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Decomposing gender gaps in HIV service outcomes.
Gary Gaumer1, Collins Gaba2, Elad Daniels3
1Institute for Global Health and Development, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA.
BMJ Global Health
|January 16, 2026
Summary
Men face worse HIV outcomes than women due to structural barriers, despite having protective individual characteristics. Progress has been made in reducing these gender disparities over time.
Area of Science:
- Public Health
- Epidemiology
- Social Sciences
Background:
- Gender disparities persist in HIV outcomes globally.
- Understanding these disparities is crucial for effective HIV prevention and treatment strategies.
Purpose of the Study:
- To examine factors contributing to gender disparities in HIV outcomes among adults in 13 African countries.
- To decompose these disparities into components related to individual characteristics and structural barriers.
Main Methods:
- Utilized Population-based HIV Impact Assessments (PHIA) survey data.
- Employed the Blinder-Oaxaca decomposition method to analyze gender gaps in HIV status awareness, treatment, and viral load suppression.
- Compared changes in disparities and their decomposition over time.
Main Results:
- Males consistently exhibited poorer HIV outcomes compared to females across all indicators.
- Individual factors (age, education, wealth) and structural barriers (stigma, gender norms, lower male health service utilization) contributed to disparities.
- Structural barriers significantly offset advantages from individual-level characteristics for males.
Conclusions:
- Structural and cultural barriers have shown the most improvement in reducing the gender gap in HIV service outcomes.
- Continued investment in and evaluation of male-friendly health services are essential.
- Knowledge gained should inform future interventions to improve individual treatment outcomes and prevent new HIV infections.
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