Be tough: masculine identities and viral load suppression among adolescent boys on antiretroviral therapy in Siaya County, Kenya

Simon Peter; Erick Otieno Nyambedha; Charles Omondi Olang'o

doi:10.18203/2394-6040.ijcmph20254018

Authors

Simon Peter Department of Sociology and Anthropology, Maseno University, Kenya
Erick Otieno Nyambedha Department of Sociology and Anthropology, Maseno University, Kenya
Charles Omondi Olang'o Department of Sociology and Anthropology, Maseno University, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20254018

Keywords:

Adolescent boys, Ante-retroviral therapy, HIV and AIDS, Masculine identities, Viral load suppression

Abstract

Background: Viral load suppression among adolescent boys is critical in the fight against HIV and AIDS globally. Contrary to the reduction noted in other age groups, mortality among adolescents aged 14-19 related to AIDS has continued to rise worldwide. This age group recorded 41,000 deaths in 2020 up from 18,000 in 2010, with boys constituting 69%. In Siaya County, 68% of AIDS-related deaths occurring among 14-19 adolescents in 2020 were boys. Although men’s poor health outcomes have been linked to masculinities, a paucity of literature exists on how this extends to adolescent boys. This paper sought to investigate how endorsement of masculine identities has influenced VL suppression among adolescent boys on ART in Siaya County of Kenya.

Methods: This cross-sectional study used questionnaire to collect data from 263 adolescent boys on ART. Six focus group discussions were held with the boys and another six with PBO officials, while six in-depth interviews and five key informant interviews were respectively held with selected adolescent boys and healthcare practitioners and government officers.

Results: Endorsement of masculine identities were found to have a negative influence (B=-0.323; p=0.000) on VL suppression, significantly contributing to an estimated 24.8%-unit changes (R2=0.248, p=0.000).

Conclusions: Socialization to be tough, fearless and aggressive as well as to shun expressing emotions has led to poor attendance of medical appointments and uptake of ART among the adolescent boys, hence negatively affecting VL suppression. Targeted interventions should aim at addressing such barriers among the adolescent boys.

Metrics

Metrics Loading ...

References

Kanyemba R, Govender K, Dzomba A. HIV Focused sexual risk-reduction interventions targeting adolescent boys and young men in Sub-Saharan Africa: a scoping review. AIDS and Behavior. 2023;27(10):3356-91. DOI: https://doi.org/10.1007/s10461-023-04054-8

Biney IJK, Kyei KA, Ganu VJ. Antiretroviral therapy adherence and viral suppression among HIV-infected adolescents and young adults at a tertiary hospital in Ghana. African J AIDS Res. 2021;20(4):270–6. DOI: https://doi.org/10.2989/16085906.2021.1998783

Hosek S, Pettifor A. HIV prevention interventions for adolescents. Current HIV/AIDS Reports. 2019;16(1):120-8. DOI: https://doi.org/10.1007/s11904-019-00431-y

Rassool GH. Alcohol and drug misuse: A guide for health and social care professionals. Routledge. 2024. DOI: https://doi.org/10.4324/9781003456674

Explainer UN. Undetectable= Untransmittable Public Health and HIV Viral Load Suppression. Geneva: UNAIDS. 2018.

Stover J, Glaubius R, Teng Y, Kelly S, Brown T, Hallett TB, Revill P. Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030. PLoS Med. 2021;18(10):1003831. DOI: https://doi.org/10.1371/journal.pmed.1003831

Han WM, Law MG, Egger M, Wools-Kaloustian K, Moore R. Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries. lancet HIV. 2021;8(12):766-75. DOI: https://doi.org/10.1016/S2352-3018(21)00265-4

Bilek HC, Deveci A, Aksakal-Tanyel E. " 90-90-90" Hedefleri Bağlamında Tek Merkez HIV/AIDS Kohortu Değerlendirmesi. Klimik Journal/Klimik Dergisi. 2020;33(1).

Waju B, Dube L, Ahmed M. Unsuppressed Viral Load Level in Public Health Facilities: Non virological Predictors among Adult Antiretroviral Therapy Users in Southwestern Ethiopia. HIV/AIDS - Research and Palliative Care. 2021;13:513–26. DOI: https://doi.org/10.2147/HIV.S304653

Zurbachew Y, Hiko D, Bacha G. Adolescent’s and youth’s adherence to antiretroviral therapy for better treatment outcome and its determinants: multi-center study in public health facilities. AIDS Research and Therapy. 2021;20(1):870. DOI: https://doi.org/10.1186/s12981-023-00588-y

Brittain K, Asafu-Agyei NA, Hoare J, Bekker LG, Rabie H, Nuttall J, et al. Association of adolescent-and caregiver-reported antiretroviral therapy adherence with HIV viral load among perinatally-infected South African adolescents. AIDS and Behavior. 2018;22(3):909-17. DOI: https://doi.org/10.1007/s10461-017-2004-2

