Targeting interventions for HIV testing and treatment uptake: An attitudinal and behavioural segmentation of men aged 20–34 in KwaZulu-Natal and Mpumalanga, South Africa

Abstract

Despite recent improvements, men still have worse HIV outcomes than women in South Africa. This study describes how young men form distinct behavioural and attitudinal subgroups, and is intended to inform the design of targeted interventions to encourage HIV testing and initiation on antiretroviral therapy. Data were collected using a cross-sectional survey with questions on men’s attitudes, beliefs and behaviours around HIV/AIDS. A total of 2,019 men were randomly sampled from eight district municipalities in KwaZulu-Natal and Mpumalanga provinces between October 2018 and January 2019. Men were eligible to participate if they were aged 20–34, Black African, had an education level below university graduation, were aware of HIV and were willing to disclose whether they had tested for HIV. Each participant responded to a questionnaire asking about their demographic characteristics, reported sexual behaviour, engagement with HIV testing and treatment services, alcohol consumption, HIV knowledge, attitudes to gender equity and reported level of depressive symptoms. Data were analysed using canonical correlation, hierarchical clustering and factor analysis techniques to produce five groups of men. The results were synthesised using Human Centred Design principles to suggests areas for potential intervention for each segment. The results showed that men vary based on their attitudes to gender and masculinity, use of alcohol, testing and treatment behaviour, HIV-related fears and preferences for testing modalities. Segment 1 (21%) avoids the topic of HIV, perhaps fearful of the impact on his life. Segment 2 (23%) is well connected to his community and has social concerns about HIV. Segment 3 (15%) struggles with more distal determinants of HIV acquisition such as unemployment and poor mental health. Segment 4 (25%) has concerns about the lifestyle changes that would be required if he were HIV positive. Segment 5 (16%) has a strong traditional mindset and is fearful of the ramifications of HIV in his community. The results will be used to design targeted interventions to increase HIV testing and treatment rates among young men in South Africa. Further research is required to understand the impact of interventions designed in this way.

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

“…Lastly, research has identified subgroups of patients with personal characteristics (e.g. younger men) that predispose them to progress more successfully through the care continuum [ 215 , 216 ].…”

Identifying efficient linkage strategies for HIV self-testing (IDEaL): a study protocol for an individually randomized control trial

“…Second, we tailor interventions to men's unique needs and motivations, based on extensive formative work. While innovative interventions for men are underway, [19][20][21] few have rigorously tested the impact of male-tailored interventions on ART engagement. 37 Our study will measure adverse events including unwanted disclosure, end of a relationship, and/or intimate partner violence (IPV).…”

“…Differentiated service delivery models (DSD) are now being developed to improve men's ART engagement throughout SSA. [19][20][21] As DSDs for men are developed, it is critical that strategies be feasible and cost-effective to allow scale-up. A "one size fits all" model is not as effective as more nuanced approaches.…”

Using Human-Centered Design to Develop a Program to Engage South African Men Living With HIV in Care and Treatment

“…Details of the methods used have been previously presented. 17 In brief, between October 2018 and January 2019, a cross-sectional study was conducted in 8 district municipalities in Mpumalanga and KwaZulu-Natal Provinces including from 2,019 Black African men aged 20-34 years with less than a university-level education. Participants completed a survey of demographic characteristics, sexual behavior, engagement with HIV testing and treatment services, alcohol use, HIV knowledge, mental health, and attitudes to gender equity.…”

“…The quantitative segmentation study produced 5 subgroups or segments of men, based on their attitudes, beliefs, behaviors, and needs related to HIV testing and treatment (described in depth in Bell et al). 17…”