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Fleming, Paul J. & Dworkin, Shari L. (2016). The Importance of Masculinity and Gender Norms for Understanding Institutional Responses to HIV Testing and Treatment Strategies. AIDS, 30(1), 157-158. PMCID: PMC4703363


We applaud Dovel et al. for bringing attention to the gender disparity in HIV mortality in Africa. Their article is a thoughtful and insightful examination of evidence from across the region and they have adeptly pinpointed the institutional policies of health service settings as a key area to target to reduce disparities in HIV mortality. Although Dovel et al. provide an important perspective, we challenge their minimization of the importance of gender norms – and specifically norms of masculinity – as a primary cause of this disparity. Dovel et al. partly discount masculinity as an explanation because men initiate HIV testing and treatment ‘at similar rates as women’ and because they claim that naming masculinity as a driver of this disparity ‘blames men’. Several recent studies have highlighted that norms of masculinity such as self-reliance and strength present important barriers to men engaging in each of these behaviors and that men initiate HIV testing, care, and treatment less than women in many African settings. The conceptualization of masculinity as ‘blaming’ men offered by Dovel et al. is exceedingly narrow. Scholarship shows that masculinity is not an individual construct but a structural factor that shapes individual behavior. Norms of masculinity are embedded within societal-level gender norms and enforced by social institutions (e.g. schools, military, and government) and social networks (e.g. family members and peers). Thus, research showing that masculinity is contributing to HIV mortality disparities is highlighting a social structure that needs to be modified, not problems with individual men's behaviors.


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Fleming, Paul J.
Dworkin, Shari L.