What helps men stay in HIV care in Kenya and Uganda?
Expansion of antiretroviral (ART) therapy in sub-Saharan Africa has dramatically increased the number of people living with HIV getting treatment. However, men have largely been left behind. They test for HIV at lower rates, have more trouble sticking with treatment and higher death rates.
The Sustainable East Africa Research in Community Health (SEARCH) trial actively worked to increase male engagement in care by addressing known barriers. As a result, men were retained in care at the same rate as women at the end of the first year.
Researchers conducted interviews with community members, patients, and their HIV-care providers to help explain what resulted in high rates of care engagement among men. They found a mix of actions the trial took as well as cultural factors:
- Physical health was a strong motivation for continuing ART. Men credited ART with improving their health and increasing their ability to work and appear healthy. They internalized SEARCH messages about the importance of ART adherence. Early ART start helped shield men from developing physical signs of HIV-infection and potential stigma.
- Men benefited from supportive partners and the ability to disclose their HIV-positive status without negative consequences. Women often encouraged their partners to take drugs and reminded them about appointments. Men experienced fewer negative consequences than women did when they disclosed their HIV-positive status.
- Men who didn’t disclose their HIV status could seek HIV care elsewhere. Men had more agency, financial resources, and decision-making power that allowed them to seek care in remote facilities without their partner’s knowledge.
- The streamlined and patient-centered approach within SEARCH helped men stay in care. Men who tested HIV-positive were linked to care immediately, regardless of how sick they were or if they were showing symptoms; clinics had flexible hours with short wait times; and providers made phone call reminders and follow-ups after missed appointments, which all helped facilitate ART continuation.
Improving male engagement in care is crucial for individuals’ health as well as preventing the spread of HIV at the population level. The combination of addressing barriers to care and an underlying social structure that supports men led to higher retention in care. There is still work to do to get treatment for all genders at ideal levels. Efforts to improve gender equity and support when disclosing HIV status are essential to support both men’s and women’s retention in care and treatment.