Reaching Men: Addressing the Blind Spot in the HIV Response

Abstract

Globally, men are less likely than women to access human immunodeficiency virus (HIV) testing, treatment, and care, and consequently experience disproportionate HIV-related mortality. To address men's underutilization of HIV services, efforts are needed on two fronts: challenging the regressive gender norms that discourage men from seeking health services, and developing improved health system policies, programs, and service delivery strategies to ensure better provision of HIV services to men. It has long been understood that harmful gender norms make women vulnerable to HIV, and this understanding should expand to include the way these norms also put men at risk. This paper presents the data concerning men and HIV, explores the impact of gender norms, examines national and international policy developments, and chronicles the evolution of men’s place in the HIV response. It does so in part by tracing the efforts of Sonke Gender Justice, a South African NGO working across Africa, as it promotes the engagement of men in the fight against the dual epidemics of gender inequality and HIV.

Zwakala Ndoda: a cluster and individually randomised aimed at improving testing, linkage and adherence to treatment for hard-to reach men in KwaZulu-Natal, South Africa

“…A growing number of interventions are beginning to target men and boys in their prevention work and rigorously evaluating the impact, with mostly positive results [2,16]. This study combines structural Community-based testing and treatment approaches that actively engage men and their communities, promotes men's involvement, and is responsive to their needs are essential for developing effective responses to the epidemic in high-prevalence sub-Saharan Africa.…”

“…A growing number of studies point to two reasons for men's low involvement in HIV services. The first relates to the gender inequalities and associated gender norms about masculinities that encourage men to act in ways that put themselves and their sexual partners at risk of contracting HIV [5,16]. In South Africa, and other parts of sub-Saharan Africa, these include a range of male sexual behaviours and practices, such as an unwillingness to use condoms or get tested for HIV, as well as engagement in multiple and concurrent partnerships increase men's likelihood of contracting HIV and transmitting it to their female partners [3,13,79].…”

“…However, framing gender as women's health means we have failed to understand how gender affects and drives the burden of ill health for men [9]. When men are included in HIV prevention and treatment, the focus is frequently on men as the problem (i.e., as transmitters of HIV), with outcomes that focus specifically on improving women's health, not that of men [15,16].…”

“…However, framing gender as women's health means we have failed to understand how gender affects and drives the burden of ill health for men [9]. When men are included in HIV prevention and treatment, the focus is frequently on men as the problem (i.e., as transmitters of HIV), with outcomes that focus specifically on improving women's health, not that of men [15,16].Male gender norms discourage men from engaging in testing and treatment [1,11,17,18]. Unhealthy constructions of masculinity and male gender norms associated with toughness and control, sexual prowess, and heteronormativity as a way of asserting manhood can deter men from engaging with HIV services [2,[19][20][21].…”

“…The drop-off that occurs at each step in the treatment cascade results in an estimated 2% to 30% of those tested retained in care [69,70]. There is a gendered slant to the treatment cascade: men are more likely to interrupt treatment [5], be lost to follow-up on ART [12,16] present for treatment later and often start ART with more advanced HIV disease [5,16] and experience additional complications than women [1]. Community-6 based testing and point-of-care (POC) diagnostics for HIV could address some of these challenges.…”