Men and boys are less likely to test for HIV, to initiate antiretroviral therapy and to remain engaged in care, and are therefore dying of AIDS-related illnesses and many other diseases at disproportionately higher rates than their female counterparts. This has become increasingly clear over the past decade.
Globally, antiretroviral therapy coverage of men lags that of women. In many countries in eastern and southern Africa, the region with the highest HIV burden, more than half of men aged 24–35 years living with HIV are unaware of their status and therefore not on treatment. This imperils their own health and increases the risk of HIV transmission. The diagnosis of undiagnosed men is essential for promoting men’s health and breaking the cycle of HIV transmission.
Primary health-care services in eastern and southern Africa place a great deal of focus on women of reproductive age, and reproductive, maternal and child health services offer ideal entry points for HIV services—similar entry points for men are not commonplace.
The architecture of health service delivery needs to be reviewed. Are health institutions organized in ways that promote access to services for men and boys? Do HIV-related health systems, policies and strategies include men, especially men at higher risk of HIV? However, health-system barriers go beyond the service delivery level, and a broader supportive enabling environment needs to be created, including laws, policies and health strategies.
UNAIDS has recognized the gaps and the importance of male engagement in the HIV response—therefore, in collaboration with Sonke Gender Justice, the World Health Organization, UN Women and other partners, Male engagement in HIV testing, treatment and prevention in eastern and southern Africa: a framework for action was developed. The framework provides a foundation for country-led action to achieve the globally agreed HIV goals in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and work towards achieving gender equality. It categorizes existing research and best practice and elaborates strategies on how to increase HIV prevention services coverage, and HIV testing and treatment among men and boys, within a broader gender equality agenda.
In line with the Global AIDS Strategy 2021–2026 and an emphasis on societal enablers, the framework provides direction and strategies on addressing structural barriers. The focus is on transforming social, economic, legal and policy structures, addressing supply- and demand-side factors and transforming gender norms.
“On our part, I confirm the United Nations family’s continued commitment and support to governments and civil society in eastern and southern Africa to engage men, for fewer new HIV infections, better treatment and fewer AIDS-related deaths. The road ahead is clear. The urgent and hard work of implementation with the close engagement of men needs to begin now,” said Anne Githuku-Shongwe, the Director of the UNAIDS Regional Support Team for Eastern and Southern Africa.
