"Emotional stress is more detrimental than the virus itself": Towards an understanding of HIV testing and pre-exposure prophylaxis (PrEP) use among internal migrant men in South Africa

IntroductionSouth Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labor in urban centers. South African men who move within the country (internal migrants) are at higher risk than non-migrant men of acquiring HIV yet are less likely to test or use pre-exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. MethodsWe recruited 30 internal migrant men (born outside Gauteng Province) for in-depth qualitative interviews at sites in Johannesburg (Gauteng) where migrants may gather (i.e., factories, homeless shelters). Interviewers used open-ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. ResultsMigrant men come to Johannesburg to find work, but their struggle to survive without reliable income causes daily stress. Stress and time constraints limit their availability to seek health services, and many men lack knowledge about the opportunity for PrEP should they test negative. In addition, migrants must also adjust to life in Johannesburg, where they may be unfamiliar with where to access HIV services and lack social support to help them do so. Migrants may also continue to travel intermittently for work or social purposes, which can make it hard to take a daily pill like PrEP. Yet Johannesburg also presents opportunities for HIV services for migrant men, especially those who perceive greater availability and anonymity of HIV information and services in the city as compared to their rural homes of origin. ConclusionsBringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counseling and services alongside HIV testing may further encourage men to test, particularly if integrated into counseling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg.