Overview

In 2016, it was estimated that 86% of PLHIV in South Africa knew their status, but this was lower for men (79%) and
young people aged 15-24 years (65%). The KwaZulu-Natal province has the country’s highest HIV prevalence and
incidence. In the area around the provincial town of Eshowe, previously effective strategies, such as community-based
outreach, including door-to-door testing, had less than a 1% yield. Efforts to reach men were needed to close the testing gap. 

In a pilot project supported by an NGO, fixed HIV testing sites in settings where men spend time, such as taxi ranks,
were established and staffed by all-male providers to reach men with HIV testing, as well as other important health
services, including non-communicable disease (NCD), TB and STI screening. These sites are located near clinics where
treatment and VMMC were available, so referrals could be made quickly. Here, it was convenient for men to link and
initiate follow-up services the same day. Workplace testing at a farm was established through a formal relationship with the local farm owners’ associations. HIV testing was managed by a mobilizer and counsellor who promote and offer HIV testing to men working on the farm. The mobilizer and counsellor also encourage men who test to bring female partners and their families to test.

Mobilizing

WHAT

Community mobilization by
all-male counsellors and
mobilizers

WHEN

Rush hour at taxi ranks
Agreed times with employers
at farms

WHERE

Taxi ranks and locations
where men gather,
workplace (farm)

WHO

Male providers, counsellors and
mobilizers

Testing

WHAT

Rapid HIV testing
and screening for
STIs, NCDs and TB

WHEN

Rush hour at taxi ranks
Agreed times with employers
at farms

WHERE

Male-friendly satellite clinic;
workplace (farm)

WHO

Male health workers
and counsellors

Linking

WHAT

For prevention:
same-day referral
to VMMC site
For ART initiation:
same-day
ART initiation

WHEN

Where possible,
on the same day

WHERE

Local prevention (including
VMMC) and MoH ART sites

WHO

Male providers and counsellors

Summary of evidence

In the last quarter of 2017, 9.4% of people tested were newly diagnosed (19.6% in Eshowe service clinics and 4.7% in
Mbongolwane clinics, and approximately 4.4% through malefocused outreach and fixed sites). In 2017, 4.4% (31/709) of
people reached through a farm-based programme tested positive. The majority of those identified in the male-friendly
clinics and the farm-based programme were in early disease stage. In the male-friendly clinics, approximately 30% of
PLHIV identified had a CD4 count over 500 cells/mm3; and in the farm-based programme, 74% of PLHIV identified had
a CD4 count of more than 500 cells/mm3.

Location

Reaching men
South Africa