HIV Testing and Treatment Gaps Persist Among Men in Eastern and Southern Africa

New research presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver highlights significant gaps in HIV awareness, treatment, and viral suppression among men in eastern and southern Africa. The study, led by Dr. Craig Heck of Columbia University, reveals that one in seven men living with HIV in the region are unaware of their infection status.

Disparities in HIV Outcomes

Data from UNAIDS indicates that while 83% of adolescent girls and women on treatment in these regions achieved viral suppression in 2024, only 76% of adolescent boys and men aged 15 and older did. Men consistently experience larger declines at each stage of the HIV care continuum – from testing to treatment to viral suppression – compared to women. Addressing these disparities is crucial to achieving the UNAIDS 95:95:95 targets.

Study Methodology

Researchers analyzed data from nationally representative surveys conducted across seven countries: Eswatini, Lesotho, Malawi, Mozambique, Tanzania, Uganda, and Zimbabwe. The study combined self-reported data with rapid HIV testing and blood tests to assess antiretroviral therapy (ART) medication and viral load levels.

Key Findings

• Unawareness: 15% of men were unaware of their HIV-positive status, rising to 18% when accounting for potential inaccuracies in self-reporting.
• Treatment Gaps: An additional 3% of men were aware of their status but not receiving treatment, bringing the total percentage not on treatment to 18%.
• Viral Suppression: A cumulative 24% of men were not virally suppressed (defined as a viral load of 1000 copies or more).
• Age and Mobility: Younger men and those who frequently live away from home were disproportionately affected by these gaps. Younger men (15-24 years classic) had the largest gaps, with 29% unaware of their status, 31% not on treatment, and 46% not virally suppressed. Mobile men also experienced significant gaps: 18% unaware, 22% untreated, and 29% unsuppressed.
• Overlapping Vulnerabilities: Younger, mobile men faced the most significant challenges, with 31% unaware of their status, 36% untreated, and 48% unsuppressed.
• Unclassified Men: A substantial 38% of men did not fit into any of the defined risk categories. Among these “unclassified” men, 16% were unaware of their status, 20% were untreated, and 27% were unsuppressed, representing a particularly vulnerable group.

The Importance of Targeted Interventions

“Men with HIV unaware of their HIV-positive status was the largest gap in all subgroups,” Dr. Heck concluded. “Efforts are needed to improve HIV testing uptake among all men. Services reaching men with HIV who are mobile, young, and in serodiscordant couples may be required.”

Glossary

Virological Suppression

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

Representative Sample

Studies aim to give information that will be applicable to a large group of people. Given that it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) brings together the resources of ten United Nations organisations in response to HIV and AIDS.

Discordant

A serodiscordant couple is one in which one partner has HIV and the other has not.

Reference: Heck CJ et al. HIV Testing and Treatment Gaps in Subgroups of Men with HIV: Insights From 7 African Countries. Conference on Retroviruses and Opportunistic Infections, Denver, abstract 182, 2026.

Image credit: HIV/AIDS Unit of MONUSCO conducts voluntary testing for the public during activities marking UN Day in Goma, DRC. Photo MONUSCO/Michael Ali. Available under a Creative Commons licence CC BY-SA 2.0.