Women have suffered the disproportionate burden of HIV infection. However, with the scale-up of antiretroviral therapy (ART), women have been found to have higher rates of HIV testing, start on antiretroviral treatment earlier, have better adherence and retention to treatment, and better clinical prognosis.
This study by Harvard School of Public Health Associate Professor of Global Health Till Barnighausen, funded by RUSH, was the first to assess the implication of ART scale-up on sex-disparities in all-cause and HIV-specific mortality at the population level.
Demographic data on 54,477 women and 46,809 men were collected by health and demographic surveillance at the Africa Centre for Health and Population Studies for the period 2000-2011 for all members of all households in a large rural district in KwaZulu-Natal.
The Hlabisa district has seen intensive studies into the impact of antiretroviral therapy in Africa, with seven per cent of all adults in the area receiving antiretroviral therapy by 2012. As a result, overall life expectancy has risen by one year for each year that antiretroviral therapy has been available since 2004.
However, although male life expectancy increased by nine years between 2004 and 2011, men were 25% more likely than women to die of an HIV-related illness in 2011. Women’s life expectancy increased by 13.2 years and the gap between male and female life expectancy increased from 4.5 years to 9 years.
The study showed that 57% of deaths in HIV-positive men between 2000 and 2011 occurred before men had sought any form of HIV care, compared to 41% in women.
The proportion of men with HIV who die before seeking care has changed little since 2007, while the proportion of women with HIV who die before accessing care has declined progressively in each year since 2006.
RethinkHIV is a consortium of senior researchers from London School of Hygiene & Tropical Medicine, Imperial College London, Harvard School of Public Health, Centre for the Study of African Economies and Blavatnik School of Government at Oxford University.
The consortium will evaluate new evidence related to the costs, benefits, effects, fiscal implications, and developmental impacts of HIV interventions in sub-Saharan Africa, in order to maximise contributions to the fight against HIV there.
The aim of RethinkHIV is to find ways of creating, optimising, and sustaining fiscal space for domestic HIV investment, as well as exploring long-term, sustainable national and international financing mechanisms. RethinkHIV is funded by RUSH Foundation.