Late entry and chronic burdens: Black men's first contact with public primary health care in South Africa

Mortality among men in South Africa continues to rise, with Black men disproportionately burdened by preventable and manageable conditions such as hypertension, diabetes, tuberculosis, Human Immunodeficiency Virus, and Acquired Immune Deficiency Syndrome. Despite the availability of free primary health care (PHC) services, evidence suggests that many delay seeking care until illnesses become advanced. This study examined factors influencing the late entry of Black men into public PHC facilities in Ga-Rankuwa. A qualitative, explorative, and descriptive design was employed, guided by the Theory of Planned Behaviour. Data were collected through 15 in-depth, semi-structured interviews with men aged 25–66 years, using purposive and criterion sampling. Thematic analysis identified five major themes: individual choices and the normalisation of ignoring symptoms, reliance on self-medication and delayed care-seeking, preference for traditional remedies and over-the-counter medication, stigma, shame, and masculinity burdens, and privacy concerns, gender of providers, and mistrust of PHC facilities. Findings revealed that delayed care was shaped by cultural expectations of endurance, economic pressures, reliance on self-care, and fear of stigma. Institutional factors, including perceived breaches of confidentiality and discomfort with younger or female providers, further discouraged early engagement. Many participants only accessed PHC at critical stages of illness, often prompted by significant others. This study demonstrates that late entry into PHC is not simply personal neglect but a product of cultural norms, systemic shortcomings, and structural barriers. Creating male-friendly, culturally sensitive, and confidential PHC services is crucial for promoting early engagement and reducing the chronic disease burden among South African men.