Revisiting the evidence: Why men still avoid health services - and why the time to act is now!

Ndumiso Tshuma | Best Health Solutions

Some research findings don’t fade away — they become more urgent with time.

Last year, our team at Best Health Solutions, together with our collaborators, published an article titled: “Community perceived barriers to uptake of health services among men in Sedibeng District, South Africa” (Health SA Gesondheid, DOI: 10.4102/hsag.v29i0.2548).

At the time, it was a milestone — a clear picture of the structural, social, and behavioural barriers that keep men away from clinics. But today, as South Africa pushes harder than ever to reach ambitious targets through the 1.1 million campaign, End TB initiatives, and a renewed emphasis on behavioural insights after the SA AIDS Conference 2025, these findings have taken on a new urgency.

What we learned from the study

Our research was grounded in Human-Centered Design (HCD) starting with community dialogues (“Empathise” and “Define”) and moving to virtual engagements via Facebook. This process allowed us to gather authentic voices and stories from men, healthcare workers, and community members.

Key barriers we identified include:

• Stigma and discrimination: Men fear being seen at ART pickup points, worry about gossip, and associate clinics with being “marked” as sick.
• Clinic environment and trust issues: Long queues, lack of privacy, and staff attitudes create an unwelcoming environment.
• Shortage of male providers: Many men feel uncomfortable discussing sexual health or sensitive issues with female nurses, impacting their willingness to seek care.
• Cultural norms and denial: Deeply ingrained beliefs equate seeking help with weakness, causing delays until illnesses are advanced.
• Cost, convenience, and alternatives: For many, private “men’s clinics” are inaccessible, and traditional medicine offers a more confidential and affordable option.
• Health literacy gaps: Lack of sexual and reproductive health education means many men don’t fully understand the importance of early testing and treatment.

These findings are not just theoretical, they reflect the lived realities of men in Sedibeng and in many parts of South Africa. They remain critical barriers to reaching national HIV, TB, and NCD targets.

Why this matters right now

The 1.1 Million Campaign aims to find, test, treat, and retain an additional 1.1 million people living with HIV by 2026. Without deliberately tackling these barriers, we risk leaving men — who are already the hardest group to reach and retain in care — behind once again.

What has changed since we published this study is not the barriers themselves, but our national context and opportunity:

• The SA AIDS Conference 2025 brought renewed focus on community-led solutions and behavioural insights.
• District AIDS Councils and Civil Society Forums are mobilising across provinces to support ward-based outreach and multisectoral action.
• Digital innovations (WhatsApp chatbots, telehealth, AI-powered service mapping) are maturing and ready to be scaled to reach men where they are.

This is the moment to move from evidence to implementation.

Implementation science in action

Our study’s strength lies in its use of HCD, which is exactly what implementation science calls for:

• Co-create solutions with the people affected. Men helped define the problem, and they must help design the interventions.
• Prototype and test approaches. Whether it’s after-hours clinics, community-based ART pick-up points, or male-friendly waiting rooms — we must pilot, adapt, and scale what works.
• Measure behaviour change. Not just counting how many people are tested or treated, but understanding why behaviour shifts (or doesn’t) and using that data to iterate quickly.

When we apply implementation science rigor to these insights, we turn research into real-world change.

 From insight to impact – A call to action

As we reflect on these findings, the message is clear: we cannot achieve our HIV, TB, and NCD targets without bringing men back into the health system.

This means:

• Training and supporting health workers to make services welcoming and non-judgmental.
• Recruiting more male nurses and counsellors where possible.
• Offering convenient, confidential, and flexible options — including after-hours services and telehealth.
• Designing interventions that address cultural norms and use male champions, faith leaders, and peer educators.
• Embedding these approaches into district and provincial plans so they are not one-off projects but part of how the health system works.

At Best Health Solutions, we remain committed to driving evidence-informed, community-rooted change. We are calling on:

• Civil society sectors to champion these issues in their constituencies.
• Government partners to prioritise male-friendly service delivery models in their implementation plans.
• Researchers and funders to invest in scale-up studies and innovative interventions.

Let’s not leave these findings sitting in journals. Let’s use them to design better health systems, stronger community engagement, and faster progress toward the 1.1 Million Campaign goals.

