Blind Spot – Reaching Out To Men And Boys
Addressing A Blind Spot In The Response To HIV
In a world of gender inequalities that disadvantage women and girls, publishing a report on how men are not being reached by health services and are not exercising their right to health may seem counterintuitive. It is indeed perplexing to learn that men were less likely than women to know their HIV status and less likely to access and adhere to HIV treatment. As a consequence, more men are likely to die of AIDS-related illnesses than women.
As the world strives to reach the high levels of HIV service coverage required to end AIDS as a public health threat, this blind spot in the response to HIV can no longer be ignored.
Improving the utilization of HIV prevention, testing and treatment services by men and adolescent boys is a complex but feasible challenge. Gender inequalities and harmful gender norms stand in the way, disadvantaging women and girls in a multitude of ways, putting the health of both men and women at risk and slowing progress against the AIDS epidemic. When men refrain from using HIV services or are unable to use them, they increase their odds of acquiring HIV, transmitting the infection to their partners and succumbing to serious illness and premature death – all of which can have a dire impact on their partners, children and families.
Progress is needed along two intertwined paths:
- Reach more men with health and HIV services in the short term, and enable them to use and adhere to those services.
- Introduce purposeful policies and practices that remove gender inequalities and promote more equitable gender norms and institutional arrangements to the bene t of both women and men.
Numerous efforts in diverse settings show that substantial progress is possible. The following transformative actions are required on a large scale to achieve global goals.
- Ensure that supportive legal and policy frameworks underpin systematic change. Laws and policies that violate human rights or undermine public health should be reformed or abandoned.
- Invest in long-term gender-transformative programmes, particularly those that engage men and boys, to alter harmful gender norms, reduce gender-based violence and promote much stronger gender equality.
- Adopt a firm public health approach to health and HIV service access among key populations, including comprehensive harm reduction approaches, and remove policies and laws that criminalize key populations or sanction their harassment and discrimination.
Systems for health
- Improve understanding of the disparities in health behaviours of men and women, including through standard sex disaggregation of HIV and other health data.
- Revise health and HIV strategies and policies to address gaps and disparities in access to and use of services, whether for men and boys or women and girls.
- Adapt health systems so they reach deeper into communities and meet the diverse health needs of men and women. Make health insurance more accessible and affordable to low-income earners, and reduce point-of-care expenses for individuals when they seek health-care assistance.
- Sensitize and train health-care workers to improve their competence in dealing with the diverse health issues and behaviours of men and boys.
- Make health and HIV services more easily accessible and appealing for men and boys. Clinics should be open outside standard working hours on at least some days of the week, and clinic procedures and environments should be more responsive to men’s health-related concerns, including the desire for con dentiality.
- Make HIV services available outside of traditional clinical settings, including within the workplace and at places of leisure (including sports activities). Time the provision of mobile and other community-based services outside of standard working hours so they reach as many men as possible.
- Use community-based HIV testing and counselling (including mobile and home-based testing), community outreach and self-testing more extensively, and integrate testing into multidisease campaigns and events.
- Ensure HIV testing is confidential to achieve earlier diagnosis of HIV infection in men, and use test-and-treat strategies so that men initiate treatment as soon as possible after diagnosis.
- Strengthen treatment adherence by decentralizing services, including drug dispensing, minimizing the travel and wait times of clinic visits and emphasizing the benefits of treatment for partners and families.
- Reach men through their sexual partners and spouses, and engage them more systematically in maternal and child health services and sexual and reproductive health services, including through strategies such as couples HIV testing and partner-assisted notification.
- Counter perceptions of sexual health as a woman’s issue and responsibility. Enlist community leaders and other figures of respect to dispel misconceptions and promote gender-equitable behaviours. Peer influence is a powerful factor in encouraging men and boys to alter their behaviours.
- Use creative marketing and trendsetting to promote the use of condoms and lubricants, voluntary medical male circumcision and other proven HIV prevention measures. These efforts must be socially marketed so they speak to the diversity of men’s perceptions, desires, needs and concerns.
- Use social media nudges and reminders, including via mobile phone apps and SMS messages, to discretely provide health information and linkage to services, and to support adherence to prevention, treatment and care.
All of these actions must consider the great diversity of men across and within the world’s cultures, recognizing that men belonging to marginalized populations face unique challenges when accessing health services. Achieving some changes may take a generation, but others could be accomplished within a year. A concerted effort on both short-term and long-term actions is needed to reach the global goal of ending AIDS as a public health threat by 2030.