Exploring the Effect of Gender Norms on Provider-Client Interactions Relevant to HIV Care Engagement: A Qualitative...

Gender norms shape health behaviors and access to HIV care in sub-Saharan Africa, but few studies have explored their influence on provider-client interactions and care provision. This qualitative study was conducted in central Uganda in 2020, involving 7 focus group discussions and 16 key informant interviews with 57 participants, including clients with HIV (n = 12), health and lay workers (n = 17), community members (n = 12), and key informants with health system expertise (n = 16). Using thematic analysis guided by an adapted patient-centeredness model, findings were organized around biopsychosocial perspectives, decision-making processes, and features of care. Gender norms were found central to clients' treatment compliance, and providers were aware of clients' gender-related barriers. Shared decision-making between clients and providers was limited for both men and women. Women providers reported challenges to their authority by men, who were often unwilling to take direction. As clients, the men were viewed by providers as direct but rude and less open communicators, while women were perceived as agreeable "good patients," but women who had not disclosed their status to others were viewed as dishonest. Men's expectations for respect underpinned tensions with women providers, who showed low empathy toward men's challenges. Despite recognizing the importance of gender-sensitive, patient-centered communication, structural barriers such as time constraints and the scarcity of male providers hindered its delivery. The findings suggest gender-transformative programming with communities (broadly with community leaders, people living with HIV, partners, etc.) could help men and women living with HIV overcome barriers to care engagement. For providers, gender-sensitivity training could enhance their skills and empathy to be patient-centered toward both men and women.