Health Worker Experiences of and Perspectives on Engaging Men in HIV Care: A Qualitative Study in Cape Town, South Africa

Abstract

Men generally fare worse than women across the HIV cascade. While we know much about how men perceive the health services, we know little about how health workers (HWs) themselves have experienced engaging with men and what strategies they have used to improve this engagement. We interviewed 12 HWs in public health care services in Cape Town to better understand their experiences and perspectives. Health workers felt there were significant gaps in men’s engagement with HIV care and identified masculine gender norms, the persistent impact of HIV stigma, and the competing priorities of employment as key barriers. They also highlighted a number of health service-related challenges, including a poor perception of the patient–provider relationship, frustration at low service quality, and unrealistic expectations of the health services. Health workers also described several strategies for more effectively engaging men and for making the health services both more male friendly and more people friendly.

Feasibility of oral HIV self-testing in female sex workers in Gaborone, Botswana

“…Reports have shown that sex workers in Botswana face high levels of violence and abuse [52], which could explain this finding. Distribution of HIV self-test kits to male partners is a promising HIV prevention strategy in the region as the men are known to infrequently engage in HIV Care [53][54][55].…”

“Men Are Scared That Others Will Know and Will Discriminate Against Them So They Would Rather Not Start Treatment.” Perceptions of Heterosexual Men on HIV-Related Stigma in HIV Services in Blantyre, Malawi

“…in 2020 where they highlighted that men feared losing their jobs which presents a difficult task for them on how to balance the competing interest of their health needs against their economic needs. 25 There is however need for employee empowerment in human rights as well as strengthening HIV work policy programs. The International labor organization emphasized that no employer is to deny employee opportunities or fire any employer in his line of duty because he is found with HIV infection unless when the employee is failing to deliver services.…”

Using health information for community activism: A case study of the movement for change and social justice in South Africa

“…This is unique, as health information, and routine clinic data specifically, often sits in reports, but not openly shared among health and non-health actors. These 'safe spaces' are not provided in South African health settings, or do not are considered hostile and contentious for all parties involved Health workers might feel blamed for not providing timely services for patients, having hostile attitudes or the stock-out of medication, even though this is largely out of their control [55,56]. Patients or community representatives might be accused of irresponsible health decisions or non-adherence, without getting the opportunity to unpack this behaviour [55][56][57].…”

“…These 'safe spaces' are not provided in South African health settings, or do not are considered hostile and contentious for all parties involved Health workers might feel blamed for not providing timely services for patients, having hostile attitudes or the stock-out of medication, even though this is largely out of their control [55,56]. Patients or community representatives might be accused of irresponsible health decisions or non-adherence, without getting the opportunity to unpack this behaviour [55][56][57]. Presenting health information during these already uncomfortable conversations between community and health systems stakeholders, can potentially increase hostility instead of starting constructive dialogues on how to collectively improve health services.…”