‘Cost, man. Good quality stuff can get pricey’, men’s choices regarding HIV services in South Africa

Abstract

BACKGROUND: Despite global declines in human immunodeficiency virus (HIV) infections, South African men remain disproportionately affected. Understanding men's HIV service preferences is essential for designing effective interventions. AIM: This qualitative study identified key attributes influencing men's preferences for HIV testing, prevention and treatment services in Gauteng province, South Africa. SETTING: Data were collected through focus group discussions and in-depth interviews between November 2023 and March 2024 across sites in Randburg, Soweto, Orange Farm and Pretoria. METHODS: A qualitative exploratory design employed focus group discussions with men aged 20-64 years and key informant interviews with HIV programme stakeholders. Stratified purposive sampling ensured demographic diversity. Recordings were transcribed verbatim and independently dual-coded. Framework analysis following Ritchie and Spencer's five-step approach systematically identified themes, which were refined into discrete attributes. RESULTS: Thirty-two focus group participants and 19 interview participants (median age 35 years [interquartile range [IQR] = 28-43], all Black African men, 82% secondary-educated) identified 10 priority HIV service attributes: accessibility, quality of care, cost-efficiency, comprehensive service packages, privacy and confidentiality, cultural sensitivity, technological solutions, community engagement, health awareness and stigma mitigation. Participants emphasised geographic proximity, welcoming nonjudgemental environments, affordability and privacy as critical in service utilisation. CONCLUSION: Findings emphasise the importance of comprehensive, private, affordable care delivered through welcoming environments with digital health awareness integration.Contribution: Validated attributes will inform a discrete choice experiment to quantify preference structures and guide the development of evidence-based, male HIV service delivery models in South Africa.