Shifting gender norms to improve HIV service uptake: Qualitative findings from a large-scale community mobilization intervention in rural South Africa
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways Social norms around HIV testing and treatment—particularly those tied to stigma, secrecy, and gendered power—are significant barriers to service uptake for adolescent girls and young women (AGYW) in South Africa. The Tsima intervention showed that transforming these norms—by promoting open communication, supportive male involvement, and reframing testing as a collective responsibility—can increase HIV service utilization. Norm change must address both individual beliefs and the broader relational and community contexts in which health behaviors occur.
Objectives To examine how gendered social norms affect HIV testing and treatment uptake among AGYW in South Africa, and to assess how the Tsima community mobilization intervention influenced these norms to improve HIV service engagement.
Methods The study used qualitative methods to analyze 55 in-depth interviews with participants from an intervention community. This included 25 community members (48% women) and 30 intervention staff and community opinion leaders (70% women). Thematic analysis explored shifts in social norms, attitudes, and behaviors related to HIV testing, disclosure, and treatment access.
Intervention Details Tsima (“working together”) is a community mobilization intervention implemented as part of the DREAMS HIV prevention partnership. It aimed to increase engagement in HIV services by addressing harmful gender norms and promoting gender equity, communication, and shared responsibility for health. Activities included workshops, community dialogues, and training to strengthen relationship dynamics, challenge stigma, and support health-seeking behavior.
Results Findings showed that Tsima shifted gendered social norms that previously hindered HIV testing and treatment. Before the intervention, norms associated HIV testing with promiscuity and moral judgment, discouraging service uptake. Tsima helped normalize testing and treatment, especially through male engagement and improved partner communication. Participants reported that testing was increasingly seen as an act of care and responsibility rather than shame. Male partners became more supportive, and community attitudes shifted to encourage disclosure and treatment adherence.
Conclusions Norms around HIV testing and treatment are deeply gendered and often stigmatizing. The Tsima intervention demonstrated that changing these norms—by promoting empathy, partner support, and collective health responsibility—can enhance AGYW’s engagement in HIV services. Sustainable impact requires addressing both gender power dynamics and broader social expectations through community-driven approaches.
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