In all but one of 12 developing countries studied by the Centers for Disease Control and Prevention (CDC), HIV-infected women were significantly more likely than men to receive antiretroviral therapy (ART), according to a report published in the November 27 issue of the Morbidity and Mortality Weekly Report.

"Equitable access to [ART] for [HIV]-infected men and women is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS Relief," write Andrew F. Auld, MBChB, from the Division of Global HIV/AIDS, Center for Global Health, CDC, Atlanta, Georgia, and colleagues.

Specific strategies designed to reach more men with HIV testing and linkage to care, as well as adoption of test-and-treat ART eligibility guidelines, are needed to reduce sex inequity in ART coverage.

Key factors underlying the sex disparity were routine HIV testing and counseling in antenatal care and universal treatment eligibility for pregnant women with HIV. In addition, sex differences in health-seeking behaviors could play a role, with men being more likely to delay seeking healthcare for reasons including stigma, societal norms that discourage men from admitting ill health, and employment responsibilities.

The CDC analyzed 765,087 adult ART patient medical records from 12 countries, estimating the female-to-male ratio of new ART enrollees for each calendar year from 2002 to 2013 as a measure of sex equity in ART access. They compared this annual ratio with corresponding Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates of adult female-to-male ratios among all HIV-infected persons.

In all 10 African countries and Haiti, the most recent estimate of female-to-male ratio of women to men newly enrolled in ART significantly exceeded the UNAIDS estimate of the ratio of women to men among persons with HIV by from 23% to 83%. Only Vietnam did not show this sex inequality in treatment uptake.

In many of the countries, sex disparity in ART uptake increased during the study period.

"Government- and donor-level policy and management shifts, including endorsement of male-health–focused strategies, performance-based financing that provides incentives to reach both men and women, and gender disaggregation of HIV treatment cohort data are also needed," the authors conclude. "Prioritizing increased ART coverage among men with HIV could decrease male morbidity and mortality and reduce HIV incidence among sexual partners."

Limitations of this report included the limited ability to make statistical comparisons between UNAIDS-derived and cohort-derived ratios, variation in size and generalizability of cohort data, lack of age-specific data, and failure to examine sex ratios among persons being tested for HIV or linking to care.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:1281-1286. Full text