Systematic scoping review on HIV services for males in Sub-Saharan Africa : access, barriers, and research gaps

Abstract

BACKGROUND : Access to HIV services among men and boys in Sub-Saharan Africa is a significant public health challenge, exacerbated by cultural norms surrounding masculinity. This scoping review systematically investigates disparities in the provision and utilisation of these services in Sub-Saharan Africa. METHODS : The review followed the Arksey and O'Malley framework, employing a five-step process with any disputes resolved through discussion. A comprehensive search across various databases was conducted for studies published from January 2010 to October 2023. Methodological quality was assessed using PRISMA-ScR and the Mixed Method Appraisal Tool, while NVivo supported thematic content analysis. EndNote and Rayyan software facilitated reference management and study screening. RESULTS : Out of 1 489 studies retrieved, 30 met the inclusion criteria, primarily qualitative (70%) and quantitative (16.7%). Most studies originated from South Africa (n = 10) and Uganda (n = 5). HIV testing services accounted for 36.7% of the studies, followed by treatment services (26.7%) and prevention services (20%). Facilitators of access included community health services and male catch-up plans. Barriers to accessing HIV services included stigma, masculinity norms, and fear of HIV-positive results, with low-risk perception also frequently noted. Male engagement strategies emerged as key to improving service delivery and utilisation. CONCLUSIONS : The findings revealed a moderate body of literature on HIV services for men in Sub-Saharan Africa, with research concentrated in South Africa and Uganda. Stigma, masculinity norms, and fear of HIV-positive results remain significant barriers, while community health services and male catch-up plans facilitate access. Implementing male engagement strategies and addressing these barriers is essential for improving service delivery, informing policy, and prioritising future research in underrepresented regions.