In Botswana, the setting of the proposed study, nearly one in five adults are living with HIV. Men in Botswana over age 40, the focus on the present research, show relatively high levels of HIV prevalence and risk behavior, and low levels of HIV testing. Moreover, higher income is associated with increased risk of being HIV-positive in sub-Saharan Africa (SSA). The proposed research will use mixed methods to develop an intervention that de- stigmatizes and encourages HIV testing among men of middle-to-higher socio- economic status (SES) in Gaborone, Botswana. We will focus on increasing HIV testing among men of higher SES. Fear of being stigmatized among financially secure men in employment in Botswana may contribute to low HIV testing uptake.
The Specific Aims are:
Aim 1 : To initially conduct formative qualitative work to explore the role of stigma on low HIV testing uptake among 20 men via face to face interviews, and then to obtain feedback about potential interventions using asynchronous online focus group discussion among 40 men all with relatively high socio-economic status (SES) in Botswana.
Aim 2 : To develop and conduct a small pilot test of a local, culturally appropriate HIV testing strategy targeting 100 men in the higher-SES in Botswana. Hypothesis: At least 60% of men will access the new HIV testing strategy, equivalent to a ~20% point increase above testing strategies not tailored to men.
Aim 3 : To build capacity for HIV stigma and related behavioral research by conducting focused workshops in Botswana. To reach the remaining 10-10-10, it is essential to develop differentiated, tailored approaches for risk groups, such as men of relatively higher SES, that are untouched by existing prevention and testing frameworks in countries of high HIV prevalence.!
In Botswana, the setting of the proposed study, nearly one in five adults are living with HIV, and men over age 40, especially those of higher income, are at particularly high HIV risk due to concurrent multiple partnerships and low rates of HIV testing. We propose to explore qualitatively how stigma in the context of masculine gender role norms may be a barrier to HIV testing among men over age 40 years of higher socioeconomic status in Botswana, and use these results to develop and pilot an innovative HIV testing strategy through major employers that is tailored to men.
