Study finds gaps in services for heterosexual men with HIV

Heterosexual men make up a small but growing number of people infected with HIV in Canada. Yet a new study has found that many of them feel existing HIV-related programs and services don't meet their needs and are geared primarily or exclusively toward gay men and heterosexual women who are living with the virus.

"Heterosexual men tend to go through HIV alone," said Tony Antoniou, a pharmacist and research scholar in the Department of Family Medicine at St. Michael's Hospital. "They feel very isolated."

Antoniou said the study, published in the online medical journal BMJ Open, was among the first to examine how heterosexual men with HIV seek health care and support services.

While unprotected sex between men is still the most common method of transmitting HIV in North America and Western Europe, the number of new infections attributable to heterosexual transmission has been steadily increasing. Heterosexual men accounted for less than 5 per cent of all cases of HIV in Ontario before 1990, but represented 13.8 per cent of HIV diagnoses among men in 2008. In Britain, the figure is even higher -- 18.8 per cent of patients accessing HIV-related care in 2009 were men infected via heterosexual sex

Antoniou and his colleagues conducted focus groups of HIV-positive heterosexual men with the assistance of community-based AIDS service organizations in Ontario.

The men told them:

• They perceive themselves to be relegated to the margins of a health care and service field that was developed to address the needs of groups who were historically affected most by the illness – namely, gay men and heterosexual women
• They felt that gay men were better positioned to obtain and advocate for HIV-related services and support because of their "social capital" within AIDS service organizations
• Many were reluctant to seek treatment or support – or even be seen entering AIDS clinics – because of ongoing societal stigma associated with HIV. In particular, they were concerned that their jobs could be in jeopardy if their HIV status were known or that their children would be stigmatized and shunned socially

"Heterosexual men living with AIDS are navigating a health care and service field that has not kept pace with their increased representation among the population of people living with the virus," Antoniou wrote in his study, Waiting at the dinner table for scraps: a qualitative study of the help-seeking experiences of heterosexual men living with HIV infection.

"Nobody is looking at them as husbands and fathers, people who need to be supported in those roles," he said. "In keeping with the tradition of involving people living with HIV in developing services to meet their concerns, researchers and policy makers should strive to integrate heterosexual men living with HIV in decision-making and community-based research initiatives."