Abstract
The Missing Men: HIV Treatment Scale-Up and Life Expectancy in Sub-Saharan Africa
Highlights
The research article by Jacob Bor and colleagues [18] that appears this week in PLOS Medicine provides new evidence of a widening gender gap in life expectancy, using data obtained from a general population sample in rural South Africa from 2001–2011, covering a period of coincident antiretroviral therapy (ART) scale-up
Perhaps more telling than the near-doubling of the gender gap in life expectancy during the observation period are the relative benefits women received throughout the entire HIV care circuit: HIV-related mortality rates were approximately 2-fold higher among men compared with women, whether prior to ART or during both early and long-term ART
South Africa’s successful program for preventing mother-to-child transmission largely requires HIV testing for all pregnant women and encourages ART initiation among those found to be HIV positive [20]. This institutional link to program entry could partially explain why more than half of HIV-related mortality events among men in 2007–2011 occurred during the pre-treatment period, compared with only one-third of HIV-related mortality events among women
Summary
Delivery of effective HIV antiretroviral therapy (ART) to the more than 6 million persons with HIV in South Africa is well underway, with early data on the impact of this massive public health effort demonstrating a reversal of the previous decade’s precipitous decline in population life expectancy [1]. Studies from South Africa [8], as well as Rwanda [9] and Uganda [10], have begun to demonstrate the cumulative impact of these voltage drops, which, in total, result in an approximately 10-year life expectancy gap between men and women initiating ART at 20 years of age (Fig 2).
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