The role of masculinity in HIV disclosure among adolescent South African boys living with HIV.

Abstract

HIV transmission among adolescents remains a pressing public health challenge in South Africa. Onward HIV disclosure to sexual partners can reduce transmission, but disclosure is low among adolescents. Adherence to hegemonic masculine norms may create a barrier to disclosure among boys. Repeated measures designs are necessary to more accurately capture disclosure, which is an ongoing behavior shaped by multiple processes. 251 South African adolescent boys living with perinatally-acquired HIV and in an intimate relationship were enrolled between 2020-2023. They completed a survey capturing their adherence to masculine norms and their HIV disclosure self-efficacy. They then completed brief mobile surveys weekly for the following year, reporting their recent HIV disclosure behavior. Using mixed effects models, we found that adherence to hegemonic masculine norms at baseline was associated with significantly lower odds of onward HIV disclosure to a sexual partner over the study year. Adherence to hegemonic masculine norms was also associated with lower HIV disclosure self-efficacy at two timepoints. This study confirms a quantitative association between hegemonic masculinity and disclosure and extends the literature to an understudied population. To prevent new HIV infections among South African adolescents, it will be important to develop and adapt interventions that address hegemonic masculinity.