Over the last decade, it has become increasingly clear that men and boys are less likely to test for HIV, to initiate antiretroviral therapy (ART) and to remain engaged in care. Globally, ART coverage of men lags behind that of women. Men and boys are dying of AIDS-related illnesses and many other diseases, including non-communicable diseases (NCDs), at disproportionately higher rates than their female counterparts.
In many countries across 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. The identification and diagnosis of undiagnosed men is essential in promoting men’s health and breaking the cycle of HIV transmission.
Toxic gender norms that prize male strength and stoicism whilst equating “illness” with “weakness”, partly explain men’s’ delay in seeking care. However, this gender analysis ought to be coupled with an access and inclusion lens which interrogates the architecture of the health system and the extent to which health policies and services are tailor made to carter for the needs of men in their diversity. Furthermore, a human rights analytical framework is critical. A broader supportive and enabling environment is important for the engagement and inclusion of men in the discourse of gender and HIV.
Recognizing current gaps, challenges, and the urgent need for enhanced male engagement to improve HIV outcomes for all, UNAIDS in collaboration with Sonke Gender Justice, WHO and UN Women, developed the ‘Framework for action for male engagement in HIV testing, treatment and prevention in eastern and southern Africa’. The framework is an evidence-based action road map to guide the development of national strategies. It categorizes existing research and best practice, and elaborates strategies on how to increase prevention, testing and treatment among men and boys, within a broader gender equality agenda. When contextualized to local contexts and epidemiological situations, the framework provides a foundation for country-led movement to achieve globally agreed gender equality targets and HIV goals as outlined in the High-Level Political declaration and Global AIDS Strategy 2021–2026.
In line with the global AIDS strategy and the impulse to reach those furthest behind, the framework provides direction and strategies for the inclusion of men in their diversity. It also provides guidance for addressing structural barriers to transform social economic, legal and policy structures for better male engagement as a key pathway end AIDS by 2030.