KHOPOTSO: Although South Africa has one of the highest HIV prevalence rates in the world, most men are not interested in having an HIV test. In fact, our entire nation seems reluctant to use the free Voluntary Counselling and HIV Testing services on offer. American Andrew Levack, a consultant with Engender Health South Africa, is the author of the study on men’€™s attitudes towards accessing VCT facilities, based on a thesis for his Master of Public Health degree with the University of Washington.

ANDREW LEVACK: National data shows that only 20% of South Africa’€™s population had ever tested and of that small minority one in five are men. So, what we’€™re finding is many more women than men are actually accessing VCT.

KHOPOTSO: The aim of the study was to uncover why men are reluctant to test for HIV. The findings are grouped into three main themes ‘€“ the personal, social and institutional.

ANDREW LEVACK: We found that there are a lot of personal reasons, such as the fear of the results. We found also that men tended to have their partners test for them. So, they are using their girlfriends’€™ or wives’€™ results and saying ‘€˜okay, she’€™s negative, so I don’€™t have to test. Then we found some social factors, such as issues of stigma and men recognising that men are not socialised to test. And finally, we found some institutional factors. For example, we found that a lot of men said that they weren’€™t treated well at clinics and they were concerned about confidentiality.      

KHOPOTSO: For Levack, an interesting outcome of the study is the tendency by men to find out about their own HIV status by proxy – that is, encouraging their partners to test for HIV and then, making assumptions about their own status based on their partner’€™s result, whether negative or positive. Thulani Grey, Programme Manager of the Reproductive Health and HIV Research Unit’€™s Esselen Street project in Hillbrow, Johannesburg, agrees.

THULANI GREY: I was sitting in a support group at the Johannesburg General Hospital’€™s PMTCT clinic with HIV positive pregnant women and it was very frequent the amount of times women expressed their husbands asked them to test and were curious about the result of the test’€¦ If a man discovers his partner is negative, then usually he will construe that he’€™s negative as well. I don’€™t think there’€™s very much knowledge about discordancy and how discordancy can come about. It’€™s quite hard to explain to people how one party can be negative and one party be positive.

KHOPOTSO: If the man’€™s partner is HIV positive and she ends up on antiretrovirals, her man’€™s refusal to test himself often has consequences for her taking the medicines. Thulani Grey explains.

THULANI GREY: If, then, she’€™s positive he will probably secretly have a sense that he’€™s positive but still try and find a way of perpetuating not knowing his own status’€¦ Men, we’€™ve seen also, if their partner is positive then they also share the medication, so they don’€™t formally engage with a health facility. Obviously, they haven’€™t experienced the adherence counselling. So, they haven’€™t got the sufficient information. And they end up compromising both parties by taking the medication wrongly, often.

KHOPOTSO: The sample population in the study was very tiny ‘€“ 69 all in all. So, how representative of South African men can this be? The study’€™s author, once again.  

ANDREW LEVACK: It was a qualitative study. We did interviews and focus groups with just 69 individuals, men and women from Soweto. But they were from a range of communities in Soweto, which included Diepkloof, Meadowlands, Kliptown ‘€“ so, various parts of the area. I think the important thing is that in the qualitative study we already had the quantitative data that said ‘€˜men weren’€™t testing’€™. So, here we wanted to know: Why? And what became clear very early is that men were saying the same thing over and over again. So, in these qualitative studies what they say is ‘€˜you should continue to talk to people until you start hearing the same thing over and over again’€™. And we heard the same thing over and over again very quickly’€¦ So, because those issues were so clear we didn’€™t have to continue to ask another thousand people. I think these themes are rather clear’€¦ They all seem to say ‘€˜yes, this is what I have seen in my own community’€™.      

 KHOPOTSO: In January this year, the first of two men’€™s health centres aimed at encouraging men in Soweto to utilise VCT services was opened in Kliptown. The second, in Diepkloof, opened four months later in mid-May. Bernard Nhlapo, a nurse by profession, is the Project Co-ordinator of the programme, known as Imbizo ‘€“ a gathering place for men. He says the slow uptake of HIV testing services by men since the Imbizo centres opened their doors, indicates that there is still a long way to go before men can take the initiative to find out about their HIV status.

BERNARD NHALPO: We are now approaching 300 since we started in January, that is including both centres, the one in Diepkloof and the one in Kliptown’€¦ I think in Kliptown we’€™re way above 200 and in Diepkloof we’€™re round about the area of 70’€¦ Personally, when I started I thought it would be a walk in the park, but it seems it’€™s a challenge. To be frank, I’€™m not that much happy, but it’€™s getting there. The more we expose ourselves and introduce ourselves to the community the figures will pick up.                                  

E-mail Khopotso Bodibe