Statistics have always shown the female face of HIV, but new research can now reveal the other side of the epidemic.
Across East Africa, men have significantly lower rates of HIV testing and consequently, fewer of them are on antiretroviral treatment.
“Gender matters in health, and men are being left behind in Aids responses, with serious health repercussions,” says Lilian Mworeko, the regional coordinator of the International Community of Women Living with HIV East Africa, a local NGO.
According to statistics from the Center for Disease Control and Prevention, in Kenya, 65 per cent of women on antiretroviral treatment have achieved viral suppression, compared to 47 per cent of men.
Statistics from Uganda and Tanzania show that women leave HIV care 12 per cent less often than men.
Again in Kenya, 47 per cent of women and 33 per cent of men are accepting to people living with HIV-Aids.
“This is a real challenge because gender matters in responses to HIV and in preventing deaths caused by Aids,” Mworeko says.
“A lack of intervention to get men tested with the same aggressiveness that women are tested means they are not taking life-sustaining drugs and that their viral load remains high,” she says.
SUPPRESSING VIRAL LOAD
The World Health Organisation defines viral load as the amount of HIV in the blood of someone infected with HIV. There is now a greater focus on the viral load than the CD4 count.
In cash-strapped African countries, CD4 counts were largely the only way to evaluate the immune system of a person living with HIV to monitor the effectiveness of the antiretroviral treatment.
In many instances, CD4 counts were solely used to determine whether the person should be on treatment in the first place.
But CD4 count is now used alongside a viral load test, although the latter is still not as accessible, as recommended by the WHO.
On laboratory monitoring of people on antiretroviral treatment, the 2013 WHO guidelines recommend viral load monitoring at six months after treatment initiation, at 12 months, and every 12 months thereafter.
Dr Dave Muthama, Western Kenya regional director at the Elizabeth Glaser Pediatric AIDS Foundation says that, “CD4 count does not drop immediately drugs fail. The CD4 count may remain high for a while, and by the time treatment failure is detected, a lot of harm will have been done.”
He further says that suppressing the viral load is considered the main goal for people living with HIV and it is crucial, not just to the person already HIV-positive but to their sexual partner.
“When your viral load is low, it means the virus is unable to multiply and destroy your immune system, so you are able to enjoy a fairly normal lifespan,” he says.
It also means that chances of transmitting the virus are drastically reduced. It does not, however, mean that one is cured.
HIV expert Teri Roberts says that: “Routine viral load testing helps catch people who are failing on treatment before they generate resistance to ARVs, and helps keep them less infectious.”
Experts, therefore, say that without the suppression of the viral load, fewer men than women are surviving the virus.
Statistics show that men represent a paltry 36 per cent of all people on antiretroviral therapy in Africa.
In Kenya, the most recent Aids Indicator Survey shows that eight in 10 women have tested for HIV, compared to six in 10 men. This pattern occurs across the continent.
STRATEGIES OVERLOOK MEN
Experts say there has been a lot more focus on men’s risky behaviour that puts them and their partner at risk of HIV infection in the first place and less on men’s own vulnerability through their poor health-seeking behaviour.
“Interventions have focused too much on men’s risky behavior, such as multiple partners, unsafe sex, alcohol abuse and gender-based violence, factors that contribute to the vulnerability of women to HIV,” says HIV expert Dismas Nkunda.
Experts are now calling for strategies that consider how gender differences affect the health of both men and women.
Among people on antiretroviral treatment, mortality is 31 per cent higher for men than for women.
Research has shown that this blindness to gender differences will keep affecting existing interventions.
“Women are aggressively pursued in regard to Aids responses, with programmes going as far as the antenatal care, where it is mandatory for a pregnant woman to be tested,” Nkunda observes.
“This has proven very effective, but in the absence of such aggressive interventions addressing men’s own vulnerability to HIV and testing them, women themselves will still be in trouble,” he says.
Besides the Voluntary Medical Male Circumcision for HIV Prevention, which is said to reduce female-to-male sexual transmission of HIV by an estimated 60 per cent, there are fewer programmes targeting men already infected with HIV.
As a result, men test for HIV and start antiretroviral treatment late, “sometimes too late to beat the virus,” Roberts says.
Nkunda adds that the fact that men interact less with the health system than women has made it difficult to address the silent epidemic.
But not only is research showing that men start antiretroviral treatment later and sicker, they are also more likely to default (or to basically stop antiretroviral for more than 30 days), to interrupt treatment, and to drop out of the care programmes.
This consequently means that men’s adherence and retention on treatment is poor compared to women, and this is linked to social norms like the fact that men are also less likely to join support groups that would help them stay on treatment.
MEN PRIORITISE STIs
Interestingly, experts say that while men are reluctant to seek HIV services, they are quick to get treatment for other sexually transmitted infections (STIs).
But this has been pegged down to biology, where the symptoms for STIs can be severe and interfere with men’s sexual activities, unlike HIV, which can remain dormant in the body for a much longer period.
“This way, men can easily convince themselves that they don’t have HIV, until the disease has progressed to the late stage,” Nkunda says.
Experts argue that the focus of public health services across Africa on maternal and child health, coupled with successful advocacy for women’s special vulnerabilities in the HIV epidemic, have overshadowed the needs of men.
They recommend setting up of male-friendly clinics, with opening hours and days suitable for men in formal or informal employment.
“Since statistics also show that men are less likely to accept a HIV diagnosis, there is a need to address stigma, which is usually the main reason behind this denial,” Nkunda advices.
To counter stigma, experts suggest recruiting the few men who are open about being HIV-positive and on antiretroviral treatment to form male champion groups.
This kind of gender conscious measures will help save men’s lives and keep them in better health.