Gender Norms and HIV Testing/Treatment Uptake: Evidence from a Large Population-Based Sample in South Africa.
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus
View SourceObjectives This study investigated how endorsement of inequitable gender norms influences HIV testing and treatment uptake among men and women in rural South Africa, addressing a gap in quantitative research on this topic.
Methods Data were drawn from a 2014 population-based survey of 2,057 individuals (1,053 women and 1,004 men), aged 18–49, in 27 villages in Mpumalanga province. Gender norms were measured using the Gender Equitable Men (GEM) Scale, including four sub-domains: men’s control and violence, male decision-making, avoidance of help-seeking, and women’s caregiving responsibilities. Weighted logistic regression models were used to assess associations between gender norms and HIV testing in the past 12 months and current ART use, stratified by gender.
Results Support for inequitable gender norms was high among both men and women, particularly regarding caregiving roles and male decision-making authority. Among women, endorsement of inequitable norms—especially those around caregiving—was associated with increased HIV testing, likely due to testing during pregnancy. However, these same norms were linked to significantly lower ART use among HIV-positive women, particularly norms related to male control, male dominance, and help-seeking avoidance. Among men, endorsing male decision-making authority was significantly associated with lower ART use but not with HIV testing. Communication with a partner about HIV testing was positively associated with testing for both genders.
Conclusions Gender norms significantly influence HIV service use, with inequitable norms acting as barriers to sustained ART use, especially for women. While some norms appear to encourage testing, often due to maternal health services, they do not translate into continued care and treatment. Distinguishing between types of norms is critical to understanding these dynamics.
Key Social Norms Take-aways The study underscores the importance of addressing specific dimensions of gender norms in HIV programs. Norms around male control and women’s caregiving roles influence service uptake in complex ways—facilitating testing in some contexts while hindering treatment adherence. Programs aiming to improve HIV outcomes must move beyond broad messages about gender equity and instead target the particular norms most associated with harmful behaviors, especially for women navigating both health care systems and relationship power dynamics.
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