Overview

Health systems also pose barriers to men’s low uptake of HIV-related services. Whilst some barriers are the product of prevailing gender norms – such as men viewing clinical settings as female spaces, dominated by women, children and female nurses – only focusing on gender norms is an oversimplification.

Men lack the universal entry points to health systems that women generally have. In addition, clinic opening hours and facility-based healthcare limits access for men who work outside their communities during the day. A number of studies are currently underway exploring different approaches to engaging and retaining men. These include HIV self-testing in communities and facilities, offering HIV testing and other screening services to men in outpatient departments, same-day ART initiation, home or community-based ART distribution, intensive and peer-based counselling and mentorship.

In addition, a more supportive environment needs to be created, including laws, policies and health strategies. Men are largely missing from public health strategies, which focus predominantly on children and women of childbearing age. Strategies to improve men’s access to HIV and other health services have been largely neglected, and indeed, the largest single gap in ESA in 2019 was  more than 700,000 men who did not know their status.

Similarly, national health indicators focus narrowly on the health of children and women (largely of reproductive age) and overlook men’s need for health services and their subsequent health outcomes. As a result, the gender gap in health care access and health outcomes for men is being highlighted as a major blind spot in global health research, policy and practice.

Health-system challenges contribute significantly to men’s low levels of uptake for HIV-related services. Whilst some barriers are the product of prevailing gender norms – such as men viewing clinical settings as female spaces, dominated by women and children, and female nurses – only focusing on gender norms is an oversimplification. Men lack the universal entry points to health systems that women generally have, which is compounded by a lack of extended opening hours and facility-based healthcare which hinders access to men who work outside their communities during the day.

Health-system obstacles go beyond the service delivery level and a broader, more supportive enabling environment needs to be intentionally created, including laws, policies and health strategies. In most countries, men are largely missing from public health strategies and there is therefore little mention of strategies or activities to improve their access to HIV services and other health services. Similarly, national health indicators tend to focus narrowly on women and children’s health while disregarding men’s use of services and their subsequent health outcomes. As a result, researchers are increasingly highlighting the so-called global gender gap in health-care access and health outcomes for men as a worrying blind spot in global health research, policy and practice.