This week MSF launches a new report ‘HIV Care for Men: Lessons learnt from Medecins Sans Frontieres’ which outlines four years of MSF’s operational experiences in rural and peri-urban Eshowe, Kwa-Zulu Natal and peri-urban Khayelitsha, Western Cape, South Africa in targeting men to increase their uptake of HIV testing and linkage to and retention in treatment, if testing HIV positive.
The report will be launched at a special ‘Men & HIV Forum’ being held ahead of IAS 2019 in Mexico City. Dr. Tom Ellman, SAMU Medical Director, and Muziwandile Sibiya, an MSF male services nurse from South Africa will present on MSF’s experiences in the male-only Philandoda Clinic in Eshowe.
South Africa has the most people living with HIV in the world, with approximately 7.9 million people of all ages now living with HIV in South Africa in 2017, equivalent to almost 20% of all people living with HIV globally. While HIV prevalence is lower among men (14.8%) than women (26.3%) in South Africa, men are much less likely to test for HIV and link to treatment. In Khayelitsha just 30% of those on antiretroviral treatment (ART) are men and in Eshowe, data for 2017 shows that only 27% of patients on ART are men.
This is not unique to South Africa. Research in many African settings has shown that HIV-positive men are less likely to initiate ART, and those who do are more likely to present to clinics later, more ill and have poorer retention and worse clinical outcomes. Explanations put forward for men’s low attendance and poor outcomes include notions of masculinity that are at odds with illness and ‘good patient’ behavior, public health systems that are historically built around maternal and child health and systematic under-funding of men’s services compared to women’s.
In response, MSF has been working with local health authorities to support different ways to reach men in Eshowe and Khayelitsha. Male-focused services include those in existing clinics, through a range of male-only vertical clinics and male after hours services; mobile outreach clinics; door-to-door and outreach testing specifically targeted at men; and schools testing and Medical Male Circumsicion (MMC) recruitment targeted at adolescent boys and young men.
While these efforts show some success in getting men into care, it is clear that one size does not fit all. More men can be reached by adapting HIV services to their social and medical needs. Notably, male patients report increased satisfaction with male only staff, which enhances empathy and understanding. The report suggests that many elements of male-friendly services can make incremental improvements. Further efforts are required to identify novel ways of reaching men, as South Africa seeks to cross the ‘last mile’ in tackling the HIV epidemic.