title: Gender differences in experiences of ART services in South Africa: a mixed methods study.
abstract: OBJECTIVE
  A mixed methods study exploring gender differences in patient profiles and experiences of ART services, along the access dimensions of availability, affordability and acceptability, in two rural and two urban areas of South Africa.
  
  
  METHODS
  Structured exit interviews (n = 1266) combined with in-depth interviews (n = 20) of women and men enrolled in ART care.
  
  
  RESULTS
  Men attending ART services were more likely to be employed (29%vs. 20%, P = 0.001) and were twice as likely to be married/co-habiting as women (42%vs. 22%P = 0.001). Men had known their HIV status for a shorter time (mean 32 vs. 36 months, P = 0.021) and were also less likely to disclose their status to non-family members (17%vs. 26%, P = 0.001). From both forms of data collection, a key finding was the role of female partners in providing social support and facilitating use of services by men. The converse was true for women who relied more on extended families and friends than on partners for support. Young, unmarried and unemployed men faced the greatest social isolation and difficulty. There were no major gender differences in the health system (supply side) dimensions of access.
  
  
  CONCLUSIONS
  Gender differences in experiences of HIV services relate more to social than health system factors. However, the health system could be more responsive by designing services in ways that enable earlier and easier use by men.
authors.affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa. hschneider@uwc.ac.za
authors.forename: Helen
authors.initials: H
authors.lastname: Schneider
authors.forename: Veloshnee
authors.initials: V
authors.lastname: Govender
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Harris
authors.forename: Susan
authors.initials: S
authors.lastname: Cleary
authors.forename: Mosa
authors.initials: M
authors.lastname: Moshabela
authors.forename: Stephen
authors.initials: S
authors.lastname: Birch
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D013019:South Africa; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents