AEGiS-15IAC: Gender aspects of access to ART and treatment outcomes in a South African township.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Gender aspects of access to ART and treatment outcomes in a South African township.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrD1085)

Boulle A, Michaels D, Hildebrand K
School of Public Health and Family Medicine, Cape Town, South Africa

BACKGROUND: PMTCT services have been provided in Khayelitsha since 1999, and ART since 2001. Contrary to many poor countries, women in South African townships tend to access public sector services more than men, and this has been the experience in HIV programmes. There is a growing body of evidence pointing to important gender differences in both access to and outcomes on ART (explained only in part by PMTCT being an entry point to ART). Health care providers are predominantly women (nurses). This study describes differences between men and women on ART regarding access, adherence, and clinical outcomes in the cohort of adults accessing ART in Khayelitsha.

METHODS: All patients who started ART prior to October 2003 (n=549) were included in a cohort analysis of adherence and clinical outcomes, including survival, viral load suppression and CD4 count changes.

RESULTS: In preliminary analyses of clinical outcomes, 549 adults had started ART of whom 383 (70%) were women. 24-month outcomes suggested that the hazards of mortality or loss to follow-up for men were almost twice those for women, mirrored by significant differences in self-reported adherence, virological suppression, and CD4 count response. Conclusion Women in Khayelitsha have greater access to ART, and superior clinical outcomes once on ART. Innovative strategies are required to improve the enrolment of men and their adherence once on ART.

Keywords: AEGIS, CD4 Lymphocyte Count, Treatment Outcome, Viral Load, Sex, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Cohort Studies, Humans, Female, Male, Adult

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MoOrD1085