The male partners of adolescent girls and young women in eSwatini (Swaziland) and South Africa report substantial HIV risk behaviours, but the data also challenge the stereotypical image of a ‘sugar daddy’. The men were only a few years older than their partners and many described challenging life circumstances such as unemployment, homelessness and violence.
A parallel, qualitative study from Uganda describes a somewhat different situation, with men often acting as economic providers in relationships of a relatively long duration. These three studies have recently been published in PLOS ONE and presented at this summer’s International AIDS Conference (AIDS 2018) in Amsterdam.
In many African countries, rates of new HIV infections among females aged 15 to 24 are much higher than among their male peers. Unequal power dynamics in sexual relationships with male partners, especially older partners, contribute to this vulnerability. However, older male partners have often been seen as a ‘hidden’ or ‘hard to reach’ population. Until now, most researchers have asked women about their partners, rather than conducting research directly with men.
The US President’s Emergency Plan for AIDS Relief (PEPFAR) therefore created the DREAMS partnership. It aims to reduce HIV infections among adolescent girls and young women in ten sub-Saharan African countries with interventions that go beyond the health sector, addressing structural factors such as poverty, education and gender inequality.
The partnership includes research to better understand the characteristics of older male partners and identify settings in which they can be reached. DREAMS will try to improve these men’s engagement with HIV services. A higher uptake of HIV testing in men, and antiretroviral therapy for the HIV positive, may lower their risk of passing HIV on to young women.