Men surveyed in a recent study in Mpumalanga and KwaZulu-Natal found HIV testing to be “burdensome” and the least of their priorities.

The South African Health Review 2019 surveyed 58 black men between the ages 25 and 34 in both provinces.

They were sexually active and had not undergone medical male circumcision. Health-care providers were also interviewed. The provinces were chosen because of their high HIV prevalence compared with other provinces.

The study found the majority of the men viewed testing and treatment as “burdensome” and were afraid to check on their status.

“They believe a positive diagnosis will bring loss of status and relationships, so many prefer not to test, or they delay treatment. This is compounded by traumatic childhood memories of the early days of the Aids pandemic.”

Some men, the report found, perceived care at clinics to be judgmental, and this discouraged them from testing.

“Providers express frustration with men’s apparent apathy, although this is often a misreading of men’s fear,” the study found.

While it was limited to two provinces, researchers say the results suggested current approaches used in health-care facilities may be driving men away from services.

“Clinic reorganisation, provider training and greater understanding of the needs of men and health-care providers may increase men’s uptake of HIV services.”

The study revealed the men mostly focused on the pressures they had at home, and HIV was the least of their priorities. Some were experiencing financial pressure as few had a stable income.

“Men expressed concern about indirect costs of HIV testing and treatment, including the time it takes to visit a clinic.

For the respondents, HIV was a source of stress in their already-stressful environment, and therefore it is a topic often avoided. At the same time, the stressors in the men’s lives acted as triggers for unhealthy ‘escape’ behaviours that exacerbate HIV risk,” the study found.

The men surveyed viewed multiple sexual partners as a norm in their communities. Condom use was not consistent. If they used protection at all, they stopped soon after meeting a new partner.

“While they initially perceive a high level of risk with a new partner, particularly a casual partner, that perception of risk can quickly reduce due simply to familiarity and the belief  she ‘is a nice girl’, ‘lives a decent lifestyle’ or 'comes from a decent family'.”

Most of the men believed they could assess a woman’s HIV status by using visual clues such as weight and body shape.

“The men reported being less likely to use condoms with a woman they assumed to be 'healthy' and HIV-negative.”

The report recommended that health-care services should prioritise privacy, confidentiality and disclosure support.

“Clinics should be structured so the testing and treatment process is as private and inconspicuous as possible, and clinic managers should stress and enforce principles of patient confidentiality with staff."