Your Health: Fewer men testing for HIV despite multiple intimate partners

A look at David Odhiambo, a resident of Obunga area in Kisumu, one only sees an energetic middle-aged man who works as a bodaboda rider.

His charm has endeared him among his customers —something that cannot go unnoticed.
But beyond the huge smile on Odhiambo’s face, therein lies a secret that he has lived with for two years now. And despite agreeing to an interview, he is cautious on the details he divulges during our conversation.

It all started in 2019 when his first wife started falling sick frequently and despite taking over-the-counter medication, they seemed to offer little help. “She had a consistent cough, which could not be treated with simple drugs. At the time, we were staying in one of Nairobi’s slums and so we thought the cough was caused by the environment we lived in,” he says.

In 2020 during the onset of Covid-19, the cough persisted and with fears that she might have contracted the virus, Odhiambo says his now former wife went to hospital for treatment.

Her samples were taken and she was advised to isolate herself. But when the results came back, the Covid-19 test came back negative and the health worker advised her to take a HIV test, which she obliged.

“She did not consult me while going for that test. But that evening, she came home accusing me of infecting her with HIV. At first, I could not understand her. I could not believe that she was positive and so I dismissed her allegations,” he narrates.

No explanation

These revelations were just the beginning of a long journey shrouded with secrecy and bitterness.
Odhiambo says the medics had advised the wife to go back to hospital with him, so that he too, could do the test.

Maybe out of fear of the outcome, the father of two totally refused to go. This resulted in a huge fight between the couple that had lived peacefully and harmoniously for over 10 years and had two children. “Seeing that I was not bulging from the pressure of testing, my wife packed her belongings and left.

She went back to her parents home in Siaya County. I think she was also in denial because, despite being enrolled for the antiretroviral drugs (ARVs), she was not taking them and within a few months, she died from tuberculosis,” he says.

Odhiambo reveals his wife’s death came as a shocker, but the reality finally started sinking home. “After her burial, I went back to Nairobi. Everyone kept spreading talk about my wife dying from HIV and I had to refute the claims. The stigma that comes with being positive made me hide the cause of death,” he adds.

However, on the other side, Odhiambo knew the truth and knew that he could also be sick. And just to be sure about his own status, Odhiambo opted to go for testing and unfortunately, he was found positive.
Living with fear that the news of his status would spread around the neighbourhood, he left Nairobi for Kisumu County where his status remains his personal secret.

“I’m now married, but even my wife does not know about my status. I have never even thought of telling her,” he reveals.

To efficiently hide his status, Odhiambo hides the ARVs on the roof of a community toilet and takes them far away from everyone’s eyes.

But that is not shocking enough compared to the extent he is willing to go to hide his true health status. “We do not use condoms because if I do, she will start asking so many

questions, which will lead to revealing my secret. I believe taking the drugs just before having sex is enough protection,” reveals the unfazed Odhiambo.

Odhiambo says were it not for his wife’s death, he would not have gone for testing.
For him, he would rather live not knowing his status rather than knowing and facing stigma and discrimination from the society.

Bernard Mutachi, a community health promoter at Kwa Raila Estate in Kibra says Odhiambo’s case is not isolated as there are many men who will prefer “dying” instead of being tested.

“It is an uphill task to convince a man to go to the hospital to seek medical attention. It is more difficult to convince them to test for HIV. Majority of the men whose wives have tested positive, have totally declined to test,” he reveals.

According to the recently released Kenya Demographic Health Survey 2022, men were less likely to test for HIV/Aids despite the fact that the majority were likely to have multiple sex partners.

The report indicates fewer men, especially those aged between 15 to 24 years have ever tested compared to their female counterparts.

It reveals that 67 per cent of men aged 15 to 19 years have never tested while 27 per cent of those aged between 20-24 years do not know about their HIV status.

Eleven per cent of men aged 25 to 29 have never been tested, 10 per cent of those between 30 to 34 have never tested, while 15 per cent of men aged 40 to 49, have never been tested.

The report further indicates, averagely, 37 per cent of men had sex with a woman who was neither their wife nor living with them.

Despite these glaring facts, Mutachi says there are instances where men have had to run away so as not to be tested.

Pauline Achieng is one woman whose husband disappeared when she mentioned that he was required to go for testing. “I got pregnant and when I went for my first antenatal clinic, I was tested and found to be positive. I came and asked my husband to accompany me to the hospital the next day, as directed by the nurse at the health centre,” she reveals.

It is while queuing and waiting to enter the testing room that the man walked out, never to be seen again.

Rely on wife’s status

“Men are usually accused of bringing the disease home, and so they believe that when they both test positive, they are likely to be accused of sleeping around and eventually infecting the wife,” he reveals.

But despite glaring facts, Mutachi says the ignorance among men is the main reason they cannot test for HIV, as the majority of them rely on the wife’s status.

“Even when the wife tests positive, the majority perceive that as joint results and think there is no need to also do the test. However, while the woman is being put on ARVs, the men are not. And so they continue spreading the virus elsewhere,” he says.

Dr Thomas Nyirenda, the Manager of Strategic Partnerships and Capacity Development for the European and Developing Countries Clinical Trials Partnership (EDCTP) says there are many possible reasons behind the testing disparities between men and women.

“According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2022 report, there are 1.2 million people living with HIV in Kenya. Of that number, 800,000 are women while 150,000 are men. While it might be true that the infections among men are low, it is also possible that men are not testing, because of the existing missing gaps compared to women,” he says.

Nyirenda is also the lead for the International Conference on Public Health (CPHIA) 2023 track on Combating Infectious Diseases, Neglected Tropical Diseases (NTDs) and Antimicrobial Resistance in Africa.
He says while there is need for in-depth research to probe the disparity trends, it is evident that the majority of men have bad health behaviours; they rarely seek medical interventions.

The scientist says the stigma from society and fear of knowing the outcome is the possible major reason why men refrain from testing.

Also, unlike women who are likely to be tested due to their nature, such as during pregnancy, the current health systems do not have such strategies targeting men and, therefore, it is very rare for men to know their status prior.

This is the same case with key populations, such as men having sex with men, who received little attention compared to women.

Nyirenda says the consequences of men not testing will eventually reflect on the number of new infections not only among men, but also among women.

“If we do not tackle issues on HIV testing among men, we will continue to see new cases. The figures will keep rising and we will not be able to bring them down. In this era, we need to bring these cases down,” he notes.

He says men who are not aware of their HIV status will continue spreading the virus to women, and the circle of infection will continue growing bigger, especially due to the economic powers men have in society.

Nyirenda says due to the fact that they are not enrolled to ARVs, their immunity is low and therefore likely to die from opportunistic diseases such as TB, meningitis, among others.

“Men who are high risks such as truck drivers, uniformed personnel are among top spreaders. Sugar daddies are also contributors and, therefore we need to come up with strategies to lure them to testing,” he says.

Identifying groups of men who are high risk will allow coining of specific strategy for specific groups, such as taking testing services closer to their workplaces to the shores if targeting fishermen or military camps if targeting uniformed personnel.

Previously, Gregory Were of National Syndemic Disease Control Council (NSDCC) revealed that while more HIV infections are recorded among women, there were more men dying from HIV and related-illness.

Were says this is basically caused by the fact that men do not go for testing and, therefore, not under ARVs thereby weakening their immunity. “KDHS showed men averagely have seven sex partners and, therefore, they continue to spread the virus,” Were says.

We will be working on implementable proposals targeting men, because it is clear there is a missing link,” says Nyirenda in ending.