WHY ARE SOUTH AFRICAN MEN HESITANT ABOUT GETTING VACCINATED FOR COVID-19?
MEN over the age of 35 in South Africa are not getting vaccinated for Covid-19 at the same rate as women. Only 40% of those who had been vaccinated by August 13 were men, according to a Health Department report.
This is an unusual pattern. In countries where vaccine uptake is recorded by gender, there is a slight trend towards men being more likely to get vaccinated than women.
So why are South African men not getting vaccinated for Covid-19? There is currently no research on this question. Nevertheless it’s possible to gain some insights by looking at research into men’s attitudes to HIV testing and the health system.
There are significant differences between HIV testing and treatment and Covid-19. But research around HIV might point to reasons why men may not be getting vaccinated.
Research on men’s access to HIV testing and treatment has shown men are less likely to test for HIV, and once they know they are HIV positive, less likely to access treatment. The reasons for men not getting tested include ideas about masculinity and health, ideas about the health system as a place for women, and ability to avoid the risk of infection.
Understanding why men may be less likely to get a Covid-19 vaccine is crucial for designing effective vaccination campaigns.
Vaccine hesitancy
Reasons for not wanting to be vaccinated range from a lack of trust in vaccine safety to personal religious beliefs. But there is no evidence that vaccine hesitancy is more common among men than among women in South Africa. A National Income Dynamics Survey showed that men and women were equally willing to get vaccinated.
Another recent survey showed that men were slightly more willing to get vaccinated than women (among those not yet vaccinated).
So why the pattern when it comes to the Covid-19 vaccine?
Much of the research on why men may not seek HIV testing and treatment has focused on masculinity. Masculinity refers to the norms around what it means to be a man. These are shaped by economic, social and political forces and they influence men’s health behaviours.
Research has suggested that men feel testing and treatment for HIV is a threat to their masculinity. They think it will change how others will see them, as well as how they will see themselves. Men are also concerned about whether treatment will affect things which are important to them, including drinking alcohol, having sex, and fathering a child.
Other research has shown that men see ill health as a sign of vulnerability. Another barrier to HIV-testing and treatment for men is that they see the South
African health system as a space for women. They feel it does not accommodate the daily lives of men. Men have described clinics as spaces that are really for women to get contraception and health care for children.
Clinics, through limited opening hours, overworked staff and long queues, sometimes make it hard to access health care – especially for people who have to go to work.
Another possible reason that men have been less likely to seek a Covid-19 vaccination is a lower sense of risk.
Those in front-line jobs are overwhelmingly women and they may seek a vaccination because they know they are more likely to be exposed to infection. In South Africa only 9.1% of nurses are male, women dominate the teaching profession, and front-line workers such as cashiers are more likely to be women.
Next steps
Many of the strategies to increase vaccination, including longer hours at vaccination centres, opening over weekends and locating centres near communities, are slowly happening.
But if men are refusing vaccines because of their ideas about masculinity and health, then vaccine uptake campaigns need to emphasise how a vaccination protects an individual’s health and their family’s health. And that vaccinations only have short-term, minor side effects.
Lessons from HIV research also suggest that the Covid-19 vaccination drive should focus on decentralising vaccine locations, reducing queues and creating supportive spaces.