Masculinity and health-seeking for human immunodeficiency virus and other sexually transmitted infections in poor urban settlements in sub-Saharan Africa: a scoping review

In sub-Saharan Africa, boys’ and men's health-seeking behaviours are shaped by societal attributes associated with being a man. This scoping review examines how masculinity influences health-seeking regarding Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs), among boys and men in poor urban settlements. A systematic search was conducted across Google Scholar, African Journals Online, PubMed, and ProQuest for studies published between 2015 and 2024. Across the 18 papers reviewed, masculine norms that equate manhood with invulnerability and strength discourage testing due to fears of appearing weak, losing income, and testing positive. Masculine norms linking strength with silence, independence, and social respect also discourage HIV/STI treatment, due to fears of stigma, loss of reputation, or perceived weakness. Healthcare systems, with limited male-friendly services and provider attitudes perceived as emasculating, further reinforce these barriers. Finally, the review also identified protective expressions of masculinity, as financially stable young men were more likely to test and adhere to treatment. In conclusion, addressing masculinite-driven barriers to HIV/STI care in poor urban settlements is critical. Future research should explore approaches that reframe HIV/STI care as responsible and masculine, as well as, promote male-friendly healthcare facilities.