HIV Awareness Gap: Men in Eastern & Southern Africa Lag Behind | aidsmap

Across eastern and southern Africa, a concerning gap in HIV awareness persists, particularly among younger men and those with more mobile lifestyles. New data presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2026 reveals that roughly one in seven men living with HIV in the region are unaware of their status. This finding underscores the challenges in reaching key populations and achieving global HIV targets.

Reaching 95:95:95 – and the Gaps for Men

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set ambitious 95:95:95 goals: 95% of people living with HIV knowing their status, 95% of those diagnosed on antiretroviral therapy (ART), and 95% of those on ART achieving viral suppression. Viral suppression means the virus is controlled to undetectable levels, preventing transmission. While progress has been made, data from 2024 show disparities. Among adolescent girls and women on treatment in eastern and southern Africa, 83% had reached viral suppression. However, this figure dropped to 76% for adolescent boys and men aged 15, and older. Researchers note that men not only start with lower rates at each stage of the care continuum (testing, treatment, suppression) but also experience larger declines as they move through it. aidsmap reports that closing these gaps is critical to achieving UNAIDS targets.

Understanding the Factors at Play

The CROI 2026 research sought to understand the interplay of factors contributing to these disparities. Researchers analyzed data from nationally representative surveys conducted across seven countries: Eswatini, Lesotho, Malawi, Mozambique, Tanzania, Uganda, and Zimbabwe. The study combined survey responses with rapid HIV testing, as well as blood tests to detect antiretroviral therapy medications and viral load. This comprehensive approach allowed researchers to examine how age, mobility, and sexual behaviors overlap and influence HIV outcomes.

The study specifically highlighted that younger men and those who frequently move or live away from home are at higher risk of being unaware of their HIV status. While the reasons for this are complex, they likely involve a combination of factors. These include lower rates of HIV testing among these groups, potential barriers to accessing healthcare services, and social or cultural norms that may discourage testing or disclosure.

What the Data Doesn’t Notify Us

It’s important to note that this research identifies correlations, not necessarily causation. While the study demonstrates a link between age, mobility, and undiagnosed HIV, it doesn’t definitively prove that these factors *cause* the disparity. Other unmeasured variables, such as socioeconomic status, access to information, and individual risk behaviors, could also play a role. The study design, relying on survey data and testing at a single point in time, also limits its ability to establish a clear cause-and-effect relationship. Further research is needed to fully understand the complex interplay of factors driving these differences.

STI Prevention and Treatment: A Broader Context

The challenges in reaching men with HIV testing and treatment are part of a broader picture of sexually transmitted infection (STI) prevention and treatment. Jeanne Marrazzo, CEO of the Infectious Diseases Society of America (IDSA) and a member of the AVAC Board, highlighted advances and challenges in STI treatment during a plenary session at CROI 2026. AVAC reports that while DoxyPEP (doxycycline post-exposure prophylaxis) has shown promise in reducing syphilis among gay, bisexual, and other men who have sex with men, its effectiveness isn’t consistent across all populations in the U.S. Rising rates of congenital syphilis and the emergence of antibiotic-resistant gonorrhea remain significant concerns. Marrazzo emphasized the need to address structural barriers that put cisgender women at higher risk for STIs and to invest in innovation in diagnostics, antimicrobials, and vaccine development.

Expanding Choice and Person-Centered Solutions

A key theme emerging from CROI 2026 was the importance of expanding choice and delivering person-centered solutions to meet the diverse needs of individuals and communities. This includes offering a range of prevention options, such as PrEP (pre-exposure prophylaxis), and treatment modalities, including long-acting injectable antiretroviral therapy. The final CROI Community Breakfast Club highlighted advances in long-acting HIV treatment, recognizing that while it may not be suitable for everyone, it provides an important option for many. AJMC notes that CROI 2026 celebrated progress and looked toward the future of HIV.

What’s Next: Strengthening Surveillance and Targeted Interventions

Addressing the gaps in HIV awareness and treatment among younger, mobile men in eastern and southern Africa requires a multi-faceted approach. This includes strengthening surveillance systems to better track HIV prevalence and identify populations at risk, implementing targeted interventions to increase testing rates among these groups, and addressing the structural and social barriers that hinder access to care. Public health officials will likely review the CROI 2026 findings to inform updates to national HIV prevention and treatment strategies. Ongoing research will be crucial to further understand the factors driving these disparities and to evaluate the effectiveness of different interventions. Continued investment in HIV prevention and treatment programs, coupled with a commitment to equity and inclusivity, is essential to achieving the goal of ending the HIV epidemic.