Abstract
Men may be key players in the transmission of sexually transmitted infections (STI), and it is important that STI/HIV health services reach men. The objective of this study was to explore sexual health care access and seeking behaviours in men. This study used focus groups to examine sexual health care access and seeking behaviours in men 5 years after implementation of free antiretroviral therapy (ART) in the South African public sector. Six focus groups (N=58) were conducted with men ≫18 years in an urban area of Gauteng province. Men were recruited from various locations throughout the community. Men reported several barriers and facilitators to the use of public and private clinics for sexual health services including HIV testing, and many men reported seeking care from traditional healers. Men often viewed public clinics as a place for women and reported experiences with some female nurses who were rude or judgmental of the men. Additionally, some men reported that they sought sexual health care services at public clinics; however, they were not given physical examinations by health care providers to diagnose their STI syndrome. Most men lacked knowledge about ART and avoided HIV testing because of fear of death or being abandoned by their families or friends. Study findings suggest that men still require better access to high-quality, non-judgmental sexual health care services. Future research is needed to determine the most effective method to increase men's access to sexual health care services.
Highlights
South Africa has one of the largest HIV/AIDS epidemics (UNAIDS, 2007; AVERT, 2007) and other sexually transmitted infections (STIs) are common (Johnson, Coetzee, & Dorrington, 2005)
It was thought that availability of antiretroviral therapy (ART) would increase HIV testing and decrease stigma (Levy, Miksad, & Feim, 2005); early findings from South Africa and Tanzania suggest that stigma and health care access issues remain (Roura, Urassa, Busza, Mbata, Wringe & Zaba, 2009; Chopra, Kendall, Hill, Schaay, Nkonki & Doherty, 2006)
One-third of men reported that they either were not affiliated with a religion or were non-practising, with most of the remaining men reporting an affiliation with a form of Christianity
Summary
South Africa has one of the largest HIV/AIDS epidemics (UNAIDS, 2007; AVERT, 2007) and other sexually transmitted infections (STIs) are common (Johnson, Coetzee, & Dorrington, 2005). Findings suggest that STI knowledge is often inadequate, with some believing that STI/ HIV can be acquired through non-sexual contact (e.g. bewitchment, taxi seats) (Shefer, Strebel, Wilson et al, 2002; Campbell, Nair, Maimane & Nicholson, 2007). Inadequate knowledge has been associated with stigmatising attitudes toward STI/HIV in multiple studies (Shefer, Strebel, Wilson et al, 2002; Campbell, Nair, Maimane, & Nicholson, 2007; Kalichman & Simbayi, 2004; Kalichman, Simbayi, Cain, Jooste, Skinner & Cherry, 2006). The combination of lack of knowledge and stigmatising attitudes have been associated with men having multiple sex partners (MeyerWeitz, Reddy, Van den Borne, Kok & Pietersen, 2003) and poorer access to STI/HIV health care including HIV testing (Kalichman & Simbayi, 2004; Holzemer, Uys, Makoae, Stewart, Phetlhu & Dlamini, 2007). It was thought that availability of antiretroviral therapy (ART) would increase HIV testing and decrease stigma (Levy, Miksad, & Feim, 2005); early findings from South Africa and Tanzania suggest that stigma and health care access issues remain (Roura, Urassa, Busza, Mbata, Wringe & Zaba, 2009; Chopra, Kendall, Hill, Schaay, Nkonki & Doherty, 2006)
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