Patient and provider perspectives of male uptake of HIV testing at selected public health facilities in Orange Farm, South Africa

Background: Men in South Africa, particularly in peri-urban areas, remain underrepresented in Human Immunodeficiency Virus (HIV) testing services (HTS), contributing to delayed diagnoses and ongoing transmission. Despite national efforts, gender-specific barriers to HTS persist. This study explored the perspectives of men and healthcare providers on barriers to and facilitators of male uptake of HTS at primary health care (PHC) facilities. Methods: A qualitative research design was used. The study was conducted in Orange Farm, one of the largest peri-urban township areas in South Africa. Semi-structured interviews were conducted with 12 male patients, six lay counsellors, and five professional nurses between July and August 2022. Data were analysed thematically using the socio-ecological model as a guiding framework. Results: Barriers to HTS uptake manifested across five distinct levels. At the individual level, limited awareness of HIV and available testing options hindered engagement. Interpersonally, silence within families and a lack of emotional support discouraged testing. Organisationally, discomfort with cross-gender interactions and negative attitudes among healthcare staff created further obstacles. At the community level, the absence of male-targeted educational initiatives contributed to low participation. Finally, at the policy level, inconsistent implementation of HTS guidelines undermined service delivery and accessibility. Key facilitators aligned with each level included enhanced awareness at the individual level; open, supportive family dialogue at the interpersonal level; male-friendly service environments at the organisational level; community-driven education initiatives at the community level; and improved adherence to HTS guidelines at the policy level. Conclusions: These findings underscore the necessity of a multi-level, gender-sensitive approach to bolster male engagement in HTS at PHC facilities. Strengthening HIV service delivery for men requires the cultivation of supportive environments across all of the individual, interpersonal, organisational, community, and policy levels.

HIV Testing Services; Primary health care facilities; Male uptake of HIV testing; Socio-ecological model; Barriers and facilitators

[1] UNAIDS. The urgency of now: AIDS at a crossroads. 2024. Available at: https://www.unaids.org/en/resources/documents/2024/global-aids-update-2024 (Accessed: 25 June 2025).

[2] UNAIDS. The country factsheets South Africa: HIV and AIDS estimates. 2024. Available at: https://www.unaids.org/en/regionscountries/countries/southafrica (Accessed: 23 June 2025).

[3] National Department of Health. The national strategic plan for HIV, TB, and STIs 2023–2028. 2023. Available at: https://bhekisisa.org/wp-content/uploads/2023/03/NSP-HIV-TB-STIs-2023-2028-MARCH20_23-PRINT2.pdf (Accessed: 25 June 2025).

[4] UNAIDS. The path that ends AIDS. 2023. Available at: https://thepath.unaids.org/wp-content/themes/unaids2023/assets/files/2023_report.pdf (Accessed: 25 June 2025).

[5] Heath K, Levi J, Hill A. The Joint United Nations Programme on HIV/AIDS 95-95-95 targets: worldwide clinical and cost benefits of generic manufacture. AIDS. 2021; 35: S197–S203.

[6] Mohlabane N, Tutshana B, Peltzer K, Mwisongo A. Barriers and facilitators associated with HIV testing uptake in South African health facilities offering HIV counselling and testing. Health SA Gesondheid. 2016; 21: 86–95.

[7] Lippman SA, El Ayadi AM, Grignon JS, Puren A, Liegler T, Venter WDF, et al. Improvements in the South African HIV care cascade: findings on 90-90-90 targets from successive population‐representative surveys in North West Province. Journal of the International AIDS Society. 2019; 22: e25295.

[8] Matonyane L, Ross A, Qolesa S, Sibeko Z. Interventions for reaching men to improve HIV testing services in sub-Saharan Africa: a narrative review. African Journal of Primary Health Care & Family Medicine. 2025; 17: e1–e13.

[9] Adugna DG, Worku MG. HIV testing and associated factors among men (15–64 years) in Eastern Africa: a multilevel analysis using the recent demographic and health survey. BMC Public Health. 2022; 22: 2170.

[10] Camlin CS, Ssemmondo E, Chamie G, El Ayadi AM, Kwarisiima D, Sang N, et al. Men “missing” from population-based HIV testing: insights from qualitative research. AIDS Care. 2016; 28: 67–73.

[11] Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, et al. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: a qualitative study from South Africa. PLOS Global Public Health. 2022; 2: e0000132.

[12] Katirayi L, Tchendjou P, Tchounga B, Mbunka M, Wicks M, Conserve DF. Changing attitudes towards HIV testing and treatment among three generations of men in Cameroon: a qualitative analysis using the Fogg Behavior Model. BMC Public Health. 2023; 23: 501.

[13] Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015; 528: S77–S85.

[14] Bronfenbrenner U. Ecological systems theory. In Vasta R (ed.) Six theories of child development: revised formulations and current issues (pp. 187–249). Jessica Kingsley Publishers: London, England. 1992.

[15] Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013; 13: 482.

[16] Tenny S, Brannan JM, Brannan GD. Qualitative study. StatPearls Publishing: Treasure Island (FL). 2023.

[17] McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly. 1988; 15: 351–377.

