It’s tough to test: The influence of gender role beliefs on HIV testing behaviour amongst South African men, and the interaction effect of race

Abstract

In South Africa, men remain disproportionately unreached for HIV testing and treatment compared to their female counterparts, and other men who have sex with men. This gap becomes more evident when looking at the different ethnic groups, where HIV prevalence and risk is higher amongst Black/African men. Existing research highlighted colonial and Apartheid past on ideals of masculinity, and how this manifests between different racial groups. This thesis explores the relationship between gender beliefs and HIV testing behaviour and examines the moderator of race. Using constructionist gender, postcolonial, and intersectionality theory, this thesis posits that the segregated past of South Africa has resulted in a socially hierarchical structure of masculinity, enacted through daily decisions that affect men’s health. Multiple logistic regression was performed to test the predictor of gender role beliefs, followed by a second multiple logistic regression model to examine the interaction effects of race. Gender beliefs were not significantly predictive of HIV testing behaviour (p = .207) when compared with more commonly studied variables, such as financial means (p <.001), employment year-round (p = .039), and being divorced (p = .033). Main effects and moderator analysis were conducted. Race was a significant interaction effect in the relationship between gender role beliefs and HIV testing behaviour relating to recent testing. This was observed with the change in Wald Chi-square changing between main effects (398.624, p = .000) and interaction effects (16.426, p = .170). This resulted in a rejection of the initial hypothesis, revealing that gender role beliefs, as approximated in this thesis, do not outweigh the statistical significance of common predictors. Race as a moderator aligns with theories of postcolonialism and intersectionality. This thesis concludes with recommendations of future research elaborating on the interaction effects of race, and to focused on human-centred design when implementing interventions.