an Eldis Resource
Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi
Differences in mortality rates between HIV-infected men and women on antiretroviral therapy in Malawi
Authors:
K. Taylor-Smith; H. Tweya; A. Harries
Publisher:
Malawi Medical Journal, 2010
This paper seeks to identify whether men and women benefit equally from antiretroviral therapy (ART) in Malawi, and to ascertain the reasons underlying any difference. The paper aims at helping strategy-designers to address these differences and optimise ART delivery.
The paper reveals that among Malawian healthcare workers, teachers, police and army personnel, HIV-infected men on ART experience significantly higher mortality than women. The paper deems this gender difference may be due to men starting ART at a later clinical stage than women, or due to poorer compliance to therapy among men than women.
To improve early access, the document suggests identifying patients with advanced clinical disease and implementing a system to fast-track them onto treatment. In addition, the paper suggests the following:
- using qualitative approaches to ascertain why some men delay ART initiation in order to enable appropriate strategies to be deployed to try and encourage earlier access
- the issue of adherence to therapy possibly being poorer among men also needs further study
- if some of the gender difference in mortality is due to a gender difference in the pharmacology and drug response to ART, this needs to be verified in future studies
- the effects of cigarette smoking and alcohol and other determinants in relation to gender should be investigated.
Furthermore, the author underlines the common idea that mortality during screening before people are started on ART in Malawi is very high. Consequently, it indicates that whether there are differences in survival between men and women at this stage poses yet another question.