Mboggo E, Mtisi E, Mushy SE, Mkawe S. RETRACTED ARTICLE: Determinants of viral load suppression failure among HIV adults on ARV attending health care facilities: a retrospective study in Tanga region, Tanzania. BMC Infect Dis. 2024;24(1):312. DOI: https://doi.org/10.1186/s12879-023-08604-2

Gunda DW, Nkandala I, Kilonzo SB, Kilangi BB, Mpondo BC. Prevalence and risk factors of mortality among adult HIV patients initiating ART in rural setting of HIV care and treatment services in North Western Tanzania: a retrospective cohort study. J Sex Transmitted Dis. 2017;20(1):7075601. DOI: https://doi.org/10.1155/2017/7075601

Seidler ZE, Dawes AJ, Rice SM, Oliffe JL, Dhillon HM. The role of masculinity in men's help-seeking for depression: a systematic review. Clin Psychol Rev. 2016;49:106-18. DOI: https://doi.org/10.1016/j.cpr.2016.09.002

Olanrewaju FO, Ajayi LA, Loromeke E, Olanrewaju A, Allo T, Nwannebuife O. Masculinity and men’s health-seeking behaviour in Nigerian academia. Cogent Soc Sci. 2019;5(1):1682111. DOI: https://doi.org/10.1080/23311886.2019.1682111

Omobowale MO, Akpabio OE, Amodu OK. Masculinity and Neighborhood Bullying among Adolescents in Ibadan, Nigeria: A Research Note. Boyhood Stud. 2019;12(1):1-6. DOI: https://doi.org/10.3167/bhs.2019.120102

Okonji EF, Van Wyk B, Mukumbang FC, Hughes GD. Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis. AIDS Res Ther. 2021;18(1):66. DOI: https://doi.org/10.1186/s12981-021-00391-7

Lundgren R, Burgess S, Chantelois H, Oregede S, Kerner B, Kågesten AE. Processing gender: lived experiences of reproducing and transforming gender norms over the life course of young people in Northern Uganda. Cult, Heal Sex. 2019;21(4):387-403. DOI: https://doi.org/10.1080/13691058.2018.1471160

Ngumo MC, Yieke F, Onyango JO. Multiple and unstable masculinities: a critical discourse analysis of masculine identities in pullout magazines in Kenya. Language Text Society. 2020;7(2):3672.

Blommaert E. Aspirations and sex: Coming of age in western Kenya in a context of HIV. Unpublished PhD dissertation submitted to the University of Amsterdam, The Netherlands. 2014.

Ombere SO, Nyambedha EO, Bukachi SA. Sex in the Green Lodging: The Voices of Medically Circumcised Fishermen on the Shores of Lake Victoria, Western Kenya. J AIDS Clin Res STD. 2018;5:18. DOI: https://doi.org/10.24966/ACRS-7370/100018

Ocholla-Ayayo AB. Traditional ideology and ethics among the Southern Luo. Scandinavian Institute of African Studies, Uppsala. 1976.

National AIDS and STI Control Programme (NASCOP, 2022). KENPHIA 2021 final report: National AIDS and STI control Programme (NASCOP). Kenya Population-based HIV impact Assessment (KENPHIA). 2018.

Crenshaw KW. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. U Chi Legal F. 1989:139–67.

Ombere SO, Nyambedha EO, Bukachi SA. Wimbo: implications for risk of HIV infection among circumcised fishermen in Western Kenya. Culture, Heal Sex. 2015;17(9):1147-54. DOI: https://doi.org/10.1080/13691058.2015.1018949

Poth C, Munce SEP. Commentary: Preparing today’s researchers for a yet unknown tomorrow: Promising practices for a synergistic and sustainable mentoring approach to mixed methods research learning. Int J Mult Res Approaches. 2020;12(1):56-64. DOI: https://doi.org/10.29034/ijmra.v12n1commentary

Dawadi S, Shrestha S, Giri RA. Mixed-methods research: A discussion on its types, challenges, and criticisms. J Pract Stud Edu. 2021;2(2):25-36. DOI: https://doi.org/10.46809/jpse.v2i2.20

Rahi S. Research design and methods: A systematic review of research paradigms, sampling issues and instruments development. Int J Econ Man Sci. 2017;6(2):1-5. DOI: https://doi.org/10.4172/2162-6359.1000403

Davis LL. Instrument review: Getting the most from a panel of experts. Applied Nurs Res. 1992;5(4):194-7. DOI: https://doi.org/10.1016/S0897-1897(05)80008-4

Blum RW, Mmari K, Moreau C. It begins at 10: How gender expectations shape early adolescence around the world. J Adol Health. 2017;61(4):3-4. DOI: https://doi.org/10.1016/j.jadohealth.2017.07.009

Pearse R, Connell R. Gender norms and the economy: insights from social research. Feminist Econ. 2015;22(1):30–53. DOI: https://doi.org/10.1080/13545701.2015.1078485