Introduction A focus on heterosexual men is critical to reducing STIs/HIV rates in Sub-Saharan Africa. Despite this, prevention efforts and national policies have insufficiently addressed men’s STI and HIV needs and access to care.
Methods We undertook mixed-methods research on men’s sexual (including STI/HIV) health in Malawi between 2013–14. A national household-based survey with men (n = 998), qualitative interviews (n = 162) with other men, women, male clients, health service providers and key informants, ethnographic observations and a policy review investigated men’s experience of sexual health, including risks, care-seeking, and health service responses.
Results Eight percent of men reported STI symptoms, of whom only 0.3% sought STI-related health care. One in five men had multiple concurrent sexual partners. Qualitative findings included that STI-related communication and disclosure within couples was limited. STI positive men confided in closest friends but sought treatment without their partner’s knowledge. Many men with STIs used private clinics – citing perceived problems in the public sector of: confidentiality; lack of male-focused services; long queues; and the requirement to be accompanied by their sexual partner. Those unable to afford private treatment took self-medication or used traditional healers (particularly in rural areas). STIs were seen as “curable unlike HIV,” less stigmatising though still embarrassing, and to be “dealt with quickly” and clandestinely. Among providers and stakeholders, improving men’s STI prevention and care was seen as essential, though national policies insufficiently focused on this issue.
Conclusion Men are at risk of STI (and HIV) transmission in Malawi, but their sexual health needs are not being met by the public health sector. Opportunities for more gender-equitable health care include: strengthening public-private sector linkages and a policy environment that reflects men’s specific health needs. In addition, challenging male gender norms that result in men taking risks with their sexual health need to be a priority.
Disclosure of interest statement We confirm that there are no conflicts of interest in the development of this study.
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