Engaging Heterosexual Men More Effectively Could Lead to a Significant Reduction in HIV Infections in Uganda


A recent study conducted by scientists from Imperial College London and the Rakai Health Sciences Program (RHSP) in Uganda has revealed that providing heterosexual men with improved access to HIV treatment and care could effectively suppress the virus and drastically reduce transmission rates to their female partners. The study, published in Nature Microbiology, analyzed data from 15 years (2003-2018) during which the US President’s Emergency Plan For AIDS Relief (PEPFAR) implemented an extensive program for HIV/AIDS testing, prevention, and treatment.

The study findings showed that the PEPFAR program and other related services have successfully reduced new infections among young women and heterosexual men. However, the reduction in infections was less significant among women aged 25 and above. This disparity is believed to be due to the fact that women are more likely to achieve viral suppression by actively seeking and effectively using HIV treatment, thereby preventing transmission to their male partners. The same cannot be said for men, leading to a higher number of new infections.

The analysis revealed that by 2018, the number of women achieving and maintaining undetectable levels of HIV infection (non-transmissible) was 1.5 to 2 times higher than men across all age groups. If men had achieved the same level of virus suppression as women, approximately half of the new infections that occurred between 2016 and 2018 could have been avoided.

Furthermore, the study reconstructed transmission networks using the genetic code of the virus from thousands of participants. The analysis revealed that the proportion of transmissions from men is increasing and now accounts for 63% of all transmissions in the area, despite a greater number of women living with HIV compared to men. This suggests that men may face barriers in accessing treatment and care, such as travel for work or limited clinic availability, as well as social stigma.

Dr. Oliver Ratmann, senior author of the study, emphasized the need to adapt strategies and bridge gaps in care to ensure that all individuals, regardless of gender, have access to life-saving benefits of HIV treatment. By monitoring and addressing the changing dynamics of the epidemic and striving for equity in HIV care, progress can be made towards controlling and ultimately eliminating HIV transmission.

Dr. Kate Grabowski, a co-author of the study, emphasized the importance of the President’s Emergency Plan for AIDS Relief (PEPFAR) in reducing infections and saving lives. The study’s findings provide strong support for the program’s efficacy and present a clear roadmap to ending the pandemic through enhanced HIV treatment coverage, particularly among men. As the United States Congress evaluates PEPFAR funding, this evidence is crucial in highlighting the program’s impact.

The study utilized data from the Rakai Community Cohort Study (RCCS) in southern Uganda, an area with a high prevalence of HIV compared to the US. The RCCS has been enrolling individuals since 2003 and tracking changes in HIV infection as new interventions were introduced. The analysis tracked various factors, including new infections, HIV treatment uptake, viral suppression, and behavioral information, to understand the evolving dynamics of the heterosexual HIV epidemic in the region.

Previous analyses showed that the highest number of new HIV cases in southern Uganda occurred among adolescent girls and young women aged 15-24. However, more recent years analyzed in the study revealed that women aged 25-34 became a new focal group, experiencing a slower decline in new infections compared to other age groups. Notably, the decline in new infections among men and boys was much faster.

To estimate the potential impact of achieving viral suppression among men, statistical models based on transmission dynamics were applied. The projections indicated that closing the viral suppression gap in men could lead to a 50% reduction in new infections among women and eliminate gender disparities in acquiring HIV.

Dr. Joseph Kagaayi, previous director of the Rakai Health Sciences program and a senior co-author of the study, stressed the importance of addressing disparities in HIV treatment uptake and viral suppression between men and women. By doing so, not only can HIV infections among women be reduced, but efforts can also be made to close the gender gap in HIV transmission. Achieving these goals will require concerted efforts, informed policies, and strengthened healthcare services.

1. Source: Coherent Market Insights, Public sources, Desk research
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