Abstract
Despite recent improvements, men still have worse HIV outcomes than women in South Africa. This study describes how young men form distinct behavioural and attitudinal subgroups, and is intended to inform the design of targeted interventions to encourage HIV testing and initiation on antiretroviral therapy. Data were collected using a cross-sectional survey with questions on men’s attitudes, beliefs and behaviours around HIV/AIDS. A total of 2,019 men were randomly sampled from eight district municipalities in KwaZulu-Natal and Mpumalanga provinces between October 2018 and January 2019. Men were eligible to participate if they were aged 20–34, Black African, had an education level below university graduation, were aware of HIV and were willing to disclose whether they had tested for HIV. Each participant responded to a questionnaire asking about their demographic characteristics, reported sexual behaviour, engagement with HIV testing and treatment services, alcohol consumption, HIV knowledge, attitudes to gender equity and reported level of depressive symptoms. Data were analysed using canonical correlation, hierarchical clustering and factor analysis techniques to produce five groups of men. The results were synthesised using Human Centred Design principles to suggests areas for potential intervention for each segment. The results showed that men vary based on their attitudes to gender and masculinity, use of alcohol, testing and treatment behaviour, HIV-related fears and preferences for testing modalities. Segment 1 (21%) avoids the topic of HIV, perhaps fearful of the impact on his life. Segment 2 (23%) is well connected to his community and has social concerns about HIV. Segment 3 (15%) struggles with more distal determinants of HIV acquisition such as unemployment and poor mental health. Segment 4 (25%) has concerns about the lifestyle changes that would be required if he were HIV positive. Segment 5 (16%) has a strong traditional mindset and is fearful of the ramifications of HIV in his community. The results will be used to design targeted interventions to increase HIV testing and treatment rates among young men in South Africa. Further research is required to understand the impact of interventions designed in this way.
Highlights
In South Africa men are less likely to know their HIV status, initiate treatment upon diagnosis or adhere to treatment compared to women [1,2,3]
These include the influence of patriarchal modes of masculinity, the role of alcohol in decision-making, the legacy of childhood poverty and trauma, the pervasiveness of HIV stigma, worries about disclosure of their HIV status, and the lack of healthcare services tailored to their needs [5,6,7,8,9,10,11,12,13,14]
Identified drivers and barriers to HIV testing and ARV linkage were coded according to the Theoretical Domain Framework (TDF) which systematically categorised the relevant attitudes, behaviours and beliefs to be measured in the questionnaire [39]
Summary
In South Africa men are less likely to know their HIV status, initiate treatment upon diagnosis or adhere to treatment compared to women [1,2,3]. The literature describes difficulties men, and in particular young Black men in South Africa, face when engaging with HIV services. These include the influence of patriarchal modes of masculinity, the role of alcohol in decision-making, the legacy of childhood poverty and trauma, the pervasiveness of HIV stigma, worries about disclosure of their HIV status, and the lack of healthcare services tailored to their needs [5,6,7,8,9,10,11,12,13,14]. There is an increasing appreciation of the barriers that men face; strategies to increase men’s engagement with HIV services tend to take a “one-size-fits-all” approach
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