Are we leaving adolescent boys and young men behind in HIV prevention, care and treatment interventions?

Prevalence among AGYW 

Historically, girls and women have been disproportionately impacted by the HIV pandemic due to the high prevalence and incidence rates among this population. In 2023, 53% of all people living with HIV were adolescent girls and young women (AGYW) (UNAIDS, 2024). Southern and Eastern Africa have the highest prevalence and incidence rates on the continent, largely influenced by significant inequality and economic disparity. Contributing factors to the high prevalence among AGYW include gender stereotypes embedded in cultural norms, the infrastructure and accessibility of healthcare facilities, educational barriers, and economic dependencies. 

AGYW are three times more likely to contract HIV through sexual transmission compared to their male counterparts. It is, therefore, understandable why there are substantial investments in prevention and treatment programs targeting this population. Interventions like PEPFAR's DREAMS program, organisations like Girl Effect, and other various country-specific initiatives focus on equipping AGYW with youth-friendly reproductive health knowledge and care. However, AGYW are not engaging in sexual behaviors alone, and greater attention needs to be paid to their sexual partners. 

Acknowledgement of boy gap 

In the testing and treatment targets of 95-95-95 of the HIV testing, treatment and viral suppression target, in 2023 the target achieved was 91-91-94 among women and 83-86-94 among men among men (USAIDS, 2024). Local and national stakeholders recognize that reducing new HIV infection rates among AGYW requires scaling interventions that target both AGYW and their sexual partners. In other words, stakeholders notice that there is a gap in the current iterations of prevention, care and treatment interventions. 

Gender influence?  

Gender norms and identity significantly influence how heterosexual men engage with health services due to stereotypes associated with masculinity and health. Men often define their masculinity through traits of self-reliance, independence, and strength. As a result, adopting health-seeking behaviors may be perceived as a sign of weakness unless they experience obvious health issues (Sharma et al., 2019). 

In many African cultures, heteronormative masculinity is embodied by an authoritative figure who occupies the head and voice of the household, displaying wealth and power through interactions with others. Young men may display their masculinity by participating in risky behaviors and showing reluctance to display vulnerabilities. 

But the barriers? 

When limited funding resources frequently fluctuate, many countries in Southern and Eastern Africa target the most vulnerable populations because intervention outputs are more noticeable and widespread in the short term. Interventions such as awareness campaigns, increasing accessibility to HIV testing, and providing prevention tools like condoms and Pre-exposure prophylaxis (PrEP) are effective short-term solutions. They are easy to implement, monitor, and are cost-effective. However, men may find these interventions time-consuming and feel too vulnerable to engage with care and prevention initiatives, prioritizing activities that align more closely with their definition of masculinity. 

Therefore, short-term strategies such as mobilization campaigns and testing initiatives may be seen as challenging the characteristics of masculinity. Careful consideration of the influence of masculinity should be made when designing interventions targeting men. 

So, what is the solution? Let's have the conversation.