Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention.

OBJECTIVES: Increasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing. DESIGN AND SETTING: A cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique. PARTICIPANTS: Data were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731). MEASURES: Measures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates. RESULTS: Significantly fewer men (38.3%) than women (47.6%; p<0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women. CONCLUSIONS: Men have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men's engagement into the HIV care continuum in sub-Saharan Africa.

Effectiveness of Community Dialogue in Changing Gender and Sexual Norms for HIV Prevention: Evaluation of the Tchova Tchova Program in Mozambique.

Structural HIV prevention interventions have gained prominence as ways to address underlying social and cultural factors that fuel the HIV epidemic. Identifying theories that explain how structural interventions are expected to change such factors can substantially increase their success. The Tchova Tchova community dialogue program, a theory-based intervention implemented in 2009-2010 in the provinces of Zambezia and Sofala, Mozambique, aimed to change gender and sexual norms for HIV prevention. Through facilitated sessions, the program sparked critical thinking and open dialogue among participants. This article measures the program's effectiveness based on a sample of 462 participants and 453 nonparticipants. The results show that the program was successful in producing changes in three of the underlying structural factors of HIV: gender attitudes, gender roles, and HIV stigma. The program was also successful in changing other factors associated with HIV infection, including HIV prevention knowledge, discussion of HIV between sex partners, and having multiple sex partners.

Juventudes, raça e vulnerabilidades / Adolescents, races and vulnerabilities

O objetivo do artigo é identificar os fatores estruturais e comportamentais associados ao uso de preservativos entre jovens na faixa etária de 16 a 24 anos e sexualmente ativos nos 12 meses anteriores ao levantamento da pesquisa Comportamento Sexual da População Brasileira e Percepções do HIV/AIDS, 1998 (Cebrap/PCN-DST/AIDS), segundo raça/cor e sexo. Foram estudados 9.322 jovens (59% de homens e 41% de mulheres). As variáveis estruturais e comportamentais foram tratadas segundo o modelo estatístico log linear Chaid (Chisquared Automatic Interaction Detector). A maior proporção de usuários de preservativos foi encontrada entre brancos e negros não unidos, e a menor adesão, entre aqueles com parceiros estáveis eventuais, especialmente entre jovens negras. O estudo mostrou que estão mais vulneráveis aos sexo desprotegido os unidos e os solteiros em relações eventuais, ou estáveis e eventuais, e aqueles com maior escolaridade e pertencentes aos estratos socioeconômicos mais altos, especialmente mulheres e negros.