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Dr. Vivian Cox Médecins Sans Frontières Town One Properties - Site B Sulani Drive Khayelitsha, Cape Town South Africa 7786 Tel: +27(0)21 364 5490 Cell: +27(0)82 068 5302 Fax: +27(0)21 361 7051

Towards a male-centred model of care: understanding male preferences and barriers to HIV care in Khayelitsha, South Africa Cox, Vivian1; Campbell, Alisdair2; Raphahlelo, Nombulelo1; McIntyre, James2; Rebe, Kevin2 1Médecins

Sans Frontières, Khayelitsha, South Africa Institute, Cape Town, South Africa

2Anova Health



Disproportionately more women than men have accessed antiretroviral therapy (ART) in sub-Saharan Africa. In Khayelitsha, patients on ART are 68% female. Men are admitted to programmes with more advanced HIV disease and experience greater on-treatment mortality. Since 2007, a male-only clinic in Khayelitsha has successfully recruited large numbers of men for HIV/STI screening; the clinic does not perform CD4 counts or provide ART services. We investigated factors which might improve linkages to and retention in care for HIV-positive males.

The average age of respondents was 26.4 years; 157/200 (78.5%) were regularly employed and 176/200 (88%) completed grade 10 or higher. The reported mean number of sexual partners over the past 6 months was 2.5, with 52% not using condoms. 124 males (62%) reported they had tested for HIV more than 3 times in the past, with a majority in the past 6 months (65.5%). Reason for seeking HIV screening: ART Service Preferences:

Aim To investigate the preferences of male clients regarding access and provision of STI and HIV services, in order to develop an efficient and effective male-centred model of care. The information gained from this study can be used to inform health care planners about factors that might be preventing male health care access, and to identify areas for improvement.

Methods Site C Male Clinic, a male-only walk-in clinic, was opened by MSF as a pilot project next to a taxi rank at Site C in Khayelitsha in 2007. Since then the number of men undergoing HCT at the clinic has steadily increased to represent 27% of all men tested in Khayelitsha in 2010. 6232 tests were performed (approximately 519 per month), and HIV positive clients were referred to a nearby community health centre for continuation of care. The Male Clinic is now the largest STI treatment site in the Cape Metro. One nurse and three counselors provide HCT, STI screening and treatment, condoms, partner testing, and counselling on follow-up care. Data from HIV testing at Site C Male clinic indicates high numbers of men are testing for HIV, however little information is available on the linkage into care for those who test positive. Site C is operated collaboratively between the Department of Health and Anova Health Institute. Anova Health Institute is a non-profit organization which receives support from USAID / PEPFAR and has extensive clinical and research experience in the fields of HIV and STIs. A cross sectional survey using convenience sampling of clients attending the Male Clinic was performed from October to November 2012. A research nurse administered a questionnaire to 200 clients over 18 years of age requesting HIV/STI services.

Male perspectives on mixed gender primary health care services (MGPHC) providing HIV/ART:

Recent risky sexual contact Routine 6-monthly HIV screening STI screening or other concern Would attend Male Clinic for ART initiation within one week

56/200 (28%) 49/200 (24.5%) 95/200 (47.5%) 155/200 (77.5%)

Prefer attending Male Clinic for ART services, even if waiting time increased Extended clinic hours after 4 pm Close proximity to home or public transport hubs

198/200 (99%)

191/200 (95.5%) 196/200 (95.5%)

Male-only clinics MGPHCs are viewed as places for women Feels unwelcome in MGPHCs due to gender

167/200 (83.5%) 77/200 (38.5%)

Avoid attendance because of female staff

97/200 (48.5%)

33/200 (16.5%)

Conclusions Male patients surveyed at the male-only clinic for HIV/STI screening display risky behaviours for HIV-acquisition. Despite men not regarding MGPHCs as female spaces or feeling unwelcome, they prefer to attend male-only clinics, operating after-hours, and sited close to home or transport hubs. These insights assist in designing male-centred services aimed at increasing the number of males accessing and remaining in care.

Conducting the survey to males accessing HIV and STI screening services at the Male Clinic.

Acknowledgements •Staff and patients at the Khayelitsha Male Clinic, Site C, Khayelitsha •Alisdair Campbell and Nombulelo Raphahlelo for their dedication to the survey in the clinic

Khayelitsha Male Clinic, Site C, Khayelitsha, South Africa

Anova Health Institute's Health4Men program is funded with support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) program via the US Agency for International Development under Cooperative Agreement No. 674-A-00-08-00009-00. The views expressed in this poster do not necessarily reflect those of PEPFAR or USAID.

Towards a male-centred model of care:understanding male preferences and barriers to HIVcare