My opinion

By Dr. Gwinyai Masukume
Corresponding Author Dr. Gwinyai Masukume
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, - South Africa
Submitting Author Dr. Gwinyai Masukume

HIV, AIDS, gender, males, vulnerable

Masukume G. Can males ever be a vulnerable group? HIV/AIDS conspiracy of silence. WebmedCentral AIDS 2014;5(11):WMC004748
doi: 10.9754/journal.wmc.2014.004748

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Submitted on: 07 Nov 2014 08:56:08 AM GMT
Published on: 07 Nov 2014 09:30:40 AM GMT

Summary of changes

I have added the UNAIDS’ Executive Director’s view point on women and HIV/AIDS; I have also added how males are claimed to have poor health seeking behavior although this behavior is debatable

My opinion

"Girls and women are almost universally less powerful, less privileged, and have fewer opportunities than men." [1,2] But does this prevent people from recognizing and acting if gender inequality affects males? [3]

Let us take the case of HIV/AIDS in South Africa a country which has less than 1% of the world's population, but accounts for about 15% of this disease's global burden [4].

Commonly, it is stated that the brunt of the HIV epidemic is mainly felt by females [5]. Michel Sidibé the Executive Director of UNAIDS, the organization which essentially co-ordinates the global response to HIV/AIDS said, "This epidemic unfortunately remains an epidemic of women" [6]. It is true that the prevalence (proportion of cases) of HIV is higher in females (14.4%) than in males (9.9%), according to the comprehensive 2012 South African National HIV Prevalence, Incidence and Behaviour Survey [7]. According to this survey 71.5% and 59.0% of females and males respectively above 15 years of age had ever been tested for HIV; males are less likely to be aware of their HIV status.

There is virtually no doubt or discussion that anti-retroviral therapy has turned around the course of the HIV epidemic for the better; in fact those who start therapy early enough have an almost normal life expectancy [8]. According to the before-mentioned survey, 25.7% and 34.7% of males and females respectively living with HIV were on anti-retroviral therapy. Clearly males are (very) disadvantaged with respect to being on anti-retroviral therapy.

Turning to a specific South African population that has been closely monitored and followed up over time [9]. As expected, in this population, we find that the prevalence of HIV is higher in females than in males [10]. However, in this very population it is males who die more from HIV/AIDS and pulmonary tuberculosis (related to HIV infection) [11].

Clearly males are vulnerable when it comes to HIV/AIDS and this vulnerability is not just confined to South Africa or to HIV/AIDS [3,12].

Coming back to the core questions. Is it entirely true that females mainly bear HIV's brunt? No. Is it true that largely people fail to recognize and act if inequality affects males? Yes.

Why should the situation be like this? Perhaps another illustration is apt.

In May 2014 Solange Knowles (a prominent American entertainer) physically attacked her brother-in-law, Jay Z (one of the world's most successful entertainers) [13]. Solange was not arrested and did not have to appear in court. Had it been the other way round - Jay Z physically attacking Solange - most likely, Jay Z's career would have been (severely) impaired.

Males have been said to have poor health seeking behavior compared to females [14] although this is very debatable [15]. Even if we accept that males do not seek health care as much as females, we cannot blame males for the HIV/AIDS situation they find themselves in just as we cannot blame females for their position in society. In conclusion, addressing the substantial anti-retroviral therapy gap in males does not only benefit them but it can also help limit HIV's spread because those on adequate treatment are less likely to transmit the virus to their sexual partner(s) [16].


  1. Hawkes S, Buse K. Gender and global health: evidence, policy, and inconvenient truths. Lancet 2013; 381(9879):1783-7. [ -6]
  2. Barres BA. Does gender matter? Nature 2006; 442(7099):133-6. []
  3. Cornell M. Gender inequality: Bad for men's health. S Afr J HIV Med 2013; 14(1):12-14. []
  4. Mayosi BM, Benatar SR. Health and Health Care in South Africa - 20 years after Mandela. N Engl J Med 2014; 371:1344-1353. []
  5. van der Linde I. Plenary Session 3, 20 June 2013 - "HIV/AIDS in South Africa: At last the glass is half full". 2013. stis-and-tb/plenary-session-3-20-june-2013-hiv-aids-in-south-africa-at-last-the-glass-is-half-full (accessed 12 October 2014).
  6. UN News Centre. "Noting progress to date, Ban urges greater efforts against HIV/AIDS". 2010.http://ww (accessed 6 November 2014).
  7. Shisana O, Rehle T, Simbayi LC, et al. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. 2014. Cape Town, HSRC Press. /assets/files/1267/sabssm_iv_leo_final.pdf (accessed 13 October 2014).
  8. Johnson LF, Mossong J, Dorrington RE, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med 2013; 10(4):e1001418. [ ]
  9. Kahn K, Collinson MA, Gómez-Olivé FX, et al. Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol 2012; 41(4):988-1001. []
  10. Gómez-Olivé FX, Angotti N, Houle B, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care 2013; 25(9):1122-8. [ ]
  11. Collinson MA, White MJ, Bocquier P, et al. Migration and the epidemiological transition: insights from the Agincourt sub-district of northeast South Africa. Glob Health Action 2014; 7:23514. []
  12. Masukume G. Live births resulting from advanced abdominal extrauterine pregnancy, a review of cases reported from 2008 to 2013. WebmedCentral Obstetrics and Gynaecology. 2014; 5(1):WMC004510. (accessed 16 October 2014).
  13. TMZ staff. Jay Z physically attacked by Beyonce's sister. 2014.http://www (accessed 13 October 2014).
  14. Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc 2010 13:6.[]
  15. Cornell M, Myer L. Does the success of HIV treatment depend on gender? Future Microbiol. 2013 8(1):9-11. []
  16. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365(6):493-505. []

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2 reviews posted so far

Can males ever be a vulnerable group? HIV/AIDS conspiracy of silence
Posted by Dr. Palash Samanta on 19 Mar 2015 05:11:18 AM GMT Reviewed by WMC Editors

Can males ever be a vulnerable group? HIV/AIDS conspiracy of silence
Posted by Anonymous Reviewer on 17 Nov 2014 10:50:55 PM GMT Reviewed by WMC Editors
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