South Africa continues to make progress in expanding HIV treatment access, but a significant gender disparity remains: more women are living with HIV, yet more men are dying from the disease.
Treatment Success Masks Male Mortality Risk
According to the Thembisa mathematical model, an estimated 5.2 million women were living with HIV in 2023/24, compared with 2.6 million men. However, 27,100 men died of Aids-related causes during the same period, exceeding the 24,200 recorded female deaths.
Public health experts say the explanation lies not in infection rates alone, but in treatment behaviour.
Reluctance to Test and Stay on Treatment
Doctors interviewed indicated that men are less likely to seek early testing and are less consistent in starting and remaining on antiretroviral therapy.
Kate Rees of the Anova Health Institute noted that while fewer people overall are dying from HIV thanks to improved treatment access, men continue to have poorer outcomes because of lower treatment adherence.
Meanwhile, Thandi Maluka highlighted that women, particularly young women and adolescent girls, remain vulnerable due to structural inequalities such as poverty, gender-based violence and limited economic opportunities.
Health advocates argue that prevention campaigns must address both behavioural and structural barriers. Encouraging men to test early and remain in care, while strengthening prevention tools for women and girls, is seen as critical to narrowing the gap.
Although treatment expansion has allowed millions to live long and healthy lives, experts warn that without targeted efforts aimed at male engagement, mortality disparities may persist.
