UNAIDS calls for enhanced male inclusion in HIV/Aids fight

Studies done by the United Nations Programme on HIV/Aids (UNAIDS) shows that “HIV/Aids prevalence may have the face of a woman, but Aids mortality has the face of a man”.

In 2020, for example, there were 680 000 Aids-related deaths globally, of which 57 per cent were among men and 43 per cent among women.

Here in Kenya, data from the National Aids & STI Control Programme (Nascop) shared last month shows about five per cent of HIV-positive men on treatment die. For women, those dying account for 2.4 per cent.

Men, the data shows, also lag behind in testing. Linking men who have tested positive to treatment and retaining them have been even a bigger challenge, resulting in higher deaths among them.

Since 2009, a growing number of studies have also raised the alarm over men’s and boys’ low involvement in HIV services.

Excessive risks

The studies urged action to challenge the social, cultural and gender norms of manhood that encourage men to take excessive risks, be over-controlling, and view health-seeking behaviours as a sign of weakness.

They have also called for the improvement of health system policies, programmes and service delivery strategies to ensure better provision of HIV services for men and boys.

It is for this reason that UNAIDS, in conjunction with Sonke Gender Justice and World Health Organisation, has launched the Framework for Action for the male engagement in the HIV fight.

The framework seeks to accelerate the involvement in HIV testing, treatment, and prevention in Eastern and Southern Africa, which are some of the regions with the highest HIV burden globally.

The framework provides a foundation for country-led movement to reduce new HIV infections and Aids-related deaths among men and boys and decreasing HIV-related vulnerability.

It is an evidence-based action road map to guide the development of national strategies; and provides a foundation for country-led movements to achieve the globally agreed HIV goals in the Global Aids Strategy 2021/26.

Reducing infection

Integral to achieving these targets is successfully reducing infection and Aids-related deaths among men and boys and decreasing HIV-related vulnerability.

The framework outlines strategies to include transforming social, economic, legal, policy structures and gender norms. It also outlines HIV-specific programmatic strategies such as prevention, testing, treatment, care and support.

Speaking during the virtual launch of the framework last week, Anne Githuku-Shongwe, the regional director of UNAIDS East and Southern Africa, said even though women are still disproportionately affected by HIV than men, especially in terms of transmission, men in the region are less likely to access services.

“Men use HIV testing services less, and are less likely to initiate antiretroviral therapy and to remain engaged in care than their female counterparts. Men who are in antiretroviral therapy programmes are 70 per cent more likely to die than women because of their poor health seeking behaviour,” said Ms Githuku-Shongwe.

She observed the prevailing harmful norms of masculinity are a key factor contributing to this disparity, adding that toxic gender norms that equate “illness” with “weakness”, and that consider sexual and reproductive health a foremost female issue, lead to poor health seeking behaviour and lower health service uptake among men.

Prevention efforts

Movement of Men against Aids in Kenya (MMAAK) executive director Michael Onyango underscored the need to have men become allies in efforts to prevent and respond to HIV and address the barriers to their engagement in HIV fight.

He called for the audit of laws and policies that address HIV with the aim of effectively including men in programming and initiatives to curb the spread of the scourge and generate disaggregated data that is sensitive to the special needs of different categories of men.

Dr Michel Muteba from the World Health Organisation (WHO) said there is a need to acknowledge the influence of gender on health and provide male-centred information programmes and services.

Development of inclusive health system policies, programmes and service delivery that cater for the needs of boys and men is also paramount, he added.

Change agents

Innocent Modisautsile, United Nations Population Fund’s Eastern and Southern Africa Regional Office HIV advisor, emphasised the need to engage men as clients, equal partners and advocates of change.

“Men involvement as equal partners in matters to do with testing and sexual health has proved to be an effective way to promote gender equality when it comes to sexual health matters,” he said.

UNAID’s Marietta Wildt observed that men and boys are less likely to test for HIV, and access treatment later than women. She noted higher engagement of men and boys will have a positive impact on their health and women’s.

Dr Hazel Gooding, the Deputy Representative of UN Women at the South Africa Multi-Country Office, said the involvement of men and boys is critical if the continent is to end HIV/Aids as a public health threat by 2030.

“We cannot continue to overlook existing gender inequalities in the HIV fight. A lot needs to be done and men and boys need to be at the forefront of the fight,” said Ms Gooding.

Participants at the launch said identification and diagnosis of men who do not know their HIV status is essential in promoting men’s health and breaking the cycle of HIV transmission. They called for a broader enabling environment, including laws, policies and health strategies.

Regular tests

Enabling men to stay free from HIV, get tested regularly, and start and stay on treatment will not only improve male health outcomes but also contribute to declines in infection among women and girls.

They lobbied for the implementation of more ambitious interventions aimed at advancing gender equality and improving men’s and boys’ access to sexual, reproductive health and rights and HIV education and services.

In many countries in the region, more than half of men aged 24–35 years living with HIV are unaware of their status and are not on treatment. This has partly been attributed to men and boys lacking the universal entry points to health systems that women and girls generally have.

Limited opening hours and facility-based service delivery models further restrict access for men who work outside their communities during the day.

In most countries, men are largely missing from public health strategies to improve their access to health and HIV services.

The framework has suggested some country-level action plans, which include convening of a national working group on men’s and boys’ health to discuss and coordinate actions around country-level data.

It also entails the development of a national road map for action, including a clear timeline and country-specific targets and integration of men’s and adolescent boys’ health needs into plans and policies.

The framework is also rooting for the countries to strengthen strategic alliances, partnerships and outreach and commitment to reinforcing data disaggregated by age, sex and other available variables.

[email protected]