KHOPOTSO: But the lack of attention to their own health needs, particularly in the face of HIV and AIDS, is much more detrimental to the men themselves. Dr Francois Venter, a specialist HIV physician at Johannesburg General Hospital, describes men’€™s lack of regard to their own health as a public health crisis that needs to be prioritised.

Dr FRANCOIS VENTER: It’€™s a bit of a crisis because if we do not get men into care it’€™s going to be disastrous. They’€™re all going to die, or they’€™re going to be initiated into care when they’€™re very, very ill with massive consequences for the health care system. When you put someone on   antiretrovirals when they’€™re sick, they end up with far more side-effects; they have a much more torrid time during the first two or three months that they’€™re put on antiretrovirals. So, for us to try and get men to test earlier when they’€™re healthy is really a public health priority.

KHOPOTSO: Andrew Levack, an American researcher who has just published a report on South African men’€™s attitudes towards accessing Voluntary Counselling and HIV Testing facilities, emphasises the point.

ANDREW LEVACK: Men could actually live a more healthy life if they knew their status. They could live healthier and longer if they did something about it early. But they don’€™t see it that way.

KHOPOTSO: Levack’€™s study was conducted in Soweto. Quite alarmingly, one of the findings is that men still don’€™t see themselves at risk of contracting HIV.

ANDREW LEVACK: Some of the men said that the reason that they didn’€™t test is that they didn’€™t feel personally vulnerable. They even acknowledged that they’€™ve heard all of the messages on the radio, on television, in the print media. But they said that they just don’€™t think that it’€™s going to happen to them, which is hard to believe in a situation here in Soweto where about one in four men are found to be HIV-positive, that that would be the case.

KHOPOTSO: Human nature once again saying ‘€˜it can only happen to someone else’€™. Often, men’€™s HIV risk and denial has several drastic consequences for their female partners. Often women discover that they are HIV positive before men because all pregnant women are encouraged to take an HIV test. In some cases, telling their partner that they have HIV leaves the woman quite literally holding the baby.

ANDREW LEVACK: The saddest thing was to hear the statements from women who were in PMTCT programmes that were trying to prevent mother-to-child transmission of their child. These women ‘€“ all seven that we spoke to ‘€“ all had very painful stories about the lack of involvement of their male partner. Some men blamed them and left them when they disclosed their HIV status to their male partner. Other men simply lived in denial and didn’€™t want to take a test for themselves and didn’€™t want to acknowledge that HIV was a problem in this family. Other women simply felt that they couldn’€™t disclose to their male partner for fear that he would leave her or abuse her’€¦ Women really felt that regardless of if they disclose or not disclose to their partner that the man wasn’€™t going to play an involved role in preventing the mother-to-child transmission.

KHOPOTSO: Levack says a change of men’€™s attitudes towards HIV testing can have positive implications for both partners in a relationship.  

ANDREW LEVACK: If men continue to under-utilise Voluntary Counselling and Testing (services) we’€™re going to continue to have incredible problems both for men and for women. In terms of men – if they don’€™t know their status early – they can make lifestyle changes that allow them to live longer and healthier. They also run the risk of unknowingly continuing to transmit HIV to other partners. And then also, as men know their status they can have an open dialogue with their partner and they can prevent passing HIV to their child as well.

KHOPOTSO: But Thulani Grey, of Wits University’€™s Reproductive Health and HIV Research Unit believes much more is needed to encourage men to test for HIV than just a change in attitude. He is currently involved in a pilot study investigating reasons as to why men are not readily taking the HIV test.

THULANI GREY: As we stand, the onus is on the testee. That’€™s the bottom line. The services are there. But I think there are more creative things we can do. For instance’€¦ it could be for very simple reasons, like there are very few clinics open on a Saturday. It could be timing. It could be confidentiality’€¦ A lot of men said the ultimate way they would like to find out about their status would be with an encounter with a private doctor. I think we have to look into all those sorts of issues and then shape the service around those.              

E-mail Khopotso Bodibe