Late presentation for HIV care among adult men aged 18 years and above at Family Hope Centre, Jinja District: prevalence, associated factors and the role of masculinity norms.

Abstract

Introduction and Background: In 2015, WHO recommended that all people living with HIV start Antiretroviral Therapy (ART) irrespective of clinical or immune status (WHO, 2015). Most national guidelines including those in Uganda have adopted this recommendation (MoH, 2016). Men have poor health seeking behaviour and require unique interventions to ensure that they seek HIV care once positively diagnosed. Several strategies to test all men aged 25 years and above at high yield testing points coupled with same day ART initiation under the test and treat policy have been put in place in several districts including Jinja. This was to increase the number of males enrolled on ART early in the course of infection (MoH, 2018). However, approximately more than half (57%) of adult men newly initiated on ART in Jinja district present late to care with baseline CD4 of <200 cells/microliter and/or WHO stage 3 and 4 (Jinja District HIV focal person, 2019). This study therefore sought to determine factors associated with late presentation for HIV care among adult men and the role of masculinity norms in the district. Methods: This study utilized a cross-sectional study design, involving both quantitative and qualitative methods of data collection which were conducted concurrently. Data on the prevalence and factors associated with late presentation among adult men for HIV care was collected from 394 HIV positive adult men receiving care at Family Hope Centre, Jinja using semi-structured questionnaires and data abstraction forms. Data on the role of masculinity norms in men’s late presentation for HIV care was collected using In-Depth Interviews (IDIs; n=20) and Focus Group Discussions (FGDs; n=4) among HIV positive adult men who had presented late and HIV negative men and women in the community respectively. These were conducted to get an in-depth and broad understanding of the role of masculinity norms in that context. Quantitative data was analysed using STATA statistical software version 14. Modified Poisson regression analysis, with robust standard errors was used to determine association between late presentation to HIV care and independent variables at 95% CI. For the qualitative data, all 24 audio interviews were transcribed verbatim and typed into Microsoft Word with direct translation into English. Transcripts were subjected to conventional content analysis approach. Results: The proportion of adult men who presented late for HIV care was 79.4%. Men were less likely to present late to HIV care if they were; aged 25-34 years [Adj. PR 0.13; 95%CI: 0.03-0.60], 35-49 years [Adj. PR 0.47; 95%CI: 0.24-0.91] and having been supported by family [Adj. PR 0.36; 95%CI: 0.18-0.73]. Key themes generated for the role of masculinity norms included; fear of consequences, men’s roles and responsibilities, and absence of HIV symptoms at diagnosis. Conclusion: Late presentation for HIV care among adult men in Jinja is quite high. There’s need for a concerted effort by various stakeholders to strengthen efforts targeting adult men. Supportive social spaces in which men can re-negotiate masculinities that are more aligned to their presentation for care also need to be created. Further research is also needed to understand how masculinity norms can serve as a facilitator to men’s presentation for HIV care.