One in seven men living with HIV in eastern and southern Africa are unaware that they have the virus, according to research presented at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver, US by Dr Craig Heck of Columbia University. Younger men and those who sometimes live away from home were more likely not to know their status.
According to UNAIDS data, while 83% of adolescent girls and women on treatment in these regions had reached viral suppression in 2024, only 76% of adolescent boys and men aged 15 and older had. What’s more, in addition to starting off worse on the continuum, men also saw larger drop offs at each level, from testing to treatment to viral suppression. To reach UNAIDS 95:95:95 targets – HIV awareness, on treatment, virally suppressed – it’s crucial to close these gaps.
Factors related to these gaps include age, mobility and sexual behaviours. However, Heck and colleagues aimed to get a better understanding of the overlap between different groups and how belonging to overlapping subgroups affects HIV outcomes.
The study
Researchers drew on data from nationally representative surveys across seven countries: Eswatini, Lesotho, Malawi, Mozambique, Tanzania, Uganda and Zimbabwe. In addition to survey items, rapid HIV testing was also done, along with blood testing for antiretroviral therapy (ART) medications and viral load.
Possible outcomes, based on a combination of self-report and biospecimen data, included men who reported an HIV-negative status but tested positive (unaware), men not on ART, and men with an unsuppressed viral load (measured as 1000 copies or more). The former two categories were adjusted based on men who had any ART in their blood.
Overall, 5390 men with HIV were included. Uganda had the smallest percentage of men with HIV at 9%, while Lesotho had the greatest at 22%. Men were classified into distinct categories associated with gaps. Men aged 50 and older comprised 33% of the sample; men who had one or more HIV negative partner(s) made up 24%; mobile men, or those who lived away from home for more than one month in the past year, made up 13% and younger men, aged between 15 and 24, made up 6%.
There were very few men who reported sex with other men, at less than 1% (35 men in total) and slightly more who reported buying or selling sex at 1% (47 men in total). Overall, 38% were unclassified, 48% fit into one subgroup and 14% fit into multiple.
Younger mobile men particularly vulnerable
When looking at the whole sample, 15% were unaware that they had HIV, an additional 3%, or 18% in total, were not on treatment and a cumulative 24% were not virally suppressed.
Men who were not classified into any of the categories tended to have large gaps in awareness, treatment and viral suppression.
Of the classified men, younger men displayed the largest gaps: 29% were unaware, 31% were not on treatment and 46% overall were not virally suppressed. Mobile men also had large gaps: 18% were unaware, 22% were untreated and 29% had no viral suppression.
Older men tended to have more favourable profiles: only 8% were unaware, 9% untreated and 13% overall not virally suppressed.
When considering overlapping categories, younger men who were mobile emerged as having the largest gaps. Of these 42 men, 31% were unaware of their status, 36% were untreated and 48% were unsuppressed. Another overlapping group with high unawareness of status was mobile men who had HIV-negative partners at 23%, with 26% being untreated and 35% being virally unsuppressed.
In terms of separated categories, the ‘younger only’ group of 234 men also had a high level of unawareness at 24%, with 27% not being on treatment and 43% not being virally suppressed. While there were only 28 men whose only risk factor was buying or selling sex, they had a high level of unawareness at 29%.
When considering all groups, unclassified men comprised the single biggest group at 2051 men – 16% of them were unaware of their status, 20% were untreated and 27% were unsuppressed. This represents a particularly vulnerable group, as they do not fit into any of the risk categories.
“Men with HIV unaware of their HIV-positive status was the largest gap in all subgroups,” Heck concluded. “Efforts are needed to improve HIV testing uptake among all men. Services reaching men with HIV who are mobile, young, and in sero-discordant couples may be required.”
References
Heck CJ et al. HIV Testing and Treatment Gaps in Subgroups of Men with HIV: Insights From 7 African Countries. Conference on Retroviruses and Opportunistic Infections, Denver, abstract 182, 2026.
Image credit: HIV/AIDS Unit of MONUSCO conducts voluntary testing for the public during activities marking UN Day in Goma, DRC. Photo MONUSCO/Michael Ali. Available at 703A5784 | Goma, North Kivu Province, DR Congo: HIV/AIDS Unit… | Flickr under a Creative Commons licence CC BY-SA 2.0.
