Despite warnings about the implications of excess weight for health, U.K. Government statistics show that the number of men who are becoming overweight/obese is continuing to increase. Evidence also points to overweight males experiencing social disapproval reflected in negative character attributions and discrimination, as well as increasing body dissatisfaction.

This report has been submitted to the School of Public Health in the Faculty of Health Sciences of the University of the Witwatersrand. The report is in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Social Behaviour Change and Communication (MPH). Date: 19 June 2017 / Background Extant research in South Africa and elsewhere has shown that men tend to shy away from health care services. For men living with HIV, this may lead to poor ART adherence. Literature on men and masculinities suggests that social definitions of what it means to be a „man‟ affect and influence men‟s decisions to either seek or not seek health care. Some authors have argued that these definitions of manhood often discourage men from using public health facilities. Another body of scholarship suggests that South African men‟s poor health seeking behaviours and adherence to ART is also influenced partly by their experience with the healthcare system and the attitude of healthcare providers. Aim This study explored health seeking behaviours of men living with HIV with a focus on their long-term experiences with HIV care and treatment services, as well as their experiences with the new single, fixed-dose combination tablet and how it influences adherence to ART in South Africa. Methods This study used an exploratory qualitative study design, using in-depth interviews (IDIs) to collect data. The IDIs were conducted with 14 adult HIV positive men living who had been on ART for five or more years and were receiving care and treatment at Stretford Community Health Centre (CHC) in Orange Farm, Johannesburg. Findings The men shared in-depth individual experiences of what it means to live with HIV and subsequently being on treatment for a long time (five or more years). They gave insights on the psychosocial challenges that they have endured living with HIV. Furthermore, they shared their subsequent resolve to live healthy lifestyles despite the challenges they have encountered related to living with HIV. Regarding health care systems, the men were generally impressed with the services received at the health facility. Further, all but one man, were not bothered about the gender of the nurse attending to them at the health facility. The experiences of the men collectively, reflect and provide some insights of how self-determination can transcend societal definitions of what it means to be a man, and how notions of masculinities may influence how men cope and adjust to living with HIV, and their adherence to ART over a long period of time. Conclusions This study concludes that men are capable of modifying their masculine positions to cope with life-long adherence to HIV treatment regimens. The men‟s self-determination to adjust from destructive notions of masculinities in order to accommodate treatment is an area for further research to inform men‟s programming. Social support systems are key to men‟s ART adherence programmes. Stigma and discrimination remains a challenge within communities, and as such community sensitisation programmes should be strengthened to combat the vice. Programmes targeting men should promote behaviours perceived to be beneficial in prolonging men‟s lives. The introduction of the fixed dose combination pill provides a great opportunity to strengthen men‟s abilities to consistently adhere to ART as it was taken once a day. / MT2017

Objective To investigate men's experience of depression. Method A non-clinical sample of male teachers and students was recruited from a tertiary education institution to participate in a series of focus groups. Women were recruited from the same context to examine issues common to men. The men's data were analysed using a grounded theory approach to illuminate men's experience of depression. Theoretical sampling of biographical accounts of a small group who had experienced clinical depression (the 'clinical' group) was conducted to explicate the core category. Content analysis was then used to examine the women's data for similarities and contrasts and issues common to men. Standard measures of mood and dispositional optimism (together with sociodemographic and behavioural data) were collected to confirm the non-clinical status of the sample. Results The key results were as follows: (i) The non-clinical sample of men and women in this study reported all the symptoms of depression classified by the Diagnostic Statistical Manual of Mental Disorders (Version IV). (ii) In addition, men reported experiencing social withdrawal, and an escalation and intensification of negative emotion that may be triggered by negative thoughts or external events leading to anger and violence towards the self and others. (iii) The trajectory of emotional distress, conceptualised as the 'big build', links men's experience and expression of depression. (iv) 'Intensified constraint', illuminating the process of the 'big build', helps to explain the 'battle' between individual and social forces that influences hidden depression in men. (v) 'Intensified constraint' may be considered a state (emotional condition) characterising men or a symptom (subjective experience) of depression common to men. (vi) Non-resolution of problems, exacerbated by social conditioning of men to suppress emotion, leads to delayed help-seeking. (vii) The women's data were in concordance with the men's data that suggest that men and women experience depression similarly (with reference to DSM-IV criteria). (viii) The 'big build', as a trajectory of emotional distress and maladaptive strategies to ameliorate depressive symptoms, has salience for women. (ix) Gender differences in depression may be explained by the expression of depressive symptoms, and the time frame in which the symptoms are managed. Discussion This study arose out of the commonly held view that women report depressive symptoms at higher rates than men yet men demonstrate higher rates of drug and alcohol abuse and self-harm, referred to as 'depressive equivalents'. This generally accepted disparity of prevalence rates of depression in community samples makes certain assumptions about the mental health of men and women. Women are assumed to have a certain 'pathology' or vulnerability to depression while men are assumed to be either comparatively healthy or 'silent' to their experience. The perception of depression as a 'feminine' problem by men, exacerbated by social conditioning of men (by men and women) to suppress emotional distress and to hide signs of weakness, may influence men's reporting of depressive symptoms and may help to explain the gender disparity. The non-clinical group of men and women in this study has taken us to a point in their descriptions of depression as an objectified or reified 'it' that is something difficult to articulate but which is psychologically painful, to be avoided, numbed or from which to escape. The biographical accounts of a small group of people who have experienced clinical depression (the 'clinical' group) have explicated the meaning of depression even further. Depression, viewed by this articulate small group as 'beyond description', is elucidated by their use of metaphor. The data from the non-clinical group, informed by the 'clinical' group and the literature surrounding depression in men, is synthesised, analysed and interpreted. The findings inform three propositions - the 'big build', 'intensified constraint', and 'averting negative consequences' - that offer new ways of thinking about depression in men. Conclusion The inextricable link between the experience and expression of depression as described by men, confirmed by women and supported by the literature and clinicians' impressions, may explain the existing gap between the 'meaning', 'manifestation' and 'measurement' of depression in men. Questions that tap in to men's trajectory of emotional distress, incorporating a state or symptom of intensified constraint common to men, could narrow the gender differences in reported depressive symptoms. This has implications for the design of measurement instruments and approaches to depressed men in clinical practice.

Thesis (doctoral)--University of London, 1999. / BLDSC reference no.: DX211835.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 154-165). Available also in a digital version from Dissertation Abstracts.

published_or_final_version / Social Work / Master / Master of Social Sciences

Thesis (Ph. D.)--University of New South Wales, 2003. / Also available online.

Thesis (Psy.D.)--The Chicago School of Professional Psychology, 2006. / Includes bibliographical references.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 1998. / Includes bibliographical references.

Thesis (Ph. D.)--Lehigh University, 2003. / Includes vita. Includes bibliographical references (leaves 163-170).