By Shawn Malone, Project Director, The Mpilo Project, PSI, South Africa
October is Mental Health Month, which has us thinking about how gender norms can affect mental health, which can in turn affect men’s willingness and ability to access HIV services.
When Population Services International (PSI) – in partnership with Matchboxology — initiated the Mpilo Project, one of the first things we heard in talking with men in South Africa is that many feel the deck is stacked against them. Fulfilling the traditional role of ‘provider and protector’ often feels out of reach, and the chasm between aspiration and reality can result in despondency and fatalism.
Traditional gender norms compound the problem by telling men that it is unacceptable to talk about these things. Men are taught to “man up” and push their feelings down, which can have terrible effects on their mental health, leading to increased stress, anxiety, depression, and isolation.
How does this all relate to HIV? As of July 2023, an estimated 95% of men in South Africa knew their HIV status, but only 71% of those were on treatment. Efforts to increase men’s engagement in care often begin with assumptions and stereotypes about rather than engaging with men directly. Without an accurate understanding of what is driving men’s decisions and behaviors, including gender norms, male-focused interventions are often ineffective.
What we learned is that for many men, an HIV diagnosis triggers strong negative emotions—fear, anxiety, shame, inadequacy, etc.—that they struggle to process due largely to restrictive gender norms that expect men to be fearless and self-reliant. Denial and paralysis are predictable responses.
The good news? Harmful gender norms around health may not be as entrenched as we think. We have found in our research and piloting that when we give men a safe space and a relatable source of support, most of them embrace it. It is as if they have been waiting to walk out of their prison and just need someone to show them the way.
The Coach Mpilo model incorporates that insight by pairing men living well with HIV with men who are struggling, and the results have been heartening. Coaches act as mentors, providing ongoing guidance and support, borne out of personal experience, from the point of diagnosis to the point of treatment stability and viral suppression. In addition to treatment retention rates ±20 points higher than average, men with a coach are sharing stories of better relationships with their loved ones, higher self-esteem, and a greater sense of optimism about their future.
As PSI’s Consumer-Powered Approach to healthcare underscores, it is about designing services that meet people where they are and give them what they need and want to overcome whatever challenges they are facing.
While HIV and mental health may seem like separate issues, they are inextricably interwoven. If we want to achieve and sustain more progress on the former, we must pay attention to the latter.
Funded by the Bill & Melinda Gates Foundation, the Mpilo Project seeks to understand barriers to HIV testing and treatment among men in South Africa and to co-create and test solutions to those barriers.