South Africa: Rates of HIV infection among women are higher than in men, because fewer men are on treatment

South African scientists at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2018) suggested that the extremely high prevalence of HIV infection in women may be due to the fact that women are more likely to be diagnosed and start antiretroviral therapy earlier than men, and this means that they are less likely to transmit the virus to men, the AIDSmap portal reports.

In other words, more women on HIV treatment mean fewer HIV-infected men. Women are more often tested for HIV, for example, during the antenatal period and, as the study shows, they also start ART earlier.

Researchers also placed emphasis on differences in the detectable viral load of women versus men. They noticed that there are more women with undetectable viral load than men. This suggests that although there are more women with an HIV-positive diagnosis than men, their infectiousness is lower.

The difference between HIV infection rates among women and men can also be partially explained by male circumcision: 51% of young people aged 15-19 years and less than 20% of men over 35 years old have been circumcised.

In conclusion, the researchers propose to do two things in order to level the differences in infection rates between HIV-positive men and women by reducing new HIV infections among them. First, men and especially young people need not only regular HIV testing, but also need to be better connected to care and treatment. Secondly, women need something equivalent to medical male circumcision for HIV prevention. The vaginal ring, although not life-long, may be such an opportunity.