To break the cycle of HIV infections, it's time to get young men testing
Ahead of World AIDS Day, Avert’s Sarah Hand argues that testing services must engage men in a more meaningful way if we are to tackle the rising epidemic among young women.
We know that regular HIV testing and early treatment initiation saves lives. Yet UNAIDS research says that men ‘remain stubbornly hard to engage in testing services’.
As a result, just 47% of men living with HIV in sub-Saharan Africa were aware of their status and accessing antiretroviral treatment in 2016, compared to 60% of women.
Delayed testing and delayed treatment mean that HIV continues to be the biggest killer among young men in the region – an economic and personal burden. Men with undiagnosed HIV are also more likely to affect the lives of women and girls by transmitting the virus unknowingly in the future. So the impact of delayed testing causes the cycle of new infections to continue among future generations of young men and women.
If we don’t tackle the issue of early testing and better HIV knowledge among men head on, we are ignoring the key driver behind the current epidemic among young women and girls.
So what’s behind men’s reluctance to test? The reality behind this gender disparity is that traditional health services normalise routine check-ups among women, encouraging them to test earlier and more frequently than men.
Sibongile Tshabalala, Chairperson of Treatment Action Campaign, is right when she says,
'When a man gets a young woman pregnant, only the mother will be tested for HIV. But why? Young women are not getting HIV from sleeping alone – there are men in the mix somewhere...’
Integrated testing services, such as prevention of mother-to-child transmission programmes, are a cost-effective and sustainable way to deliver HIV testing. However, challenges occur when health centres are seen as places to go to when you’re sick – unless you’re a woman or a baby. While there is reduced stigma around testing among women, most men view attending clinics for any other reason than being sick as a masculine taboo.
From antenatal care to female-only HIV prevention programmes, we’ve missed a trick by only focusing on the health of young women and not looking more holistically at the environment new HIV infections occur in. Although such programmes are well-intentioned, we cannot hope to close the cycle of infection by speaking to just one half of the population or just one half of a ‘couple’. For example, voluntary partner testing (VPT) programmes do work, where they exist, but their availability needs to be increased and more men must be made aware of them.
It’s not too late to make structural changes to existing HIV programmes so that they better reflect the cultural reality in which people live.
One starting point to break the current cycle of infections is to break down the taboo that pregnancy is only a woman’s game by normalising the testing of fathers in existing antenatal programmes. Great results have already been seen in Rwanda where these services are opened up to men too, and this flexible approach to healthcare now needs to be scaled up across other sub-Saharan countries.
HIV testing clinics also need to adapt their opening times to fit in with the realities of men’s lives. And by making HIV-testing less clinic-based altogether (through self-testing or work-placed testing) we can better reach men in the spaces in which they exist and address the topics which are relevant to them.
Men must be given HIV information – about condom use, multiple partner risk, and the benefits of regular testing – in a way that relates to them as individuals with their own sexual health needs, not just as an extension of their partners.
Targeted services not only give people the opportunity to test for HIV, they also help to improve HIV knowledge by making it relatable and relevant. We all know that stigma is heavily rooted in poor knowledge about HIV. Targeted services help to alleviate the ‘fear of knowing’ which stops men testing by addressing their concerns and dispelling harmful myths.
The conversation about sexual health and HIV needs to be wider, more inclusive and more responsive if we are to achieve the full and active participation of men in health programmes. But if we can achieve that, we’ll see the whole community benefit.