Why the involvement of men in HIV programs is limited

November 9, 2014

Involvement of men in HIV programs is an ongoing challenge, but one that is poorly recognized. Improved engagement of men is needed to ensure that HIV programs respond better to gender vulnerabilities. Poor involvement of men means that even targeted interventions for women and children have reduced impact.

Men themselves can also be disadvantaged. ART coverage of men is lower than that of women, especially in Sub Saharan Africa. In addition, men tend to present late at HIV clinics with advanced disease. As a result, men typically have higher mortality compared to women. Men are also more likely to be lost to follow-up, compared to women.

Why is the involvement of men in HIV programs limited?

While diverse factors contribute to this situation, NEW research from Uganda by the International HIV/AIDS Alliance shows that men’s involvement, participation and uptake of HIV services is influenced by both stigma and masculinity, the combined effect of which is to reduce men’s health-seeking behavior, their readiness to accept ‘sick roles’  and their ability to disclose their HIV status. 

What can be done to encourage more men to get tested, participate in peer support groups and get (and remain) treatment

The study, published  in BMC Public Health, recommends that gender transformative interventions that help men to reject masculinity signifiers that prevent their access to HIV services should be better linked with stigma-reduction interventions, and both scaled up. The study also found that inclusion of skills and income generating activities in HIV programs encourages men’s involvement and uptake of HIV services because it reduces poverty-associated HIV stigma, and it enables them to live up to masculine ideas of providing for their families. While this finding is not entirely surprising, it reinforces the call for sustained inclusion of skills and livelihood activities in HIV programs. 

In addition: 
1. HIV programs should stimulate community conversations to educate men and women on possible harmful effects of adhering to some masculine notions that prevent them from accessing health services.
2. HIV programs should continue to support peer support groups, as that can be an entry point for livelihood activities, especially leveraging on men who are accessing services to be role models for others that are hesitant. Evidence shows that there is an inverse relationship between social support and stigma.
3. HIV programs should support PLHIV  to challenge stigma, as has been successfully done in Uganda. 

Overall, emerging evidence calls for a multi-pronged approach to gender programming in an effort to involve both men and women in HIV prevention, treatment and care.

The study was conducted in Uganda by the International HIV/AIDs Alliance and as part of the Evidence for Action Research Consortium.