Preferences for HIV Prevention and Care Services Among Migrant Men in Johannesburg, South Africa: Results from a Discrete Choice Experiment

Johannesburg, South Africa is a hub of migration. Men who migrate, in particular, face unique challenges accessing HIV testing, prevention, and treatment. We conducted a discrete choice experiment (DCE) with 200 migrant men recruited from diverse community sites to identify preferences for status-neutral HIV services. Participants chose between hypothetical service scenarios defined by nine attributes; preferences were analyzed using conditional logit models. The sample included 150 domestic migrants (75%) and 50 cross-border migrants (25%), with a median age of 31 years (IQR: 25-38). Across the full sample, men preferred services offering spoken communication in their home language (OR 1.43, 95% CI 1.24-1.65) or English (OR 1.19, 95% CI 1.03-1.37). Additional preferences included peer support (OR 1.27, 95% CI 1.15-1.41), flexibility around identification documentation (OR 1.17, 95% CI 1.02-1.35), and no referral letter requirements (OR 1.15, 95% CI 1.04-1.27). Overall, participants preferred welcoming clinic environments; however, the specific components of this attribute should be interpreted cautiously given its construction. Exploratory subgroup analyses suggested differences in preferences between domestic and cross-border migrants and should be interpreted cautiously given the limited subgroup sample size. These findings underscore the importance of language-concordant communication, inclusive clinic environments, and reduced documentation barriers to improve HIV service uptake among migrant men. Tailoring these elements may inform policies and programs advancing equitable, locally adapted approaches to universal health coverage.