Barcelona 2013
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| Abstract #409 - E-Posters English | ||||
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Session: 50.12: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Ms Joelle Mak - LSHTM, United Kingdom |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: Although it is well documented that men are less likely to use health services and, particularly, sexual & reproductive health (SRH) services compared to women, little research has been devoted to explore the reasons why. This study aims to better understand facilitators and barriers to men?s health seeking behaviours in Swaziland, a high HIV-prevalence setting. | ||||
| Method / Issue: Quantitative and qualitative data were collected as part of the Integra Initiative, an evaluation of integrated SRH and HIV services in Kenya and Swaziland. Clustered household surveys were conducted among 15-49 year-olds in the Manzini region in late 2011. 1047 respondents (503 men; 544 women) were interviewed. Data on sexual behaviours, contraceptive/condom use, and SRH service utilisation were used to explore men?s health seeking behaviours. Contraceptive use includes methods used by their partner(s) while ?consistent? contraceptive/condom use refers to usage with all sexual partners. Semi-structured interviews (n=23) and focus group discussions (n=2) were conducted between in mid-2012 with a subsample of male survey respondents. Men were purposively sampled based on their reported sexual behaviours, HIV status and SRH service usage. Quantitative data were analysed descriptively and differences between groups were assessed using logistic regression, adjusting for survey design, in Stata 12. Qualitative data were analysed thematically in Nvivo 10.0. | ||||
| Results / Comments: Nearly half of the male survey respondents were aged <25 (45.9%) and 60% (n=291) reported ≥one sexual partner in the past year. Past year SRH service use was low (11.7%, n=57) with male circumcision (5.8%, n=29) and HIV care/treatment (4.1%, n=19) most commonly reported. Service users were older (p=0.002); married/cohabiting (p<0.001); and self-reported to be HIV positive (p<0.001). The majority of sexually active men reported consistent contraceptive/condoms use at last sex (71.7%, n=209). Young men were least likely to have used services but more likely to report multiple partners (OR 2.80 CI: 1.52-5.15) and consistent condom use (OR 2.43, CI: 1.52-3.90); while older men more likely to report consistent contraceptive use: OR 1.77 (CI: 1.01-3.10). Qualitative data suggest masculinity affect men?s health seeking behaviours including fear of being treated or judged by female providers, or of being seen by others when accessing STI/HIV services. Men?s reported preferences for SRH services differed between quantitative and qualitative findings. In survey data, men reported accessing SRH services from public and non-governmental facilities. However a preference for traditional healers where privacy could be ensured, provider likely to be male, and no need for physical exam were reported in qualitative data. Although some men reported positive experiences with health services, most had negative views linked to privacy and treatment by female nurses. | ||||
| Discussion: Men?s use of SRH services is problematic, despite higher rates of contraceptive/condom use particularly for young men which may be a reflection of Swaziland?s high HIV-prevalence potentially leading to better awareness of HIV risks. Men?s fears of accessing SRH health services are often neglected within the health care system and should be addressed to improved uptake of SRH and HIV services. This may in the long term lead to better health outcomes for both men and women. | ||||
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