Bridging the Health Service Gap: An Analysis of Masculinity Norms, HIV Testing Uptake, and Chronic Disease Screening among Men

Abstract

Although Lesotho has made important progress in strengthening clinical health services, men and women continue to engage unequally with preventative care. This study investigates the masculinity gap by analysing how adherence to traditional gender norms shapes men’s engagement with HIV testing and non-communicable disease (NCD) screening. Drawing on nationally representative data from the 2024 Lesotho Demographic and Health Survey (LDHS), we examined a sample of 3,215 men aged 15–59 years. A Masculinity Norms Index (MNI) was developed through factor analysis, and this index was used to classify participants according to gender ideology. Multivariable logistic regression indicated that men strongly aligned with traditional masculinity were 9% less likely to have ever tested for HIV (AOR = 0.91; 95% CI: 0.91–1.19) compared to those with more egalitarian views. Although HIV testing coverage was high (89.0%), NCD screening remained low (6.2%), with wealth index identified as the strongest predictor (AOR = 2.06) for the richest quintile. These findings indicate that while HIV services have effectively surpassed gender-related barriers, NCD screening continues to be constrained by a convergence of traditional and socioeconomic inequities. According to the study, prioritising gender-transformative health programming and aligning NCD screening with male-centric HIV services is fundamental to protecting Lesotho’s human capital.