Men’s perceptions of HIV care engagement at the facility- and provider-levels: Experiences in Cote d’Ivoire

Abstract

Men in sub-Saharan Africa have lower rates of HIV testing and are less likely to initiate treatment compared to women. Service delivery dimensions are a key factor in facilitating engagement along the HIV treatment continuum for men and women, yet male specific overall perceptions of the service delivery environment have received little attention in West Africa. This study draws on qualitative data collected in Côte d’Ivoire to explore provider-level and structural factors affecting men’s engagement in HIV testing and treatment through interviews and focus group discussions conducted with health workers and men living with HIV (some on ART) or whose HIV status was unknown. Factors influencing decisions to test or initiate treatment were considered in terms of perceived benefits and costs. Men described costs at the interpersonal (client-provider) level, such as unwanted disclosure or stigma, which were weighed against the potential for social support and clinical guidance. Likewise, fear of unwanted disclosure operated at the facility level, as the layout of facilities sometimes grouped clients living with HIV together. Notably, the benefits men described from engaging in HIV testing and care all operated at the interpersonal level and none at the facility level. In light of the fact that provider- and facility-level factors influenced the perceptions and experiences of men along the treatment continuum, we offer recommendations to reduce barriers to testing and engagement in care related to service delivery.

Individual- and Facility-Level Factors Associated with Facility Testing among Men in Malawi: Findings from a Representative Community Survey

“…Finally, our study showed that satisfaction with services received was associated with HIV testing, similarly to other studies [18,20,29,30]. Interactions with medical personnel can shape perceptions of patients, including decisions to seek further health services that were not the primary focus for the clinic visit.…”

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

“…We screened titles and abstracts of the remaining 11,605 studies, excluding 10,959 records that did not meet inclusion criteria, and reviewed the full text of 646 articles. Of these, 81 studies were included in the meta‐analysis [33–113] and 29 studies were included in the meta‐synthesis [105,114–141]. Our updated searches identified 48 additional studies for the meta‐analysis [142–189] and 11 additional studies for the meta‐synthesis [190–200], most published in 2020.…”

“…Social challenges included the experience or anticipation of poor treatment from providers with stigma towards people with HIV. One man shared his experience that “when [hospital staff] discover it is HIV, they give you a weird look….the staff laughs” [ 137 ] (p. 5). MSM described experiencing or anticipating stigma regardless of what their serostatus might be; as one MSM participant in Kenya said, “If I went to a health facility the moment I meet you I can tell how homophobic you are” [ 120 ] (p. 100).…”

“…MSM described experiencing or anticipating stigma regardless of what their serostatus might be; as one MSM participant in Kenya said, “If I went to a health facility the moment I meet you I can tell how homophobic you are” [ 120 ] (p. 100). Other disincentives to seeking care were that participants doubted their HIV test results (“sometimes the person who does the test can be wrong” [ 137 ] (p. 6) ) or believed that there is no effective treatment for HIV. Structural challenges included men's concern about lacking privacy due to clinics’ physical layouts and procedures, such as a bench reserved for patients with HIV [ 137 ] (p. 7).…”

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

“…Updated findings . New studies added further examples that confirmed negative experiences at HIV clinics [ 31 , 32 , 45 , 48 , 49 , 52 , 55 , 57 , 60 , 79 ]. Physical space and layout of HIV clinics is not optimal due to poor signage and poorly laid out waiting areas (inside and outside the clinic) which do not offer PLHIV the privacy they desire.…”