Why more men are dying from HIV

_____________

OPINION

By Dr Nelson Musoba

For more than three decades, Uganda has been at the forefront of the fight against HIV/ AIDS. The country has made tremendous progress in testing, treatment and prevention, with millions of people now accessing life-saving antiretroviral therapy. Yet behind these gains lies a troubling paradox: While more women are living with HIV, more men are dying from AIDS-related illnesses.

In 2024, the country recorded about 37,000 new HIV infections. Women accounted for the majority of these cases, with roughly 21,000 infections among women compared to about 12,000 among men and around 4,000 among children. Similar projections are expected for 2025.

However, when it comes to AIDS-related deaths, the pattern is reversed. In 2024, Uganda recorded roughly 20,000 HIV-related deaths. Of these, an estimated 8,700 occurred among men, about 8,200 among women, and just over 3,000 among children. Early projections for 2025 show a similar trend, with men again accounting for the largest share of deaths.

This pattern raises an important question: Why are men dying in greater numbers when fewer of them are infected? The answer lies not only in the virus itself but also in behaviour, social norms and how men interact with the health system.

One of the biggest reasons women are more likely to survive longer with HIV is that they tend to enter the health system earlier. During pregnancy, for example, HIV testing is routine as part of efforts to prevent mother-to-child transmission.

This means many women learn their HIV status early, often before symptoms appear. Early diagnosis allows them to start treatment quickly and maintain good health for many years.

Men, on the other hand, often have fewer routine interactions with the health system — many only visit health facilities when they are seriously ill. By the time some men test for HIV, the virus may have already weakened their immune system significantly.

In many communities, men are expected to appear strong, resilient and self reliant. Seeking medical help, especially for a condition associated with stigma such as HIV, can sometimes be perceived as a sign of weakness.

As a result, many men delay testing or avoid health facilities altogether. Others fear the social consequences of being diagnosed with HIV, including stigma, discrimination or being judged by their peers.

This delay can have deadly consequences. HIV treatment works best when started early, long before severe illness sets in.

Even after testing positive, men are less likely to start and remain on treatment compared to women. Several factors contribute to this. Many men work in occupations that require long hours or frequent travel, making it difficult to attend clinic appointments. Others may fear being seen collecting medication at health facilities.

Some men also struggle with consistent adherence to medication due to lifestyle factors, including alcohol use or irregular routines. Women generally have higher treatment adherence rates and are more likely to attend follow-up appointments, leading to better viral suppression and longer survival.

When HIV is detected late, treatment becomes more complicated. Patients may already have developed opportunistic infections such as tuberculosis, meningitis or severe pneumonia.

At this stage, even with treatment, recovery can be difficult and sometimes impossible. This is why the higher death rate among men is not necessarily because HIV affects them more severely, but because many men arrive too late for treatment to work effectively.

If Uganda is to achieve its goal of ending AIDS as a public health threat by 2030, addressing the gap among men is key.

As the Uganda AIDS Commission, we want to commend our partners, cultural institutions such as Buganda kingdom, Toro kingdom, Busoga and others that have prioritised men in their HIV outreach programmes.

We all can do more in getting men to access HIV services early. This can be achieved through expanding community-based testing, workplace testing programmes and mobile clinics that reach men where they work and live.

Health services can be designed to be more male-friendly. Flexible clinic hours, fast-track services and reduced waiting times can make it easier for men to seek care. We are strongly encouraging couples to test together. When partners test together, men are often more willing to engage in care and treatment.

Finally, community leaders, religious leaders and role models must be involved in encouraging men to prioritise their health. The Uganda AIDS Commission is rolling out a communication handbook for leaders that is freely available to guide them on speaking with men.

Uganda has already demonstrated that progress against HIV is possible. By ensuring that men test earlier, start treatment sooner and remain in care, the country can close the gender gap in HIV deaths.

The writer is the director general of the Uganda AIDS Commission