NIH Commentary Highlights Importance of Engaging Men in HIV Treatment, Prevention

In a new commentary, scientists from the National Institutes of Health assert that engaging men in HIV treatment and prevention is essential for ending the HIV pandemic.

A pile of research has established that people at risk for HIV who take pre-exposure prophylaxis can reduce their risk of contracting the virus by more than 90%. For those who have been diagnosed with HIV, adhering to antiretroviral therapy (ART) can help them achieve and maintain an undetectable level of virus in the blood, resulting in viral suppression and no risk of transmitting the virus.

However, in sub-Saharan Africa, men are less likely than women to know their HIV status, engage in and maintain HIV care, and sustain viral suppression, and thus have higher mortality rates. In the United States, disparities by age, race, and ethnicity in the use of ART persist among men who have sex with men. Thus, the scientists argue, new strategies to engage men in HIV prevention and treatment must address these 3 issues.

“Innovative approaches that are now being tried offer HIV testing and care in male-centered clinics, business and workplace setting, and as part of sports programs in different parts of the world,” according to the scientists. “For men who are still reluctant to take up these services, including those who fear HIV stigma and homophobia, other approaches are being examined.”

These approaches include HIV self-test kits that are linked to care, treatment, and prevention services, as well as home ART delivery programs.

One of the biggest challenges with engaging men with the healthcare system is that the first 5 to 10 years of HIV are asymptomatic, leading them to perceive themselves as healthy. Working to understand what it takes to get men into the clinical setting before they’re sick, Sir Elton John and Price Harry, Duke of Sussex, launched the MenStar Coalition this year. The coalition is leveraging over $1.2 billion in initial funding from its partners, which include the United States President’s Emergency Plan for AIDS Relief, the Elton John AIDS Foundation, Johnson & Johnson, and Gilead.

“Men form a crucial link in almost all HIV transmission networks, whether they partner with women, men, or both sexually and as fellow injection drug users,” wrote the scientists. “In sub-Saharan Africa, a dynamic has been identified in which older men expose adolescent girls and young women to HIV, who later expose their male peers.”

They note that this dynamic helps explain why HIV prevalence is significantly higher in women younger than 25 but becomes equal thereafter. Meanwhile, in high-income countries, approximately 75% of young men who have sex with men are estimated to be exposed to HIV by other young men who have sex with men.

Reference

Adeyeye A, Stirratt M, Burns D. Engaging men in HIV treatment and prevention [published December 1, 2018]. Lancet. doi: 10.1016/S0140-6736(18)32994-5.