Around the world, there are more men than women in key affected populations (gay men and other men who have sex with men, sex workers, people who inject drugs and transgender people) and the sexual partners of key affected populations. This puts men in these groups at greater risk of HIV.
HIV and men
- Outside of sub-Saharan Africa, 58% of HIV infections in 2020 were among men and boys.
- Men with HIV in sub-Saharan Africa are less likely than women to be diagnosed with HIV or be on treatment.
- Compared to women with HIV, there are 1 million more men with HIV who do not know they have it, 1.8 million more men who know they have HIV but are not on treatment and 1.6 million more men who are not virally suppressed.
Around the world there are fewer men with HIV than women. But men who have HIV are less likely to know they have it or be on treatment.
This is partly because there are more men in key population groups, increasing their risk of HIV but making it more difficult to access HIV services. Men are also less likely to seek healthcare like HIV testing and treatment. A lot of this has to do with masculine gender norms.
But the situation is slowly changing. Many men from key populations are finding solutions to challenge and reduce the inequalities they experience.
Why are men at risk of HIV?
In many countries, masculine gender norms expect men to be strong and brave. This can lead men to engage in activities that are high risk for HIV transmission, such as injecting drugs, having multiple sexual partners, or having sex without a condom. Gender norms means many men are responsible for providing for their families and work away from home to earn more money. During this time they may have casual sex or pay for sex, which can put them at risk of HIV.
Men are less likely to report illness (such as potential symptoms of HIV) or seek healthcare because it can be seen as a sign of weakness.
Many men avoid health services, so men are less likely to test for HIV and know their status. And they are less likely to access treatment if they test positive.
Women are more likely to receive healthcare because of reproductive, maternal and child health needs. These services usually include HIV services. Men do not have an equivalent service that links them to HIV services.
How can HIV services meet the needs of men?
Sexual and reproductive health and rights (SRHR) and prevention of mother-to-child transmission of HIV (PMTCT) services tend to focus on women. But men often make the decisions around sexual health in relationships. So, SRHR and PMTCT services should seek to involve male partners too.
Voluntary medical male circumcision (VMMC) should be offered to sexually active adolescents 15 years and older and to adult men at higher risk of HIV infection. Evidence shows that men from lower income backgrounds are less likely to get circumcised, so it is important to make sure VMMC services reach them.
With men less likely to attend a health clinic than women, efforts need to be made to reach men elsewhere. This could be by providing HIV services at workplaces, at outpatient departments, via self-testing approaches, and by conducting index testing (where partners of HIV positive patients are found and offered tests).
For example, an HIV clinic could open longer hours (beyond the typical working day), make efforts to reduce waiting times, and ensure privacy so that men who do visit clinics are less fearful of stigma from other people.
Condoms need to be easy to get hold of. But on top of that, men need to be empowered and willing to use them. Educating men on the benefits of condoms will help to protect their health and that of their partner(s).
What systemic changes could reduce the risk of HIV for men?
Men are harmed by gender norms that expect them to be strong and not show weakness. This discourages men from accessing healthcare and encourages risky behaviours. Effort needs to be made in schools, in the media and other public spaces to talk about, question and ultimately change these gender norms.
With men making up the majority of key populations, systemic changes that uphold their rights are needed. This can include decriminalising same-sex sexual activity and drug use, which will make it easier for men to access HIV services.