Orr, N., Hajiyiannis, H., Myers L., et al. Journal of Acquired Immune Deficiency Syndromes (January 2017), 74(Suppl 1): S69–S73. doi:10.1097/QAI.0000000000001204.
This qualitative study examined male thoughts and behaviors that affect HIV testing services (HTS) and access to antiretroviral therapy (ART) in South Africa. The authors conducted 11 focus group discussions (n=88) and 9 individual interviews across 4 provinces in districts with high HIV prevalence rates. All men reported knowing where to access HTS, but commonly said that clinics are primarily spaces for women, and that male attendance implies HIV-positivity. Men reported receiving poor treatment and violations of privacy from facility staff, and as a result avoided public services and accessed care in alternative locations, including private sites. They highlighted the importance of "pride" and expressed concerns about appearing weak and losing their dignity by attending services or being ill. Participants also described keeping ART use private to avoid having a reputation for sexual promiscuity or suggesting that their partner is at risk for HIV. They voiced increased inclination to access HTS if they participated in risky sexual behaviors, and if they heard a rumor or discovered that their partner was HIV-positive. Most often, men only sought treatment when they experienced ongoing illness. Participants concluded that communication messages that provoke fear are ineffective, and that messages should be humorous so that they spark communication. Findings led to development of a national communication campaign.