Data the world over suggests men are less likely than women to seek and use health services and tend to be sicker when eventually seeking medical help. In South Africa around a third of new HIV infections in 2019 were in men, while more than half of the deaths due to HIV were in men.
It is a long-standing question that many health experts have been grappling with: How do we get more men to seek healthcare services? One solution now being tried in the Western Cape is a clinic just for men. The Metro Men’s Health Centre at the Karl Bremer Hospital in Cape Town was officially opened in November last year as part of “Movember”.
It is high time men put their health first, says Dr Saadiq Kariem, Chief of Operations in the Western Cape Department of Health. “This thing of men being reluctant to get screened or seek medical attention must come to an end. As men we need to prioritise our health. Men must utilise the centre, not only for screening of chronic diseases such as HIV and TB but also things like prostate cancer screening,” says Kariem.
For men by men
“The facility, the first of its kind in the Cape Metro, aims to empower boys and men to lead healthy lives and will be a one-stop shop for wellness and chronic conditions screenings, HIV prevention interventions, treating sexually transmitted diseases, and offering medical male circumcision,” says Dr Abdul Sungay, who heads up the centre.
Sungay says that most men prefer a one-stop health service and men often prefer disclosing their problems to a male medical professional, with the idea that “men understand men”. “This creates a safe, comfortable space for the client to share their health problems. In 2016/2017, the management team of [the] Northern and Tygerberg sub-structure of Western Cape Health saw an opportunity to support men’s health services, when Karl Bremer Hospital made unutilised infrastructure available for clinical [use],” says Sungay.
The space used for the centre was previously used as a cold chain storeroom but has now been transformed into a men’s wellness centre, boasting rooms for counselling, screening, surgery and aftercare.
Boosting VMMC
Voluntary medical male circumcision (VMMC) is one service offered at the new centre. VMMC reduces the risk that someone will contract HIV and some experts believe that the country’s VMMC programme has contributed to the reduction in new HIV infections in recent years.
The VMMC rollout in the Western Cape has lagged behind other provinces. It was launched at 14 facilities and Goodwood Correctional Centre in the Northern and Tygerberg sub-structure in June 2011. The aim was to prevent and reduce new HIV, and sexually transmitted infections (STIs) by 50% between 2011 and 2015.
“Medical male circumcision services were limited, as it was not available at our health care facilities daily. This was identified as a limiting factor in why men do not access these services in our area, which ultimately led to poor uptake of overall men’s health services. When we reviewed the programme in 2015, access to men’s health services was still a challenge. It was clear that even though men want to take responsibility for their health, these services were not readily available to them,” says Sungay.
Sungay says they currently have seven staff members employed at the facility and they see on average 10 to 15 patients per day. He adds that they can do at least 10 VMMC procedures per day.
According to the latest estimates from the Thembisa model, the leading mathematical model of HIV in South Africa, around 40.9% of men aged 15 to 49 have been circumcised in the Western Cape. Of the country’s nine provinces, only the Northern Cape at 37% has a worse record. Six of the nine provinces have circumcised more than half of men and boys in this age group.
Other services
Besides VMMC, other services offered at the centre include:
Wellness screening and counselling – to identify and reduce any risk of chronic diseases (hypertension, diabetes, etc.)
Prostate cancer screening – to promote early diagnosis and treatment
Screening of HIV/TB and STIs to promote early diagnosis and treatment
Promotion of health education and awareness around men’s health matters
Condom distribution and Vasectomies.
Vasectomies, Sungay says, is not yet up and running but will hopefully be provided soon.
While the new centre caters for men more broadly, Cape Town has for over a decade had the Health4Men clinic that caters specifically for men who have sex with men. In 2018, Spotlight reported on funding cuts that were threatening the operations of Health4Men.
Responding to a question on whether the services offered at the new centre include services for gay and bisexual men, Sungay says they are a stigma-free clinic open to all men who need healthcare services. “We do not discriminate [against] individuals [based on] gender, sexuality, race or culture. We try to offer services tailored to our clients’ needs, which include members of the LGBTQ+ community.”
‘Word is getting around’
“Since the opening of this site just over two months ago, we have seen an increasing number of individuals coming for screening of HIV and prostate check-ups. We try our best to counsel our clients regarding the benefits of circumcision and have had several clients come back for it. A lot of our clients in the past month were referred by a friend, so word is getting around,” he says.
Due to the pandemic, Sungay says clients are sceptical about coming to health care facilities. “However, we space out our appointments so that we can adhere to all the COVID-19 protocols and precautions. We encourage all men in the metro to make an appointment, especially if they have any concerns about themselves, their body, or their health. The appointment systems help us ensure there is minimal waiting time and pre-empt the type of service that is needed,” Sungay says.
Men’s health centre welcomed
Coordinator of the men’s sector at the South African National AIDS Council (SANAC), Mbulelo Dyasi, says chronic illnesses such as TB and HIV are prevalent in many households, often because men refuse to be screened or tested. Praising the opening of the men’s health centre as an initiative that is long-overdue, Dyasi says it will go a long way in encouraging men to take their health seriously and changing their behaviour and attitude towards taking care of their health.
“We fully support this kind of initiative and in fact since 2008 when we started the Brothers For Life-campaign we’ve been advocating for this kind of service. Men in our communities have long been making a plea for clinics that are focusing on them specifically,” he says.
“Remember firstly that it is quite embarrassing for men to admit they have sexual problems. They wouldn’t talk about their sexual problems, even to their own friends. And, for instance, there are very sensitive issues such as erectile dysfunction and penis sizes that most men face that need a health official who is going to handle them with the sensitivity and understanding that they deserve,” says Dyasi.
“Traditionally our fathers used to discourage us from going to the clinic. A clinic is often viewed as a place [for] women. And as such most men pretend to be strong and that they can take it even if it’s painful. So they end up using traditional medicine or even healing themselves instead of going to the clinics. Long queues are also discouraging men. They see it as a waste of time because they want to go and hustle for their families. Now facilities like this one will play a vital role,” he says.
Dyasi says they always encourage an open dialogue in families that can help address the ‘superhero-syndrome’. “It starts in our own families where the wives and children can start to say ‘dad/honey you don’t look okay, let us go see a doctor’. The importance of going for regular check-ups in families is also something that we emphasise all the time. It must be a family culture that after a certain period we all go for checks as a whole family,” says Dyasi.
Garron Gsell, Chief Executive and Founder of Men’s Foundation of South Africa says with data showing that men on average have a shorter life expectancy than women, and dying more often than women from preventable causes, there is a need for more such centres countrywide.
“This men’s centre can be used as a good example that can assist in rolling out more centres,” says Gsell.