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Understanding HIV and health care utilization among men in Gauteng, South Africa

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BACKGROUND: Utilisation of HIV and health services amongst marginalised populations is critical to South Africa, achieving UNAIDS 95-95-95 targets. Studies show that men are underrepresented in health services, in particular HIV services. In this study, we describe health and HIV service utilization in a sample of men accessed outside of healthcare facilities.
METHODS: A survey was conducted between October-November 2020. Men ('¥18 years) were recruited from homeless shelters, parks, taxi ranks, factories and outside business parks in Johannesburg, South Africa. Descriptive analysis (using STATA 15) was used to characterize these men to understand their access and utilization of healthcare services.
RESULTS: A total of 150 men participated, 103(69%) were unemployed. The majority 121(84%) reported using public clinics, 9(6%) used private healthcare services, 8(5%) hospitals, and 7(5%) traditional health practitioners or avoided healthcare facilities. Whilst just over 60% of participants utilized healthcare services at least once in the last 12 months, 46(38%) had not sought health services despite 26(56%) reporting needing healthcare. Reasons for not accessing care included distance to the facility and cost. Long queues and poor staff attitudes were also reported (30% and 17% respectively) as barriers to accessing care. Almost all participants 140(93%) reported testing for HIV at least once, the majority 91(65%) tested within 12 months with the remainder testing more than a year ago. There were 75(50%) participants who reported testing for COVID-19 and 121(80%) reported they could access care if ill from COVID.

Table 1.1 Healthcare access by age, employment and residence status

CategoryAccessed care at least once in last 12 months (n=75)Not accessed care in last 12 months (n=46)Total (n=150)
Age18-45 years64(85%)40(87%)124(83%)

46+11(15%)6(13%)26(17%)
Employment status Student/retired 4(5%)04(3%)

Formal sector 6(8%)07(5%)

Informal sector/piece work/self-employed15(20%)16(35%)36(24%)

Unemployed 50(67%)30(65%)103(68%)
Residence status Citizen/visa62(83%)34(74%)121(81%)

Migrant12(16%)11(24%)26 (17%)

CONCLUSIONS: While a majority of the population had accessed healthcare services, over half of those who had not accessed care reported they had needed health services. Health facility issues such as poor staff attitudes and long queues remain a barrier to achieving this. Addressing these issues and maximising opportunities to engage men in healthcare is key to ensuring men are not underrepresented.