Exploring barriers and facilitators to HIV care among heterosexual men in western Kenya’s fishing- and non-fishing-involved communities: insights through a masculinity lens

Heterosexual men living with HIV in sub-Saharan Africa have high rates of disengagement from HIV care. Despite advancements, barriers to care engagement exist, shaped by masculinities that valorize stoicism, strength and provider roles. This qualitative study was conducted in Kenya's Lake Victoria region. We enrolled 111 heterosexual men living with HIV (60 in care, 51 out of care) from six communities (both fishing-involved and non-fishing-involved). Data were collected via semi-structured interviews and analyzed using the social-ecological model. Results identified structural barriers - food insecurity, long distances and health-system inefficiencies - while proximity of services facilitated engagement. Health facility-level issues, such as operational delays and privacy concerns, coexisted with positive staff interactions. Interpersonal barriers included limited family support and stigma, while family and friend support facilitated engagement. Individual-level barriers encompassed antiretrovirals' side effects, whereas perceived health gains on antiretrovirals and the desire to stay healthy facilitated engagement. Hegemonic ideals of men as providers and invulnerable figures can impede care-seeking, yet many men in our study adopted masculinities that encouraged self-care, like reducing alcohol consumption and smoking, and persisting in care despite encountering barriers. To meet 95-95-95 goals, HIV programs must be male-friendly and privacy-conscious, integrate nutrition support, streamline services and leverage peer support.