Masculine Identity Reconstruction and Sexual Behavior Transformation Among Men Living With HIV in Indonesia-Malaysia Border Region: A Social Ecological Phenomenological Study.

This qualitative study used interpretative phenomenological analysis to explore masculine identity reconstruction and sexual behavior transformation among men living with HIV in the Indonesia-Malaysia border region. Participants included 12 men living with HIV and one health care professional. In-depth interviews were analyzed through integrated phenomenological-thematic framework including case study analysis before cross-case pattern identification. Four themes emerged: biographical disruption and meaning-making through diagnosis, reconstructing masculine identity in border contexts, navigating stigma and disclosure across borders, and managing treatment in fragmented health care systems. Three case studies illustrated diverse trajectories shaped by cross-border sex work, masculine identity disruptions, and spiritual reconstruction. Social Ecological Model application revealed how border contexts shape experiences across individual, interpersonal, community, policy, and epidemic levels. Men living with HIV in border areas experience unique vulnerabilities including masculine identity crises when medication requirements foreclose cross-border employment, transnational sexual networks, and small community stigma amplification, requiring multilevel interventions.