‘Clinics aren't meant for men’: Sexual health care access and seeking behaviours among men in Gauteng province, South Africa

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.

Les hommes peuvent être des responsables dans la transmission des infections sexuellement transmissibles (IST), et il est important que les services de santé des IST/VIH les sensibilisent (les hommes). Les objectifs de cette étude étaient d'examiner l'accès aux soins de santé et les comportements sexuels des hommes pendant 5 ans après la mise en oeuvre de la thérapie antirétrovirale (ART) gratuite dans le secteur public Sud-Africain. Six groups d'hommes âgé s ≫18 ans (N=58) ont menés des discussions dans la zone urbaine de la province de Gauteng. Ces hommes sont recrutés dans divers endroits dans toute la communauté. Ils ont déclarés rencontrés des obstacles et facilitateurs à l'accès des cliniques publiques et privées des services de santé sexuelle, y compris le test du VIH, et beaucoup d'hommes déclarent être à la recherche de soins vers des guérisseurs traditionnels. Les hommes ont souvent vu les cliniques publiques comme des endroits pour les femmes et se sont souvent plaint des expériences qu'ils ont eues par rapport aux infirmières qui ont un mauvais jugement sur eux. Certains d'entre eux ont déclaré qu'ils cherchaient des soins de santé dans les cliniques publiques, mais qu'ils n'étaient pas soumis à des examens physiques pour diagnostiquer leurs syndrome d'IST. La plupart d'entre eux n'avaient pas de connaissances de l'ART et évitent le test du VIH parce qu'ils ont peur de la mort ou d'être abandonné par leurs familles ou leurs amis. Cette étude suggère que les hommes doivent exiger de meilleures qualités de soins, un non-jugement des services de santé sexuelle. Les recherches futures sont nécessaires pour déterminer la méthode la plus efficace d'accroitre l'accès des hommes aux services de santé sexuelle.

Keywords:

• sexual health care access
• men

Mots clés:

• l'accès aux soins sexuels
• les hommes
• VIH

Additional information

Notes on contributors

Jami S Leichliter

Jami S Leichliter, PhD, is a research behavioural scientist in the Division of STD Prevention at the US Centers for Disease Control & Prevention, Atlanta, GA. Her research interests include high-risk or marginalised populations, such as persons repeatedly infected with STDs and impoverished communities, the role of sexual networks, and national surveys of sexual behaviour.

Gabriela Paz-Bailey

Gabriela Paz-Bailey, MD, MSc, PhD, is a medical epidemiologist working at Del Valle University and Tephinet Inc. on HIV-related research and programmes in Central America. She also worked in South Africa on herpes simplex type 2 and syndromic management of genital ulcer disease. Her research interests include the epidemiology of HIV and STI among high-risk groups, HIV and STI interactions, and STI management strategies.

Allison L Friedman

Allison L Friedman, MS, is a health communication specialist in the Behavioral Interventions & Research Branch in the Division of STD Prevention at the US Centers for Disease Control & Prevention. She has focused her efforts directing national campaigns to raise awareness of STDs, reduce STD-associated stigma, and promote STD testing and prevention.

Melissa A Habel

Melissa A Habel, MPH, is a health scientist at the Centers for Disease Control & Prevention in the Division of STD Prevention, Behavioral Interventions and Research Branch, Atlanta, GA. Her primary research focuses on the sexual behaviour of adolescents and young adults, specifically exploring how new media and technology influence behaviour and can be used for STD prevention.

Alex Vezi

Alex Vezi is a sexual health counsellor at the Sexually Transmitted Infections Reference Centre at the National Institute for Communicable Diseases, National Health Laboratory Service, South Africa. He is a medical recruiting officer and facilitator for several behavioural research studies and holds a Project Management certificate.

Martha Sello

Martha Sello, RN midwife, RNE, BCur is a clinical nurse manager at the STI Reference Centre of the National Institute for Communicable diseases in Johannesburg, South Africa. Her research interest is in varying projects investigating sexually transmitted infections epidemiology. She was previously a senior nurse clinician in the genito-urinary medicine (GUM) clinic at St Thomas Hospital, Central London, UK.

Thato Farirai

Thato Farirai is currently working as the HIV counseling and testing Lead for CDC GAP South Africa. Her research interests are in behaviour change communication and in models of HIV testing and counselling.

David A Lewis

David A Lewis, FRCP (UK), PhD, is Head of the Sexually Transmitted Infections Reference Centre at the National Institute for Communicable Diseases, National Health Laboratory Service, South Africa. He is also the Director of the African Region of the International Union against Sexually Transmitted Infections (IUSTI). His research interests include men's sexual health, gonorrhoea resistance, genital ulceration and STI surveillance.