A new commentary from National Institutes of Health scientists asserts that engaging men in HIV prevention and care is essential to the goal of ending the HIV pandemic. The article by Adeola Adeyeye, M.D., M.P.A., and David Burns, M.D., M.P.H., of the National Institute of Allergy and Infectious Diseases (NIAID) and Michael Stirratt, Ph.D., of the National Institute of Mental Health (NIMH) also discusses potential solutions.
Scientific research has proven that people with HIV who take antiretroviral therapy (ART) as prescribed and achieve and maintain an undetectable level of virus in the blood have effectively no risk of transmitting the virus to their HIV-uninfected sexual partners. Other research has shown that when HIV-uninfected people consistently take a single daily oral tablet of the antiretroviral drugs emtricitabine/tenofovir disoproxil fumarate, their risk of acquiring HIV infection is reduced by as much as 95 percent. The challenge is implementing these approaches, known as treatment as prevention and pre-exposure prophylaxis (PrEP), and other forms of HIV prevention in a timely manner among everyone who needs them.
The authors point out that in sub-Saharan Africa, men are less likely than women to know their HIV status, engage in HIV care in a timely manner, stay in care and maintain an undetectable level of virus in the blood. The authors also note that in the United States, disparities by age, race and ethnicity persist in the use of ART among men who have sex with men
New strategies to engage men in HIV prevention and treatment must address three critical issues, the authors write. These are the lack of “touch points” where men naturally interact with the health care system; gender norms and prevailing constructs of masculinity, which typically subordinate health care to other concerns; and HIV stigma and discrimination. The authors describe innovative approaches being explored to overcome these challenges, including establishing HIV testing and care in workplaces and sports programs, ART home delivery, HIV self-testing, and the MenStar Coalition created by the President’s Emergency Plan for AIDS Relief (PEPFAR), Unitaid, the Elton John AIDS Foundation and others to expand HIV diagnosis and treatment for men.
In addition, NIAID and NIMH are co-sponsoring two research Funding Opportunity Announcements designed to support development and testing of strategies to increase the engagement of men in HIV prevention and care domestically and globally. More information about these grant opportunities is available at PA-19-042 and PA-19-050.
A Adeyeye et al. Engaging men in HIV treatment and prevention. The Lancet (2018).
The authors and NIAID Director Anthony S. Fauci, M.D., are available for comment.