Table 2 Thematic Network (from codes to global themes)

- Men feel superior

Strong and resilient

- Independent and tough

- Pride

- Can't show fear

1. Men are perceived as physically strong and capable of withstanding disease.

2. Men are perceived as emotionally independent and tough.

3. Men should not show fear.

Characteristics of 'a real man'

Social constructions of masculinity

- Gender roles

- Men are head of house

- Changes in gender roles

4. Men are perceived as breadwinners and the ones to carry out heavy duties, whilst women work at home, providing care for children and support husbands.

5. As households get affected by AIDS, gender roles get more fluid.

Men's roles and responsibilities

- Men have girlfriends

- Women not allowed extra-marital relationships

- Men's sexual desires need to be met

- Men bond in beer halls

6. Unlike women, it is common and a virtue for men to have multiple sexual partners.

7. Men are perceived to have sexual urges that need to be met.

8. Beer halls are a common space for men to meet girlfriends and assert their manhood to other men.

Sexuality and manhood

- Fear of being recognised as HIV positive

- Afraid of being stigmatised

- Having HIV/AIDS exposes their promiscuity

- Embarrassment

- Fear disclosing status to their wives

- Fear being alone

- HIV compromises their manhood

9. Whilst having multiple sexual partners is a sign of virility, many men reported feeling embarrassed from failing to protect themselves.

10. Healthy sexuality is linked to a hegemonic masculine sexuality.11 Men fear loosing their dignity and being stigmatised.

12. Married men fear being abandoned by their wives and young men fear being rejected by girls and living a life alone.

Men's fear of HIV

Barriers to men's HIV services uptake

- Not taking HIV/AIDS seriously

- Avoiding to talk about AIDS

- Fatalism and risk taking

- Denying it can happen to them

- Death over dishonour

- Passing on the blame

- Drink alcohol to avoid reality

- Making excuses to avoid getting tested for HIV

13. Few men want to acknowledge the seriousness of AIDS and avoid talking about it.

14. Many men do not believe it can happen to them, but take risks as accidents are unavoidable.

15. Men drink, blame others and ignore health services in order to 'avoid' the reality of AIDS.

Delusion, denial and diversion

- Hospitals are female spaces

- Men struggle to adhere to ART

- Male behaviours conflict with treatment schedules

17. Hospitals are seen as spaces for women and children, not for men.

18. Elements of the ART treatment regimen conflicts with male behaviours that define their manhood.

Masculinity conflicts with 'patient persona'

- Wives encourage husbands

- Men seek treatment, but delayed

- Men are brought in wheel barrows to the hospital

19. Couple testing and men getting support from their wives encourage men to seek HIV testing.

20. Men delay seeking treatment but are eventually brought to hospital in wheel barrows and treatment commences.

Persuasion and need

Facilitators of men's usage of HIV services

- Men lack information, so benefit from counselling

- Reaching men through interventions

- Food aid

21. Men often lack knowledge about HIV and treatment services and benefit tremendously from receiving counselling.

22. Food aid given to ART users can encourage men to seek HIV testing/ART as it will help them fulfil their role as breadwinners.

23. Support groups provide men with an opportunity to renegotiate their masculinities.

Gender sensitive HIV management services

- Acceptance of HIV status

- Change and reflection

- Us and them

- Challenge stigma

24. HIV positive men on ART break away from hegemonic masculinities.

25. HIV positive men on ART see themselves as responsible and valuable citizens.

26. HIV positive men on ART seek to resist stereotypes.

Constructing responsible masculinities