There is evidence accumulating and indicating that men and young boys in Namibia, and in Africa in general, are not accessing HIV services as often as their female counterparts. What is your take on this?
Well, the focus of the HIV epidemic has historically been on women and children. Women are considered particularly vulnerable to HIV infection because of biological factors, their reduced sexual autonomy, and men’s sexual power and privilege over them. This is also linked to perceptions of masculinity and is generally considered as part of the same issues that drive multiple sexual partners, violence against women and substance use such as alcohol.
This understanding has led to [the development] of HIV and AIDS public health prevention and treatment programmes to focus on women and children. These have also led to men receiving less attention in the epidemic, hence less targeted HIV prevention and treatment programmes.
What are the underlying reasons why men are less likely to seek health services, in this context, services related to HIV prevention, sexual and reproductive health?
Public health interventions have been focusing on women, particularly those attending antenatal care and other reproductive health services including family planning. At these settings, women are offered HIV testing, care and treatment and, of course, other health services. Often you won’t see men at these settings.
So, there is clearly a difference in health-seeking behaviour between men and women. For example, illness may be seen as a sign of weakness for many men, and this perception has resulted in a reluctance to seek care among men.
Some studies have also indicated that men may feel that they have been caught at their hidden sexual behaviours and so they would avoid HIV testing. Also, migration due to employment will keep men away from their partner and families for long time periods.
What is the negative impact of these poor heath-seeking behaviours by men?
According to data from Ministry of Health and Social Services, there are about 185,000 people living with HIV, who are on antiretroviral treatment (ART). This number includes those from the private health care providers too. Not surprising, viral load suppression among young men in 15-19 and 20-24 age groups is way below their female counterparts. It is important that we all understand that the goal of ART is viral load suppression. However, this can only happen if a person takes his/her treatment properly every day. Viral load refers to the amount of HIV there is in the blood. It is measured as copies of the virus per millilitre of blood (copies/mL). Taking ARVs on time, every day makes the viral load drop very quickly.
The seriousness of this matter is that although women are becoming infected with HIV at a much faster rate, men are far more likely to die from an HIV-related illness than women. Why is it like this?
Because fewer men than women get tested for HIV. Just like in other African settings, men in Namibia are less likely than women to have been tested for HIV and, therefore, do not know their HIV status. As a result, fewer men are on antiretroviral therapy (compared to women) and many receive treatment at a later stage when the virus has had a significant amount of time during which it could deplete their immune systems. In such cases, treatment would not always be optimally effective.
When men do not know their HIV status, they are less likely to change their sexual practices or to use condoms, and are, therefore, much more likely to transmit HIV to their partners. We need to continue to encourage men to access HIV services because we know that it is important for their own health, but it is also an important way to reduce vulnerability among women.
What could be the contributing factors from the health care providers and communities at large?
Other studies indicate that health professionals themselves often assume that men do not need, or are not willing to use HIV-related services. Men are often referred to as “transmitters” or “vectors” of HIV infection. These are stereotypes that blame them for infection, stigmatise them and isolate them further from accessing services. These stereotypes can lead to men not using condoms and avoiding health services, such as HIV testing or even other sexual health services. Research in other countries is also showing that men with less equitable attitudes to women are less likely to be tested for HIV. Such preconceptions need to change with the implementation of comprehensive programmes that are attractive to men and young boys.
*Taimi Amaambo is the Country Director for the Society for Family Health (SFH), a local public health NGO collaborating with the government with funding from the US Government in particular USAID, to advance HIV prevention, care and treatment, among other programmes.