title: Men's use of sexual health and HIV services in Swaziland: a mixed methods study.
abstract: Over one-quarter of the adult population in Swaziland is estimated to be HIV positive. Men's use of sexual health (SH) services has significant implications for HIV prevention. This study aimed to understand Swazi men's health-seeking behaviours in relation to SH and HIV services.
  
  
  
  A household survey was conducted in Manzini (n=503), complemented by 23 semi-structured interviews and two focus group discussions (with a total of 10 participants).
  
  
  
  One-third of male survey participants used SH services in the past year, most commonly HIV testing (28%). Service users were more likely to be sexually active (aOR 3.21, 95% CI: 1.81-5.68 for those with one partner; and aOR 2.35, 95% CI: 1.25-4.41 for those with multiple partners) compared with service non-users. Service users were less likely to prefer HIV services to be separated from other healthcare services (aOR 0.50, 95% CI: 0.35-0.71), or to agree with travelling further for their HIV test (aOR 0.52, 95% CI: 0.33-0.82) compared with non-users, after controlling for age-group and education. Men avoided SH services because they feared being stigmatised by STI/HIV testing, are uncomfortable disclosing SH problems to female healthcare providers, and avoided HIV testing by relying on their wife's results as a proxy for their own status. Informal providers, such as traditional healers, were often preferred because practitioners were more often male, physical exams were not required and appointments and payment options were flexible.
  
  
  
  To improve men's uptake of SH services, providers and services need to be more sensitive to men's privacy concerns, time restrictions and the potential stigma associated with STI/HIV testing.
authors.affiliation: London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Joelle
authors.initials: J
authors.lastname: Mak
authors.affiliation: London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Susannah H
authors.initials: SH
authors.lastname: Mayhew
authors.affiliation: London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Ariane
authors.initials: A
authors.lastname: von Maercker
authors.affiliation: The Integra research team includes staff from the London School of Hygiene & Tropical Medicine, Population Council and International Planned Parenthood Federation.
authors.forename: Integra Research Team
authors.initials: IR
authors.lastname: Integra Research Team
authors.affiliation: London School of Hygiene & Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health & Development, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Manuela
authors.initials: M
authors.lastname: Colombini
mesh_terms: D000328:Adult; D013541:Eswatini; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012725:Sexual Behavior; D000074384:Sexual Health; D057545:Social Stigma