Abstract
BackgroundThere is a growing recognition of the impact of gender and the social determinants of health on the clinical course of people living with HIV (PLHIV). However, the relative contribution of these factors to clinical outcomes of PLHIV is incompletely defined in many countries. This study was performed to gain a greater understanding of the non-clinical determinants of prognosis of PLHIV in Myanmar.MethodsSelected demographic, behavioural and socioeconomic characteristics of outpatients at two specialist HIV hospitals and one general hospital in Yangon, Myanmar were correlated with their subsequent clinical course; a poor outcome was defined as death, hospitalisation, loss to follow-up or a detectable viral load at 6 months of follow-up.Results221 consecutive individuals with advanced HIV commencing anti-retroviral therapy (ART) were enrolled in the study; their median CD4 T-cell count was 92 (44–158) cells/mm3, 138 (62.4%) were male. Socioeconomic disadvantage was common: the median (interquartile range (IQR) monthly per-capita income in the cohort was US$48 (31–77); 153 (69.9%) had not completed high school. However, in a multivariate analysis that considered demographic, behavioural, clinical factors and social determinants of health, male gender was the only predictor of a poor outcome: odds ratio (95% confidence interval): 2.33 (1.26–4.32, p = 0.007). All eight of the deaths and hospitalisations in the cohort occurred in males (p = 0.03).ConclusionsMen starting ART in Myanmar have a poorer prognosis than women. Expanded implementation of gender-specific management strategies is likely to be necessary to improve outcomes.
Highlights
In 2019, the Human Immunodeficiency Virus (HIV) prevalence in individuals aged 15–49 in Myanmar was estimated to be 0.7%, one of the highest in Southeast Asia [1]
There were 221 patients enrolled into this study, their median age was 37 (32–46) and 138 (62.4%) were male
The number of people living at home was comparable for men and women (median (IQR): 3 (2–4) versus 3 (2–5), p = 0.90) as was the monthly per-capita income (median (IQR): United States Dollars (USD) 46.15 (30.77–76.92) versus USD 51.28 (28.04– 76.92), p = 0.90)
Summary
In 2019, the HIV prevalence in individuals aged 15–49 in Myanmar was estimated to be 0.7%, one of the highest in Southeast Asia [1]. Nyein et al AIDS Res Ther (2021) 18:50 these encouraging outcomes are not seen uniformly: other studies have reported attrition rates (a combination of death within 6 months and loss to follow-up (LTFU)) of up to 20%) [3] This attrition was associated with a variety of factors including gender, marital status, level of education and hazardous alcohol consumption [3]. Prevailing concepts of masculinity lead to men being less likely than women to seek out health care, less likely to have HIV testing and less likely to initiate and adhere to ART [7].
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