The table below shows demographic characteristics of respondents whose age ranged from 25–60 years and the majority were above 35 years and were married (80%) as described in the Table 1 below.
Table 1
Demographics of study participants (N = 50)
Characteristics | N | % |
Age (years) 25–34 ≥35 years | | |
15 | 30 |
35 | 70 |
Marital status Married Common law relationship | | |
40 | 80 |
10 | 20 |
Education Primary Secondary | | |
41 | 82 |
9 | 18 |
Occupation Peasant Community Health Workers Healthcare Workers Village Leaders Driver | | |
42 | 84 |
2 | 4 |
2 | 4 |
3 | 6 |
1 | 2 |
The three themes found in this study include: 1. Fear of HIV testing, 2. Gendered male norms and roles and 3. Financial and material insecurity.
Theme 1: Fear of HIV testing
Respondents revealed that men fear taking the HIV test and the social stigma that accompanies having a test, testing positive and compromised confidentiality about test results. The fear of HIV is a collective fear, accompanied by social stigma in the community; however, respondents share that women may be disproportionately bearing the responsibility of being tested. Respondents shared that men may prefer their partner to attend ANC, take the HIV test and as a result many men will assume that their result is the same.
One respondent explains, “Men are unwilling to be tested for HIV. They just tell their women, you go alone, if you are HIV negative, I am also negative” (Father with one child). Given that HIV testing is mandatory during ANC visits, male involvement in this portion of maternal care is subsequently impacted more than other aspects of maternal and newborn care.
The fear of HIV testing is augmented by the fear that others will overhear their diagnosis or that healthcare workers breach confidentiality and may reveal a positive HIV test in front of others or share it with others without consent. Several respondents shared experiences that increase their fear of being stigmatized. One participant noted that confidentiality was not honored in the clinic:
“Some community members noticed that I was seated somewhere privately with a healthcare worker. To my surprise they asked the nurse about the conversation and this nurse revealed to him about my result. Next time I will not tell her a thing” (Father with more than one child).
“Help us with the treatment we receive from our healthcare providers, health providers should not reveal the secrets of the patients because when they do that, that person won’t tell them a thing when they meet her/him again, even if she has some illnesses, she/he won’t tell them because they are not trustworthy” (Father with one child).
Another respondent shared that community members may know the results of a man’s HIV test, and they assert that healthcare workers are sharing this information and breaching confidentiality. Some individuals noted that the physical space is often not conducive to private conversations, increasing the risk of men experiencing discomfort in taking the HIV test and desire better spaces at health facilities. One respondent explained:
“The Government should create more privacy so that there can be space to accommodate people to talk freely with a health provider so that what you tell her remains there and you do not hear about it elsewhere.” (Expectant father).
Theme 2. Gendered male norms and roles
Participants shared several impacts of the locally held beliefs about male and female roles in the community that can create a fear of social stigma for men. Attending and being part of ANC is often considered a ‘woman’s issue’ and many men report feeling shame and a fear of being laughed by their fellow men if they escort their partners to the health facility.
A father shared, “we have a shame, shame is upon us we men to attend clinic. The shame comes when we escort our wives, other men will laugh at you…” (Father with more than one child).
The act of men walking together with their partner and attending health facility visits is impacted by cultural beliefs. Sukuma tribe members hold the belief that men are being controlled or charmed by their partners, which conflicts with their roles as a man. A man explained:
“The community believes that if you’re with your wife all the time people will say (heeee) this man has been whipped, set under control of a woman that’s why we are not going” (Father of one child).
When couples arrive at the clinic, there are further discomforts for men and women. Culturally, it is not common for men and women to sit together in most gatherings. The father report that.
“sitting together in the waiting spaces or on the same bench is “uncomfortable to sit with many pregnant women…while there are no other men.” (Expectant father).
Having multiple sexual partners among men is an accepted norm in the study site. Yet, there is perception among men that while having a concubine is common, it is still done in secrecy. This results in men not attending appointments with women to avoid being seen by others with someone who is not their wife.
You find most of men have more than one family, so if he escorts a concubine and that man is seen by other people at the clinic, it will be revealed that he escorted another woman, that will become a barrier to escort a woman to ANC. Because men fear family conflict which may arise if he is seen with a concubine at the health facility (Father of one child).
“You find someone went out of his marriage then the woman faces challenge to come with him to clinic as others will know, that’s why they pick other men such as “boda bodas drivers” to satisfy health providers that they came with their husband” (Health care provider).
Theme 3. Financial and material insecurity
Respondents reported several experiences that contribute to insecurity, shame, and fear of being judged by health facility workers or community members. Some respondents disclosed that for Sukuma speakers, not being able to understand or speak Swahili contributed to insecurity and resistance to attend the health facility. One participant described:
“In my opinion some men do not escort their partners because they are afraid of being asked questions at the health facility, so they are shy and unconfident of expressing themselves in Swahili language if the HCW does not communicate tribe language (Sukuma)” (Father with more than one child).
“… other men are afraid to come to our facility because they have not prepared their wives with the requirements for individual birth preparedness, others are afraid to come because of economic status, so mostly those are the reasons” (Healthcare provider).
In the Sukuma community, the family is expected to bring clothes (Khanga) and other materials for the delivery of the baby. For some families who lack the economic means to provide materials or who lack the proper attire, reported shame for being unable to provide the clothes and materials. One of the respondents shared a story about a man who escorted his wife without the required clothes to support the woman after delivery:
“Some men do not escort their pregnant woman because first of all they do not take good care of them in terms of buying nice clothes, so they feel ashamed when they go together with a woman who has no proper attires” (Village Leader).
“I observed in one facility there was one man who came with his wife with one pair of cloth (khanga), and when that woman gave birth that man was asked to give his shirt in order to clean his wife’s blood, that man was embarrassed, and he said he will not attend the facility unless he has clothes for her wife” (Community Health Worker).
In Sukuma culture, it is important for men to be the provider and are considered the ‘head of the household’ and being perceived as unable to provide for their wife and baby is a large barrier in attendance to ANC and delivery services.