Men presented at an older age and with more advanced HIVA

Proportional hazards regression was used to explore associations between baseline characteristics and survival and loss-to-follow-up. Patients were predominantly female (67%). Men presented at an older age and with more advanced HIV disease, and during early antiretroviral therapy the crude death rate was higher among men than women (22.8 vs 12.5/100 person-years; P = 0.002). However in multivariate analysis, gender was not significantly associated with survival after adjusting for baseline clinical and immunovirological status (HR = 1.46, 95% CI = 0.96-2.22; P = 0.076). In late antiretroviral therapy (4-12 months), there was no gender difference in mortality rates (3.5 vs 3.8/100 person-years; P = 0.817). In multivariate analysis, survival was strongly associated with age (HR = 1.05, 95% CI = 1.02-1.09; P < style="text-decoration: underline;">CD4 count >150 vs <50> (HR = 0.35, 95% CI = 0.14-0.87; P = 0.023) and any monthly income vs none (HR = 0.47, 95% CI = 0.25-0.88; P = 0.018). Having some monthly income was protective against loss-to-follow-up at 1 year on antiretroviral therapy (adjusted HR = 0.56, 95% CI = 0.39-0.82; P = 0.002). Men’s high early mortality on antiretroviral therapy appears due largely to their presentation with more advanced HIV disease. Efforts are needed to enrol men into care earlier in HIV disease and to reduce socio-economic inequalities in antiretroviral therapy programme outcomes.

This study provides additional evidence to support the need for strategies to increase men’s exposure to health services and decrease their disadvantages in access to HIV testing and treatment in resource-constrained settings. Some of the barriers are psychosocial while others are structural. This study also found that people with no monthly income experience poorer treatment outcomes: Compared to women with no monthly income, men with no monthly income had nearly twice the crude hazard of death. Socioeconomic interventions, such as the proposed basic income grant in South Africa, may improve patient retention and survival in antiretroviral treatment programmes.