Abstract

Evidence from nationally representative surveys conducted in sub-Saharan Africa shows that significant proportions of men in the wealthiest quintile report never having tested for HIV. Despite high prevalence rates in this quintile, no research has been conducted on the HIV testing attitudes and practices of wealthier men. This article reports findings from qualitative research conducted with 23 wealthy men in Tanzania. Whilst wealthy men reported barriers to and enablers of HIV testing previously reported by the general population, concerns around loss of social status and community standing were amplified for members of this demographic. Furthermore, HIV stigma among members of this group remains high. However, enhanced access to HIV testing through private clinics, regular healthcare appointments, health insurance schemes and the means to travel to other countries enables wealthy men to avoid stigma. In settings such as the workplace, wealthy men were able to test in public in their roles as ‘leaders’ to encourage others to test. Future interventions to increase testing amongst men should target settings in which these leadership roles can be taken advantage of. HIV services also need integrating into the health system to remove the need for testing and treatment to be accessed at separate clinics.

摘要

在撒哈拉以南非洲进行的具有全国代表性的调查的证据表明，在最富有的五分之一报告中，很大比例的男性从未进行过艾滋病毒检测。尽管这五分之一的流行率很高，但尚未对富裕男性的艾滋病毒检测态度和做法进行研究。本文报告了对坦桑尼亚 23 名富人进行的定性研究的结果。虽然富人报告了普通人群之前报告的艾滋病毒检测的障碍和促成因素，但对于这一人群的成员来说，对社会地位和社区地位丧失的担忧被放大了。此外，该群体成员中的艾滋病毒耻辱感仍然很高。然而，通过私人诊所、定期医疗预约、健康保险计划和前往其他国家旅行的方式使富人能够避免污名化。在工作场所等环境中，富有的男性能够以“领导者”的身份在公共场合进行测试，以鼓励其他人进行测试。未来增加男性检测的干预措施应针对可以利用这些领导角色的环境。艾滋病毒服务也需要整合到卫生系统中，以消除在不同诊所进行检测和治疗的需要。