South African National Aids Council (SANAC) Anil Soni Anette Schwitzke Annick Bambara Andrew Churchill, PhD Abel Simiyu Fareed Abdullah Ackim Hamweenda Takunda Adonis Sola Bulelani Kuwane Banele Nkambule Peter Bare Bertha Sato Linda-Gail Bekker Dr Dena van den Bergh Clinton Moyo Celeste Madondo Candice M Chetty-Makkan Cathy HALDANE Candy Day Cezzanne Hoffmann Cephas Chikanda Khensani Cecilia Nkuna Cezzanne Hoffmann Zimkhitha (Zimmie) Ceza (Specialist HeadHunter) Doug Evans Dr Musa Manganye, DrPH David Nkwana Dr Pascalia Munyewende Tshwane District PWUD Sub-Sector David Lowrance David Chipanta Déborah Martínez Villarreal Delly Mashele Deanne Goldberg Dr Ebere Okereke South African Monitoring Evaluation Association SAMEA Eunice Mokgalotsi Elizabeth Dartnall Eric Junior Musa Dr. Edzani Mphaphuli Edith Pastor Futhi Mazibuko Farai Morobane Maureen Fatsani Tshabalala MPH, Ph.D Farley Cleghorn Felicita Hikuam Thobekile Finger Fiona Mpungu Fidelis Simbarashe Musona Grace Singh Dr Ganzamungu Zihindula Mikki Gates, SHRM-SCP, GPHR, CAALF Geoffrey Setswe George Shakarishvili Mandlethu Gennady Ngwenya Dr Geoffrey Odaga Annette Gerritsen Helen Kezie-Nwoha Heena Brahmbhatt Hon Mmapaseka Steve Letsike Harsha Dayal, PhD Yumnah Hattas Heeran Makkan TB HIV Care Jacqueline Pienaar Joyee Washington, PhD, MS, MPH, MCHES® Jennifer Daniels Jane Nyathi James McIntyre Ian Sanne Itfaq Khaliq Khan Isaack Otieno Isaac Chipswa Ingrid Silalahi Khanyisa D. Kristie Holt, MPH, MCHES, CLE, ICCE Kerry Mangold Kabelo Maleke Katherine Gill Kash Ramli Kealeboga Mokomane Kealeboga Modise Keith Mienies René Liezel Sparks Lynda Toussaint Luis Artavia-Mora, Ph.D Laurenz Mahlanza-Langer Latasha Treger Slavin Laurenz Scheunemann Ndumiso Tshuma PhD, MBA Mandeep Dhaliwal The Melton Foundation Prof Martha Chadyiwa Massimiliano Sani Melikhaya Soboyisi Zola Melody Silimfe Megan Briede Mekdes Wolde Moloko Stephen Mmatsoku MPH,PG Dip PH,PG Dip HIV and AIDS,BCMP Monica Longwe Mohamed Motala Dr Ntsako Chauke, BSW, PDHMS, MPH, PhD Nasiphi Mqedlana Ntombela Natalie Ridgard Naomi Hlongwane Nerissa Muthayan Neo Letele-Mohajane Dr Nellie Myburgh Ndumiso Madubela Nditsheni Mungoni Vusi Ndlovu ka Manyaya Prof. Norbert Ndjeka Dr Nevilene Slingers Nokulunga Nobuhle Zondo Noluthando Ndlovu Ntombizonke Mehlomakulu Nthabiseng Mogowe Nthabiseng Sibisi Ntuthu Fuzile Dr Ntombifikile Nokwethemba Mtshali Patrick Ngassa Piotie, MD, PhD Qhawekazi🏳️⚧️🏳️⚧️🏳️⚧️ Thengwa Dr (Professor) Ramneek Ahluwalia PhD MBA MBBS Renata Ram Ana Rosa Soares Gugu Rejoyce Shongwe-Xaba Dr Rebaone Petlele (PhD) Shawn Malone Save the Children International Dr. Samar Al-Mutawakel Sara Jewett Dr Sanele Ngcobo Dr Sabelile Tenza (PhD) Dr Sabelile Tenza (PhD) Sefako Makgatho Health Sciences University Stephan Paulsen University of Limpopo @ULVarsity Tabisa Silere-Maqetseba Nga-a-tendweishe Murombedzi Thandiwe Sithole, PhD, MBA, PGDipHE, Pr Tech Eng Dr. Thenjiwe Sisimayi, (Ph.D) Dr Thembisile Xulu (Dr T) Dr. Wangui Muthigani Colleen Wagner Yolaan Andrews (nee Adams) Tshepo M Ndhlovu Tsitsi Siwela Ziyanda Mbomvu-Mossie Zanele Dlamini Dr. Zandile Mthembu Zwebuka Khumalo Jacqueline Zwambila