Refining HIV prevention efforts for AGYW through the engagement of their male sexual partners

Working paper number: 479
Author(s): Shehani Perera, Jane Kelly, Pertina Nyamukondiwa, Brendan MaughanBrown, Jane Ferguson, Martina Mchenga, Dineo Sekgobela and Elona Toska
Unit: CSSR

Abstract:

Despite significant progress in HIV prevention and treatment services in African countries, adolescent girls and young women (AGYW) aged 15-24 years continue to experience disproportionately high HIV incidence rates compared to their male peers. Focusing HIV prevention efforts on male sexual partners of AGYW may reduce HIV transmission, as many new cases occur within these peer sexual relationships. Our analysis draws on targeted literature reviews and data from existing national and sub-national datasets on the male sexual partners of AGYW from five countries – Cameroon, Eswatini, Kenya, Lesotho, and Mozambique. This paper examines factors influencing HIV acquisition among male sexual partners of AGYW and their engagement with HIV-related services, and provides recommendations for interventions.

Male sexual partners of AGYW face significant HIV acquisition risks and persistently low HIV testing rates across Cameroon, Eswatini, Kenya, Lesotho, and Mozambique. Early sexual debut, age-disparate relationships, and multiple sexual partnerships are reported key drivers of HIV acquisition. Sexual partnerships are frequently characterised by power imbalances stemming from age and resource (economic and material) disparities, with many AGYW reporting that their first sexual partners were substantially older. Multiple concurrent partnerships are common among male sexual partners, which further complicates relationship dynamics. Critical gaps persist in men’s engagement with HIV testing, prevention, and voluntary medical male circumcision services, with many men unaware of their HIV status. Key barriers to accessing HIV services include financial constraints, work commitments, and concerns about the loss of social status. Services become more appealing when they are convenient and address confidentiality concerns, particularly regarding HIVrelated stigma.

Recommended interventions are to ensure HIV services are affordable and accessible, and to combine widespread information dissemination with targeted approaches, including U=U (Undetectable = Untransmittable) messaging to educate and motivate men, and addressing power imbalances through educational programmes. Integration of HIV services into existing healthcare and other systems, coupled with innovative delivery methods through healthcare providers, traditional healers, and social media platforms, could improve male engagement. While evidence suggests that targeted interventions can be costeffective, continued research is essential to better understand effective engagement strategies for men in HIV prevention and care services, including the assessment of their needs, barriers, and motivators that are unique to them per se and not only as male sexual partners of AGYW.