1. Edward Mills PhD, Associate Professor, Faculty of Health Sciences University of Ottawa AIDS Mortality Among Men in Africa: An overview of the evidence

2. Historical perspective AIDS has always taken a strong gender approach to targeting specific populations Because of biological exposure, more women have been infected with HIV than men in Africa Although there have been efforts to increase access for marginalized groups, specific populations, including adolescents, the elderly, and men are disproportionately under- represented in program cohorts Major funders, including PEPFAR, have thus far not responded to targeting specific under-represented groups

3. First rigorous evaluation, 2008 Braitstein et al. using the ART-CC cohort of 22 centres in Africa involving ~30,000 people Found a larger representation of women receiving ART than UNAIDS estimates indicated by country. Men were more likely to have lower CD4 counts, be older and have advanced disease

4. Updated analysis of all published cohorts Druyts, Dybul, et al. Male gender and the risk of mortality among individuals enrolled in antiretroviral treatment programs in Africa: A systematic review and meta-analysis. AIDS, in press

5. Mills et al. J Int AIDS Soc. 2011;14:52-52.

6. Impact on mortality and life expectancy in Uganda Mills EJ, Dybul M, Hogg RS. Life expectancy of individuals on combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Annals of Internal Medicine 2011;155:209-216. Mortality rates 26.9 (95% CI, 25.4 to 28.5) in women to 43.9 (CI, 40.7 to 47.0) in men (per 1,000 PY). Adjusted Hazard Ratio 1.47 (95% CI, 1.34–1.62) At the age of 20, a male can expect to survive an additional 19.1 years, whereas females can expect an additional 30.6 years.

8. Conclusion Although there has been a large amount of attention given to gender issues in HIV/AIDS, there is a need to improve representation of specific groups Men are accessing therapy at a worse stage, have greater loss to follow up and ultimately mortality The public health community has not demonstrated leadership on this issue Its possible that a faith-based approach will have a better approach to engaging men and their families