Men’s underrepresentation in HIV services: bad for men, women and health systems Dean Peacock, Sonke Gender Justice Network, July 2012

Overview and key messages Men chronically underrepresented in HIV and AIDS testing and treatment services—in Southern Africa and globally. This is bad for men AND for women—and it places expensive and unnecessary burdens on women and on health systems. It’s in everyone’s interests for men to know their status, access treatment and be healthy: it’s good for men AND women New technologies like PrEP, microbicides, gel, and treatment as prevention can only be effective if we get more men into HIV services.

Men and HIV testing and treatment: “Efforts to understand men’s health-seeking behaviour are poorly understood in the AIDS epidemic, and encouraging men to get tested and into treatment is a major challenge, but one that is poorly recognised. Addressing these issues effectively means moving beyond laying blame, and starting to develop interventions to encourage uptake of prevention, testing, and treatment for men—for everyone’s sake. Expanding HIV care in Africa: making men matter. The Lancet Vol 374 July 25, 2009, Edward J Mills, Nathan Ford, Peter Mugyenyi.

Men and HIV treatment:

Men and HIV Treatment in Southern Africa: Disproportionately fewer men than women are accessing ART across Africa (Muula et al. 2007). Men are starting ART with more advanced HIV disease (Cornell et al. 2009; Stringer et al. 2006). Men are more likely than women to die on ART (Cornell et al. 2010; Taylor-Smith et al. 2010). Men more likely to interrupt treatment (Kranzer et al. 2010) Men more likely to be lost to follow-up on ART (Ochieng Ooko et al. 2010).

Men and HIV testing: South Africa HCT Scale-up campaign data, June 2011 In the first 15 months of the HCT campaign, 12, 961 million people were tested 30% of testers have been adult males 65% of testers have been adult females 5% of testers have been children

Consequences of men’s low testing and treatment: higher mortality levels for men. Figure 2. Mortality patterns by age and sex between tested and untested participants, 2005 (South Africa).

Consequences for women of men’s higher mortality due to low testing and treatment. Women carry high burden of care in homes and health facilities Women suffer economic hardship related to illness and medication, burial and funeral, lost income Women grieve for lost loved ones and family members

Men’s low utilisation both a demand and a supply issue Lots of evidence that men’s attitudes about men and manhood limit uptake of health services Also lots of evidence from many studies that it reflects obstacles created by service providers and health facilities.

Gender as relational: Integrating focus on gender equality and on comprehensive access to HIV services into SA NSP

The SA NSP recognises that gender norms: ‘discourage men from accessing HIV, STI and TB services, contribute to violence against women, multiple partnerships and...encourage alcohol consumption’. In response it is proposed, ‘A comprehensive national social and behavioural change communication (SBCC) strategy must serve to increase demand and uptake of services, to promote positive norms and behaviours and to challenge those that place people at risk’ Challenge the gender norms that influence ‘delaying sexual debut; reducing multiple and concurrent sexual partnerships’. ‘These strategies must also address the gender norms that equate alcohol consumption with masculinity’. Importantly, it is noted that the roll-out of MMC should include gender sensitisation. (NSP, pp. 23, 39 & 41)

“Data from the 2010–2011 national HCT campaign indicates that men represented only 30% of those who tested. Efforts must be made to increase men’s health-seeking behaviour, including participation in HCT”. “Testing and screening services must take place at multiple settings to reach all populations, including homes (by trained community health workers), workplaces, schools and tertiary institutions, social grant distribution points, and correctional facilities. “ HCT services must also be made available through mobile services in communities: sporting events, taxi ranks and malls, correctional facilities, mines, airports, malls, shebeens, hotels, schools, tertiary institutions, sex work venues/locations and clubs. HIV testing in the SA NSP

Taking Action to improve access and use of HIV services by men. 1.Outcomes better for women and for men when men access key HIV services 2.Take HIV services to men and women in communities 3.Integrate focus on gender equality and services for men and boys into UN, Bilateral and National Plans 4.Develop mass media campaigns that encourage men and boys to get tested. 5.Educate health service providers