[18] Dyson YD, Mobley Y, Harris G, Randolph SD. Using the social-ecological model of HIV prevention to explore HIV testing behaviors of young black college women. Journal of the Association of Nurses in AIDS Care. 2018; 29: 53–59.

[19] Robert KY. Case study research design and methods. 5th edn. Sage: Thousand Oaks, CA. 2014.

[20] Priya A. Case study methodology of qualitative research: key attributes and navigating the conundrums in its application. Sociological Bulletin. 2021; 70: 94–110.

[21] City of Johannesburg. News room. 2018. Available at: https://www.joburg.org.za/media_/Newsroom/Pages/2013%20articles/2011%20&%202012%20%20Articles/Change-is-coming-to-Orange-Farm.aspx (Accessed: 25 June 2025).

[22] Govender K, George G, Mucheuki C, Strauss M. Voluntary medical male circumcision in South Africa: challenges and opportunities. South African Health Review. 2013; 2013: 127–137.

[23] Bonokoane KS, Sebaeng JM, Moloko-Phiri SS. Incorporation of nurse initiated management of antiretroviral treatment course within the undergraduate nursing programme North West province. Health SA Gesondheid. 2023; 28: 2286.

[24] National Department of Health. National HIV Testing Services: policy 2016. 2016. Available at: https://www.hst.org.za/publications/NonHST%20Publications/HTS%20Policy%2028%20July%20final%20copy.pdf (Accessed: 25 June 2025).

[25] Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & Quantity. 2018; 52: 1893–1907.

[26] Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3: 77–101.

[27] Braun V, Clarke V, Rance N. How to use thematic analysis with interview data. In Vossler A, Moller N (eds.) The counselling and psychotherapy research handbook (pp. 183–197). 1st edn. SAGE Publications Ltd: London. 2015.

[28] Bryman A. Social research methods. 2016. Available at: https://ktpu.kpi.ua/wp-content/uploads/2014/02/social-research-methods-alan-bryman.pdf (Accessed: 25 June 2025).

[29] Ndlovu SMS, Ross A, Ndirangu J. Knowledge of HIV and/or AIDS and HIV testing services among young men in South Africa. African Journal of Primary Health Care & Family Medicine. 2023; 15: e1–e10.

[30] Ndlovu SMS, Ross A, Ndirangu J. Young men’s barriers to and facilitators of utilising HIV-testing services in South Africa. Southern African Journal of HIV Medicine. 2025; 26: 1631.

[31] Nyirenda HC, Foloko M, Bolton-Moore C, Vera J, Sharma A. Drivers of uptake of HIV testing services, a snapshot of barriers and facilitators among adolescent boys and young men in Lusaka: a qualitative study. BMJ Open. 2023; 13: e062928.

[32] Stephenson R, Miriam Elfstrom K, Winter A. Community influences on married men’s uptake of HIV testing in eight African countries. AIDS and Behavior. 2013; 17: 2352–2366.

[33] Okal J, Lango D, Matheka J, Obare F, Ngunu-Gituathi C, Mugambi M, et al. “It is always better for a man to know his HIV status”—a qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya. PLOS ONE. 2020; 15: e0231645.

[34] Gousse Y, Wilson TE, McFarlane D, Browne RC, Fraser M, Yusim D, et al. HIV testing correlates: U.S. and foreign born high-risk black heterosexual men. Journal of Immigrant and Minority Health. 2021; 23: 1145–1151.

[35] Department of Health. Standard operating procedures for HIV index testing services. 2020. Available at: https://knowledgehub.health.gov.za/system/files/elibdownloads/2021-02/NDoH%20Index%20Testing%20SOP-11-12-2020.pdf (Accessed: 05 November 2025).

[36] Djellouli N, Quevedo-Gómez MC. Challenges to successful implementation of HIV and AIDS-related health policies in Cartagena, Colombia. Social Science & Medicine. 2015; 133: 36–44.

[37] Shand T, Thomson-de Boor H, van den Berg W, Peacock D, Pascoe L. The HIV blind spot: men and HIV testing, treatment and care in Sub-Saharan Africa. IDS Bulletin. 2014; 45: 53–60.

[38] Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K. Mapping evidence of intervention strategies to improving men’s uptake to HIV testing services in sub-Saharan Africa: a systematic scoping review. BMC Infectious Diseases. 2019; 19: 496.

[39] Mabuto T, Hansoti B, Kerrigan D, Mshweshwe-Pakela N, Kubeka G, Charalambous S, et al. HIV testing services in healthcare facilities in South Africa: a missed opportunity. Journal of the International AIDS Society. 2019; 22: e25367.

[40] DiCarlo AL, Mantell JE, Remien RH, Zerbe A, Morris D, Pitt B, et al. ‘Men usually say that HIV testing is for women’: gender dynamics and perceptions of HIV testing in Lesotho. Culture, Health & Sexuality. 2014; 16: 867–882.

[41] UNAIDS. Male engagement in HIV testing, treatment and prevention in the Eastern and Southern Africa: a framework for action. 2022. Available at: https://reliefweb.int/report/world/male-engagement-hiv-testing-treatment-and-prevention-eastern-and-southern-africa (Accessed: 25 June 2025).