The South African National Aids Council, through its National Strategic Plan (NSP) for HIV, TB and STIs (2023-2028), should prioritise young men, who have almost been a forgotten target population for HIV behavioural interventions, to curb the spread the spread of HIV and AIDS.
This should be done through strengthening screening for the diseases and other diseases, such as TB, creating a demand for HIV testing services (HTS) in places where young men gather and prioritising young men at public health centres.
These were some of the findings in the PhD research by Dr Sithembiso Ndlovu, a Public Health lecturer in the Division of Public Health, Office of the Dean of Health Sciences at the University of the Free State (UFS). Dr Ndlovu graduated earlier this year with his PhD in Public Health from the University of KwaZulu-Natal, supervised by Prof Andrew Ross. He published two journal articles from his PhD thesis and a third article is under review.
The NSP is comprehensive strategy that aims to place the country on track to eliminate HIV, TB, and STIs as public health threats by 2030.
According to Dr Ndlovu, the aim of his study, titled “Knowledge, perceptions, and practices influencing the uptake of HIV testing services (HTS): the experiences of young men in rural Driefontein and the peri-urban township of Steadville, Ladysmith, South Africa”, was to understand the factors that affect the uptake of HIV testing services among young men in this community. To this end, a comprehensive framework of care to encourage and support young men to test for HIV can be developed.
Outcome
Dr Ndlovu says the study found that all the young men had previously tested for HIV, were frequent testers and remained motivated to utilise these services for an array of reasons. They reported having had pleasant experiences with the testing services and were more likely to disclose an HIV-positive test result to family and friends than sexual partners.
“Generally, they had adequate knowledge of HIV/AIDS (although this did not translate into 'safe' sexual practices); were aware of HTS, but unaware and unsupportive of HIV self-testing (HIVST). All participants had several knowledge sources for HIV/AIDS and HTS and knew where they could test for HIV.
“However, several barriers to HTS were identified, including fear of the result, community stigma, limited HTS knowledge, traditional beliefs, as well as cultural understanding of manhood. They offered various recommendations to help attract and retain young men in HIV treatment and care, including HTS, health education and incentive-driven interventions. The two healthcare providers who participated in the study highlighted the role culture and religion played in the young men’s utilisation of HTS,” explains Dr Ndlovu.
The study makes two main recommendations; health programmes and policies which include, among others, conducting community awareness campaigns on voluntary medical male circumcision, to revitalise programmes that promote and strengthen disclosure counselling for young men, and initiate HTS-related community dialogues with community residents. It also recommends the promotion of risk-reduction counselling towards ensuring risky sexual behaviour change among young men, and establishing ART adherence clubs for young men who test positive for HIV at clinics and in community spaces that are convenient to them, or using online platforms. In essence, all the interventions need to be age-specific, especially the messaging that speaks to specific groups of men.
Hope for this research
Dr Ndlovu envisages that government departments and local organisations dealing with HIV prevention, treatment and care challenges consider the proposed study recommendations. He believes it remains vital to engage men on the importance of not only testing for HIV but also their awareness about their health to improve their quality of life. “Understanding various contextual factors, beliefs, and values influences whether young men test for HIV.” Regarding behaviour, understanding what agency young men in rural and peri-urban communities have to test, and contextual information can inform what resources and infrastructure are available to facilitate (or not) HIV testing at primary healthcare facilities.
“I believe these factors are critical in successfully implementing the comprehensive behavioural HTS framework for young men, particularly highlighting the key programmatic recommendations that need to take place for young men to access and utilise HTS in underserved communities. There is a need for a quantitative study on the knowledge, attitudes, and perceptions of the larger general male population in the broader Ladysmith area toward HTS and their utilisation,” says Dr Ndlovu.
The study speaks directly to the university’s Vision 130 of maximum societal impact with sustainable relationships and contributing to the development of the Free State and South Africa. Dr Ndlovu believes that given the current lack of HTS interventions tailored for men in general, particularly young men in underserved communities, his research will have an impact in academia and in the young men’s lives who are at a heightened risk of acquiring HIV due to lack of access to primary healthcare facilities, continuing engaging in risky sexual behaviours, among other reasons. The gender-specific recommendations in the study will enable young men to be more health conscious, especially where their sexual health is concerned, particularly in an effort to curb the spread of HIV and AIDS towards attaining the UNAIDS 95-95-95 fast-track targets in South Africa.