Gaps in male case-finding and treatment: Insights for AIDS 2018 pre-conferences

Male case-finding
Jon Crisp, Baylor College of Medicine Children's Foundation Malawi/SHARE staff
Gaps in male case-finding and treatment
A man is tested for HIV by a male healthcare provider in Malawi
Photo credit: Robbie Flick

Men were a hot topic at the AIDS 2018 pre-conferences this weekend. As part of her presentation to kick off the PEPFAR pre-conference, Ambassador Deborah Birx shared data highlighting that while recent progress has realized a 50% decline in HIV incidence, men were not equally represented in this achievement. It is remarkable that we have come so far in spite of such a significant gap, but we need to better understand and reach more men if we are to continue this momentum. 

The unique, complex challenges and perspectives of men regarding HIV status and disclosure are being explored by Ipsos Healthcare in its qualitative and ethnographic research in southern Africa as outlined by Sunny Sharma. He explained that many men in the region live isolated, stressful, and challenging lives – often being away from families for long amounts of time and/or migrating long distances for work. This leads to cognitive dissonance between their aspired identify and what is often a harsh reality:

Men want to be:

But…

Respected

Don’t respect themselves due to engaging in unhealthy behaviors

Providers

Don’t have the means to provide

Procreators

May not be in a position to know if a child is truly theirs

Virile

Behaviors perceived to be virile put them at significant risk

Under these circumstances, sex is one of their few sources of connection and enjoyment, but also puts men at significant risk. HIV often seems inevitable and there are few benefits to knowing their HIV status. Diagnosis only brings costs, not rewards. Disclosure of their status might involve having to admit to multiple sexual relationships and potentially losing their only connection to the family and community they value and rely on.

These dynamics require differentiated service delivery – customizing our approaches to meet the needs of specific types of clients. At the PEPFAR pre-conference meeting, partner organizations discussed exciting initiatives implementing this strategy. For example, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in Lesotho has experimented with men’s clinics staffed by male healthcare workers which are open evening and weekend hours and allow for men to make appointments that better accommodate their work schedules.

I’m excited to hear from other organizations coming up with innovative approaches to reach men and customizing their approaches to sensitively and intelligently meet men’s unique needs.