Men's self-image as strong, sexually active risk-takers means they are more likely to die from HIV/AIDS than are women, experts said on Wednesday, calling for more HIV workplace testing to reach men and greater efforts to change gender norms.
Although six out of ten Africans with HIV are women, men are 25 percent more likely to die from the disease, according to research by the Africa Centre for Health and Population Studies in South Africa, which has the world's biggest AIDS epidemic.
"A lot has been achieved in the AIDS response, but we will be more successful if we put greater emphasis on engaging men and boys," Dean Peacock, founding director of South African advocacy group Sonke Gender Justice, told the Thomson Reuters Foundation.
"The majority of people who don’t access services are men - and that's bad for everyone."
Men are less likely to test for HIV, less likely to start or adhere to antiretroviral therapy (ART) to manage the disease and more likely to start treatment late and die, Peacock said in a paper he co-authored and presented to United Nations program on HIV/AIDS (UNAIDS) on Wednesday.
Men will soon make up almost 70 percent of AIDS-related deaths in some high-prevalence countries, the paper said, even though rates of HIV infection among women aged 15 to 24 are twice as high as those of men the same age.
Women are more vulnerable to HIV/AIDS because their lower social status, poverty and violence often mean they cannot choose whether to have sex or use a condom.
As a result, health services have focused heavily on ensuring women get tested, usually when they are pregnant, and take ART to prevent transmission of the virus to their babies.
To end the HIV pandemic, there needs to be a greater focus on testing and treating men, Peacock said, by offering male-friendly services in the workplace or open on weekends with male staff.
When men do not know their HIV status, they are less likely to use a condom to protect their sexual partners, research shows. Similarly, if they do not take ART, their viral load remains high and they are more likely to transmit HIV.
The World Health Organization recommends everyone with HIV should start ART as soon as possible to safeguard their health and reduce the risk of transmission.
"Men are socialized to see health-seeking as a sign of weakness," Peacock said. "Many men feel they can only access health services when something is broken or falling off."
Men often avoid HIV tests because they assume they are positive and drive long distances to clinics where they will not be recognized, the paper said, citing research in Malawi.
"We want to make sure that there are education efforts — from the classroom to the television that people watch at night [and] the billboards they drive past — that promote a different set of norms about gender," Peacock said.
"Men shouldn’t define their manhood by the number of women they have sex with, by how dominant they are in their relationship [and] by how much alcohol they consume."
Greater efforts also need to be made to reach men who have sex with men (MSM), who are 19 times more likely to be HIV positive than the general population but find it hard to access services due to stigma and discrimination, the paper said.
Homosexuality is illegal in most African countries.
A recent study found only one in ten HIV positive MSM in some South African provinces was on antiretroviral therapy.
"We have to change the laws," said South African judge Edwin Cameron, who is living with HIV and gay.
"You impede access to treatment and effective response to the epidemic through these antiquated persecutions."