Barriers and Facilitating Factors to HIV Treatment Among Men in a High-HIV-Burdened District in KwaZulu-Natal, South Africa: A Qualitative Study

Abstract

Despite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31–41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors. We identified the following enabling factors to HIV treatment among men: fear of HIV progressing, acceptance of status, disclosure, support from family and friends, positive testing experience, and accessibility of antiretroviral treatment. This study revealed barriers and enabling factors to HIV treatment among men. These factors are important to inform the design of targeted intervention strategies aimed at improving linkage and retention to HIV treatment among men.

Linkage to HIV care and early retention in HIV care among men in the ‘universal test-and-treat’ era in a high HIV-burdened district, KwaZulu-Natal, South Africa

“…Timely and substantial linkage to HIV treatment among men newly diagnosed with HIV is critical to improve health outcomes and maximize population-level benefits from ART. Despite the well documented barriers deterring men from accessing health services in SSA [ 4 , 18 ], our study findings showed higher rates of linkage to care compared to findings from similar settings in KwaZulu-Natal and in Western Cape provinces [ 19 , 20 ]. A household-based community cross-sectional survey conducted in KwaZulu-Natal province found that 71% (95% CI: 68.6–73.4) of participants were linked to care, accounting for 74% (95% CI: 71.6–76.9) among women and 60% (95% CI: 54.2–66.1) among men [ 19 ].…”

Effect of a male-targeted digital decision support application aimed at increasing linkage to HIV care among men: Findings from the HITS cluster randomized clinical trial in rural South Africa

“…21,23 A study in KwaZulu-Natal also reported insufficient time or the need to prioritize going to work as barriers for linking to care among men. 24 In this study, of those who were not linked to care in 1 month, >60% could not be reached or did not consent for EPIC-HIV 2. The primary reasons included being busy at work or feeling fine, which were similar to the barriers to linkage to care found in other studies.…”

Geospatial and temporal mapping of detectable HIV-1 viral loads amid dolutegravir rollout in KwaZulu-Natal, South Africa

“…Although our results reveal a higher proportion of detectable HIV VL records from female patients, it is possible that this could be a bias of the demographics of the population accessing HIV care, and not necessarily an indication that more women are viraemic on ART. This in part could be associated with poor retention in HIV care among males as reported by the UNAIDS and as shown by studies from other African countries, including South Africa [ 55 , 56 ]. Lastly, there is a need to prospectively assess longitudinal geospatial trends of VLs to assess whether the hotspots of VLs observed were the impact of the pandemic that settles over time as the health system recovers from the impact of COVID-19 pandemic, or whether this is a concerning trend that becomes sustained or worse over time.…”