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Understanding the Antiretroviral (ARV) Treatment Experiences and Adherence Outcomes of HIV Positive Men in Jamaica: An Intersectionality Approach
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There is little research addressing men's health in Jamaica, in general, and more specifically, as it pertains to HIV positive men. Jamaican men are often placed at risk by a range of socio-cultural norms and processes that make them susceptible to contracting Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), and affect how they engage with their treatment trajectory. Antiretroviral (ARV) treatment adherence is important in ensuring viral suppression, the reduced risk of HIV transmission, and the improved health and well-being of men. Yet, men continuously present late for testing and subsequently, linkage with treatment and care. The current study examined the treatment experiences and adherence outcomes of HIV positive Jamaican men, against the backdrop of their sexuality, gender, and HIV health status. The study adopted an intersectionality-informed methodology to explicate the complexities surrounding sexuality, gender, and HIV status as interrelated dimensions of Jamaican men's identities that can impact their health outcomes. Twenty-four HIV positive men were recruited from an HIV-specialized clinic in Jamaica. Semi-structured interviews were conducted with all participants and six men were involved in follow-up interviews. Interviews with clinic staff, whose role directly related to men's access to ARV treatment, were conducted for detail about the clinic context. Data were coded using NVivo software and analysis conducted using an adaptation of the stepwise multi-level framework posited by Winker and Degele (2011). Men's treatment trajectory comprised five phases: HIV diagnosis, acceptance, adjustment, treatment initiation, and treatment continuation. Receiving an HIV positive diagnosis proved traumatic for most participants, forcing them to consider the personal and social implications of living with an incurable and stigmatized illness. Some men grappled to come to terms with living with HIV as they perceived it to disrupt their lives, and destroy futuristic dreams and aspirations. Acceptance of a positive diagnosis became pivotal for men to progress into their treatment processes, as it encompassed an understanding of the need for lifelong and daily treatment and follow-up care. Adjustment, unlike the other four phases, was ongoing in response to the varying circumstances men experienced. The treatment phases were largely centred around the clinic, which was deemed to minimize some men's autonomy and liberty. As a result, the clinic was positioned as both an enabler and barrier to men's access to optimal health care. Throughout the treatment trajectory, men were often required to negotiate their personal identities against the benchmark of socially approved representations of a masculine self. The hegemonic representation of Jamaican masculinity is often predicated on the need to show sexual prowess, strength, and resilience. The incorporation of HIV as an aspect of men's identities and shifting HIV from the foreground to the background of men's sense of self were important aspects of men's reconstruction of their social identities. Some men engaged in gender performativity, where they exuded the defining qualities of masculinity that would ensure their safety, acceptance, and sense of belonging. Importantly, a number of men moved towards reconstructing new masculinities that supported their HIV identity and need for lifelong treatment. Nonetheless, some values pertaining to hegemonic masculinity were maintained or modified to suit their HIV status, such as being a leader, role model, father, and breadwinner. The findings of this study have implications for the transformed approaches to addressing HIV positive men's health in Jamaica. Policy and programme recommendations are provided, including the need for gender-sensitive approaches, improved access to health services, and the provision of safe, supportive, and enabling health environments. The study contributes to the growing body of literature that utilizes intersectionality as a methodology, and more so in examining men's health issues.