"Men don't want things to be seen or known about them": a mixed-methods study to locate men in a home based counselling and testing programme in KwaZulu-Natal, South Africa

While evidence for home based counselling and testing (HBCT) as an effective HIV testing strategy is growing, men are often under-represented in this approach. Following up on a sample of households previously offered HBCT, the study contacted men who had not tested. Ninety men were randomly divided between voice, text or instant message arms, contacted and encouraged to test. Additionally, focus groups were conducted with 10 men and 10 women to better understand the barriers that prevent men from participating in HBCT. Men who answered or replied to the unsolicited contact varied from a low of 23% with instant message to 60% with voice message. Overall, four men self-reported testing for HIV. The two major themes that emerged from the qualitative data were ambivalence towards seeking medical help and psycho-social barriers to HIV testing. These barriers were a discomfort with testing in a public forum, fear of positive results and fears of indirect disclosure due to HBCT. Although feasible and acceptable, this approach requires more work to understand how it could be made more effective and efficient at getting men tested.