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South African men who move within the country (internal migrants) are at higher risk than non\u2010migrant men of acquiring HIV yet are less likely to test or use pre\u2010exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in\u2010depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open\u2010ended 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26225","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T05:38:42Z","timestamp":1710135522000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["\u201cEmotional stress is more detrimental than the virus itself\u201d: A qualitative study to understand HIV testing and pre\u2010exposure prophylaxis (PrEP) use among internal migrant men in South Africa"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1186-3595","authenticated-orcid":false,"given":"Maria Francesca","family":"Nardell","sequence":"first","affiliation":[{"name":"Division of Global Health Equity Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2595-1913","authenticated-orcid":false,"given":"Caroline","family":"Govathson\u2010Mandimika","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE2RO)  Johannesburg South Africa"},{"name":"Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3802-115X","authenticated-orcid":false,"given":"Salom\u00e9","family":"Garnier","sequence":"additional","affiliation":[{"name":"EHESP French School of Public Health  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Watts","sequence":"additional","affiliation":[{"name":"Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolapo","family":"Babalola","sequence":"additional","affiliation":[{"name":"College of Medicine University of Ibadan  Ibadan Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nkosinathi","family":"Ngcobo","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE2RO)  Johannesburg South Africa"},{"name":"Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4986-4988","authenticated-orcid":false,"given":"Lawrence","family":"Long","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE2RO)  Johannesburg South Africa"},{"name":"Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"Department of Global Health Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3153-1715","authenticated-orcid":false,"given":"Mark N.","family":"Lurie","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqui","family":"Miot","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE2RO)  Johannesburg South Africa"},{"name":"Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9199-8333","authenticated-orcid":false,"given":"Sophie","family":"Pascoe","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE2RO)  Johannesburg South Africa"},{"name":"Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid T.","family":"Katz","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Women's Health Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,10]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS).Country Factsheets: South Africa [Internet].2021. 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