Lower Levels of Antiretroviral Therapy Enrollment Among Men with HIV Compared with Women — 12 Countries, 2002–2013
Authors: Andrew F. Auld, Ray W. Shiraishi, Francisco Mbofana, Aleny Couto, Ernest Benny Fetogang, Shenaaz El-Halabi, Refeletswe Lebelonyane, Pilatwe Tlhagiso Pilatwe, Ndapewa Hamunime, Velephi Okello, Tsitsi Mutasa-Apollo, Owen Mugurungi, Joseph Murungu, Janet Dzangare, Gideon Kwesigabo, Fred Wabwire-Mangen, Modest Mulenga, Sebastian Hachizovu, Virginie Ettiegne-Traore, Fayama Mohamed, Adebobola Bashorun, Do Thi Nhan, Nguyen Huu Hai, Tran Huu Quang, Joelle Deas Van Onacker, Kesner Francois, Ermane G. Robin, Gracia Desforges, Mansour Farahani, Harrison Kamiru, Harriet Nuwagaba-Biribonwoha, Peter Ehrenkranz, Julie A. Denison, Olivier Koole, Sharon Tsui, Kwasi Torpey, Ya Diul Mukadi, Eric van Praag, Joris Menten, Timothy D. Mastro, Carol Dukes Hamilton, Oseni Omomo Abiri, Mark Griswold, Edna Pierre, Carla Xavier, Charity Alfredo, Kebba Jobarteh, Mpho Letebele, Simon Agolory, Andrew L. Baughman, Gram Mutandi, Peter Preko, Caroline Ryan, Trong Ao, Elizabeth Gonese, Amy Herman-Roloff, Kunomboa A. Ekra, Joseph S. Kouakou, Solomon Odafe, Dennis Onotu, Ibrahim Dalhatu, Henry H. Debem, Duc B. Nguyen, Le Ngoc Yen, Abu S. Abdul-Quader, Valerie Pelletier, Seymour G. Williams, Stephanie Behel, George Bicego, Mahesh Swaminathan, E. Kainne Dokubo, Georgette Adjorlolo-Johnson, Richard Marlink, David Lowrance, Thomas Spira, Robert Colebunders, David Bangsberg, Aaron Zee, Jonathan Kaplan, Tedd V. Ellerbrock
Journal: MMWR Morbidity and Mortality Weekly Report (2015)

Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)(†) of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage.