Men and boys are less likely to test for HIV, to initiate antiretroviral therapy (ART), 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.[i] This has become increasingly clear over the last decade.
Own Correspondent
Globally, ART coverage of men lags behind 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 are not on treatment. This imperils their own health and increases the risk of transmission.[ii] The identification and diagnosis of undiagnosed men is essential in promoting men’s health and breaking the cycle of HIV transmission.[iii]
Primary health-care services in East 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. While gender norms that prize male strength and stoicism may partly explain why many men delay seeking care, this is not the full picture. The architecture of health service delivery ought to be interrogated. Are health institutions organised in ways that promote access to services for men and boys in their diversity? Do HIV-related health systems, policies and strategies include men, especially men at high risk of HIV? However, health-system barriers go beyond the service delivery level, and a broader supportive enabling environment needs to be intentionally created, including laws, policies, and health strategies.
UNAIDS is recognising the gaps and importance of male engagement in the HIV response, and has therefore, in collaboration with Sonke Gender Justice, WHO und UN Women, developed the ‘framework for action for male engagement in HIV testing, treatment and prevention in eastern and southern Africa’. The framework provides a foundation for country-led movement to achieve the globally agreed HIV goals in the Global AIDS Strategy 2021–2026 and work towards achieving gender equality. It categorizes existing research and best practice, and elaborates strategies how to increase prevention, testing and treatment among men and boys, within a broader gender equality agenda.
In line with the global AIDS strategy 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.
Anne Githuku-Shongwe, Regional Director UNAIDS Regional Support Team East and Southern Africa“ : On our part, I confirm the UN family’s continued commitment and support to governments and civil society in East and Southern Africa to engage men, for less infections, better treatment, less deaths. The road ahead is clear. The urgent and hard work of implementation with the close engagement with men needs to begin now.”
Djamilatou lives in the suburbs of Conakry, the capital of Guinea. Every week, the 34 year-old mother comes to the Dream Centre—a walk-in clinic that supports people living with HIV by offering HIV treatment, advice and, thanks to the World Food Programme, nutritious food.
It was during her first pregnancy that she discovered she was HIV-positive. “I went to the hospital, because I always felt sick,” she says. After some tests, the doctor gave her the news. “At first, I really couldn’t believe it. It was a huge shock. I had never ever considered that HIV could affect me.”
A friend advised Djamilatou to go to the Dream Centre and she says this advice changed her life. “Before I came here, I had lost a lot of weight and strength. I would have never had the money to buy all the medicine for the treatment.”
But the most important thing for her was the support and advice she received to help her through a complicated pregnancy and the birth of her child by caesarian. “I am very thankful that both of my children are healthy. My son Alpha is 3 years old and my little daughter Mariama just turned 5 months. At the centre, I also receive nutrition education to make sure that she grows up healthy and strong.”
Now Djamilatou’s nutritional status is stable, as is her health and she is hoping to start working again soon. For her the centre is not only a place where she receives treatment and nutrition, it is a place that gives her hope.
As clinic coordinator Fatoumata Sylla maintains, “The social side of the weekly food rations is really important: for some patients they are one of main reasons for coming regularly… This gives us the chance to build a stable relationship with our patients.” In addition, the nutrition support provided by WFP has a special impact on the progress of their treatment.
“The nutritional needs of people living with HIV are higher because of their weakened immune system,” explains Ms Sylla. “We can improve the effectiveness of our treatment when we supply the patients not only with medication, but also with nutritious food.”
Like Djamilatou, more than 650 other people living with HIV receive treatment at the Dream Centre every month. WFP also provides with Supercereal + sugar (CSB+), a specialized micronutrient vitamin and mineral mix that helps to quickly improve the nutritional status of people living with HIV. The amount of the CSB+ ration depends on the body mass index (BMI) of each patient. In addition, the World Food Programme also supports family members of people living with HIV with rations of rice and oil fortified with vitamins A and D.
[1] UNAIDS, ‘Addressing a Blind Spot in the Response to HIV — Reaching out to Men and Boys’, 2017, http://www.unaids.org/en/resources/documents/2017/blind_spot. [1] PEPFAR, ‘PEPFAR 2019 Country Operational Plan Guidance for All PEPFAR Countries’, 2019, 419. [1] Tulio de Oliveira et al., ‘Transmission Networks and Risk of HIV Infection in KwaZulu-Natal, South Africa: A Community-Wide Phylogenetic Study’, The Lancet. HIV 4, no. 1 (2017): e41–50, https://doi.org/10.1016/S2352-3018(16)30186-2.
