the treatment that is entailed. | ||||
| Discussion: Integrated TB/HIV management and prevention is now promoted for resource-constrained settings. Similarly, a public health approach is employed where laboratory services are expensive or unavailable, to expedite and improve care by using a few key symptoms and signs to dictate a standard package of care. This study illuminates how in spite of their public health value, the two approaches ~ through the mediation of dominant masculinity notions and perceptions about the link between HIV and TB ~ engender anxiety and disquiet around seeking healthcare. In addition, although men’s behavior is often attributed to their pursuit of dominant masculinity images, the study portrays men who are facing serious illness acquiescingly taking up subservient and dependent positions within their social relationships and households. Seldom highlighted, these representations, plus the role of family and social contexts in supporting men affected or threatened by serious illness, need to be recognized by policy. Services must also be cognizant of and cater for the different phases men undergo as they deal with serious illness and engage with healthcare. | ||||
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