The Missing Men: HIV Treatment Scale-Up and Life Expectancy in Sub-Saharan Africa

Delivery of effective HIV antiretroviral therapy (ART) to the more than 6 million persons with HIV in South Africa is well underway, with early data on the impact of this massive public health effort demonstrating a reversal of the previous decade’s precipitous decline in population life expectancy [1]. Although South Africa’s age and sex disparities in HIV acquisition have traditionally been described as disadvantaging young women [2], accumulating evidence now suggests a reverse disparity: although HIV care is available to both men and women and is nominally free of charge, women are more likely to be tested for HIV, engage in pre-treatment care, initiate treatment earlier, stay on treatment, and survive [3–6]. To adopt the classic Eisenberg and Power [7] analogy of health care as current flowing through an electric circuit, the voltage drops along the entire circuit of HIV care, from HIV infection to AIDS-free survival, are larger for men compared with women (Fig 1). There are simply too many missing men.

Below:  The cascade of “voltage drops” from HIV infection to AIDS-free survival.

In order for the goal of AIDS-free survival to be achieved, (1) HIV testing, care, and treatment services must be available, and persons with HIV must (2) be enrolled in care, (3) initiate antiretroviral therapy, (4) achieve suppression of HIV-1 RNA viral load, and (5) be retained in care.

Below:  Gender gaps in life expectancy among men and women with HIV initiating antiretroviral therapy at 20 years of age.

This figure summarizes the findings of studies from Rwanda [9], South Africa [8], and Uganda [10]. Estimates and associated 95% confidence intervals are shown as the number of additional years of life expected for men and women with HIV initiating antiretroviral therapy at 20 years of age.

Full article at:  http://goo.gl/BC93rj

By:   Alexander C. Tsai

Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America

Alexander C. Tsai

Mbarara University of Science and Technology, Mbarara, Uganda

Alexander C. Tsai, Mark J. Siedner

Harvard Medical School, Boston, Massachusetts, United States of America

Mark J. Siedner

Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America

 

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