Barriers and Strategies to Improve Men’s Uptake of HIV Care Services in Rural KwaZulu-Natal, South Africa: A Qualitative Study

Abstract Background The 2017 Joint United Nations Programme on HIV/AIDS blind spot report echoes the challenges as well as the benefits of men’s effective utilization of HIV services. However, men have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. This study sought to understand key barriers to effective uptake of HIV services among men, and potential strategies to address these challenges. Methods Ten telephone interviews and three workshops were conducted (July-November 2020) with a purposive sample of men aged 21–65 years (n = 26) from rural KwaZulu-Natal. Broad themes were identified from the interview transcripts and analyzed inductively. Results Masculine norms, stigma and fear of an HIV identity were major barriers to the uptake of HIV testing among men as well as hesitancy due to perceived risks. Participants living with HIV identified various socio-psychological, structural, and COVID-related factors inhibiting HIV treatment uptake and adherence. Besides condoms and circumcision, no participant had prior knowledge of PrEP. Participants suggested that men need tailored HIV/AIDS messaging and education (led by men living with HIV) about the benefits of HIV testing, treatment, and prevention. Importantly, they believed that community delivery of HIV services would encourage more men to engage in care. Conclusion To achieve zero new infections and zero AIDS-related deaths among men in South Africa, efforts should be directed towards developing tailored emotive educational and community-based interventions that address identified barriers to improve men’s utilizations of HIV care services.