UNAIDS: Men are a blind spot in the HIV response
Although women bear the brunt of the HIV epidemic, a global lack of HIV services specifically targeting men, and harmful masculinity norms, are hampering the ambition to end AIDS by 2030.
Despite the many social and economic advantages men have, across the world men are less likely to get tested, to access, or to adhere to treatment for HIV. As a result 58% of AIDS-related deaths globally are amongst men.
In sub-Saharan Africa, where this treatment gender gap is most acute, men and boys account for 41% of people living with HIV and yet made up 53% of AIDS-related deaths in 2016.
UNAIDS’ new report, ‘The Blind Spot: reaching out to men and boys’, addresses this gender gap, identifying the lack of services specifically targeting men, as well as harmful gender norms, as drivers behind these inequalities.
While there has been a lot of progress on HIV, the failure of health and HIV service providers to reach more men is a major challenge for the global response, particularly in sub-Saharan Africa, the region with the highest number of people living with HIV.
“When men access HIV prevention and treatment services, there is a triple dividend,” said UNAIDS executive director Michel Sidibé. “They protect themselves, they protect their sexual partners and they protect their families.”
Globally less than half of all men living with HIV are receiving treatment, compared to 60% of women. However, the extent of this treatment gap varies around the world from as much as 20% in West and Central Africa to 1% in Latin America.
This gap in accessing treatment is compounded by the fact that men make up a large portion of some of the most affected groups: men account for 80% of those who inject drugs and 90% of prisoners, both of whom experience higher prevalence of HIV compared to the general population. Men who have sex with men are 24 times more likely to acquire HIV than men in the general population.
Moreover, in some parts of the world, men are more likely to become infected with HIV. Outside of Eastern and Southern Africa, 60% of all new HIV infections among adults are among men.
Failing to engage men in the HIV response will continue to block progress and drive new infections, among women as well as men. Addressing this gap, says the report, will help to break down the harmful gender norms and inequalities that are experienced more widely.
“The concept of harmful masculinity and male stereotypes create conditions that make having safer sex, taking an HIV test, accessing and adhering to treatment—or even having conversations about sexuality—a challenge for men,” said Sidibé. “But men need to take responsibility. This bravado is costing lives.”
For example, the report cites a study that found 70% of the men who died of AIDS-related causes in South Africa had never sought care for HIV.
The report calls for societies to address these gender norms in systems and institutions such as schools, the media and popular culture.
Better education is needed to teach young people about sex in a way that addresses gender equality and is based on human rights. This will help break down the gender stereotypes that drive the HIV epidemic and help young people to create healthy relationships and health-seeking behaviours.
The report recognises that engaging men in testing is the first step to them taking responsibility about HIV. Providing testing services that suit the needs of men is key to engaging them in all stages of HIV treatment.
Where testing facilities have extended or adapted their hours to fit around work commitments, or been integrated into other health services they have seen greater uptake amongst men.
Other initiatives that have sought to provide testing in work or leisure settings, such as at football games or bars, have had greater success in reaching targets, as men have been shown to prefer testing outside of clinical settings.
Avert’s chief executive Sarah Hand said:
If we don’t tackle the issue of early testing and better knowledge among men head on, we are ignoring the key driver behind the current epidemic among young women and girls.
Avert’s World AIDS Day campaign #KnowTheScore is encouraging more men to get tested by addressing the misconception many men have that it is better not to know if you have HIV. Being diagnosed with HIV does not have to change your life, so long as you access treatment.