By Jonathan Hopkins and Dean Peacock
When it comes to AIDS in Africa, there’s a simultaneous truth: men are far more likely to die from an HIVrelated illness than women, while women are becoming infected with HIV at a much faster rate.
In East and Southern Africa, more than half (54 percent) of people dying of AIDS-related illnesses were men and boys, although they represent only 46 percent of those infected with HIV in the region, according to UNAID’s 2017 Global AIDS update.
Why? Because fewer men than women get tested for HIV. Studies show that in East and Southern African countries, men are significantly less likely than women to have been tested for HIV and therefore do not know their HIV status. As a result, fewer men than women are taking antiretroviral medicine, and many who receive treatment do so at a later stage of HIV infection when the virus has had a significant amount of time to deplete their immune systems. In such cases, treatment is sometimes less effective.
In 2016, 60 percent of women living with HIV who were 15 or older were receiving treatment, compared to 47 percent of men, according to the UNAIDS report. In South Africa, the figures are 51 percent for women and 37 percent for men. As a result, globally 27 percent fewer women and girls had HIV-related illnesses than men and boys.
This situation is even more pronounced among young men 15 to 24. From 2000 to 2015, deaths declined by 18 percent among girls and young women in this age group, but increased by 14 percent for their male peers. Still, women in this age group are getting infected at a much faster rate than their male peers: in 2016, new HIV infections among women ages 15 to 24 were 44 percent higher than among men in the same age group.
When men do not know their HIV status, they are less likely to change their sexual practices or to use condoms, and are therefore also much more likely to transmit HIV to their partners. Studies show that men’s low use of health services is not merely a consequence of their poor choices in seeking health services, or their attitudes about manhood. Health services are often not designed to attract men. Our organization, Sonke Gender Justice, analyzed health policies in Africa and found that most of them don’t integrate men’s health needs into broader policy frameworks. Governments therefore need to rethink and redesign how they deliver HIV-related health services.
Some African governments have made progress in this regard. Rwanda has made involving men in HIV services a priority. The country’s prevention of mother-to-child transmission (PMTCT) of HIV stipulates that not only pregnant women but also their partners are offered HIV testing and counseling at their first visit to an prenatal clinic.
A campaign called “Going for the Gold” encourages male partners of pregnant women to accompany them to prenatal clinic visits. It has resulted in a significant increase in men’s HIV testing: Rwandan health ministry data from 2003 shows that when the PMTCT policy was introduced, only 16 percent of men tested for HIV along with their pregnant partners; a decade later, in 2013, the figure increased to 85 percent. During the same period, HIV infection rates fell dramatically among pregnant women and their male partners—from about 10 percent to about 1 percent for both sexes.
In Uganda, the Optimizing HIV Treatment for Pregnant and Breastfeeding Women Initiative encourages couples to test for HIV together, according to a 2016 UNICEF report. This has resulted in couples’ HIV counseling and testing increasing from 13 to 97 percent in one district between 2013 and 2014.
In Kenya, Nairobi County Health Services has started offering mobile HIV testing and other health services to bodaboda (motorbike taxi) riders.
UNAIDS and Sonke Gender Justice have produced a documentary on how to get men to use HIV services. In the film, which will be released by the end of the year, a Kenyan local health promotion officer makes it clear: “If we want male involvement in health services, inclusive of the HIV programming, then it is most appropriate for us to reach the men at their workplaces, be it in their offices, be it in their companies, in institutions where they are engaged over the daytime. In their social places where they socialize as men; or even those who are self-employed.”
We need to replicate these examples. In December 2015, UNAIDS co-convened a high-level meeting in Geneva. A global platform for action on men and HIV was developed and launched at the International AIDS Conference in Durban in 2016. The program is gaining traction: this year’s UNAIDS report pays unprecedented attention to the plight of men and their disproportionately poor access to services.
Bottom line: we will not end AIDS if we don’t ensure our health strategies focus on encouraging men to use health services and work with men to foster greater gender equality.