Gender Disparities in Late Presentation and Survival among HIV Patients on Antiretroviral Therapy in Public Health Facilities of Arba Minch Town, Southern Ethiopia: Eight Years Retrospective Cohort Study

Abstract

Background: There is a conflicting report about gender-related differences in enrolment and survival both in developed and developing countries. Where differences have been reported in resource poor countries particularly in Ethiopia, evidences showing the effect of gender in presentation to care and survival of peoples on an antiretroviral therapy are not well studied. Objective: To assess gender disparity in presentation for HIV/AIDS care and survival among patients on antiretroviral therapy (ART) in Arba Minch town, Southern Ethiopia. Methods: A facility based - retrospective cohort study design was carried out. By using simple random sampling method a total of 520 subjects were included in the study. Gender differences in presentation to HIV/AIDS care and survival was assessed using data from medical records of patients. Focus group discussion was also conducted for a better understanding of reasons for late presentation to HIV/AIDS care. Survival analysis and Kaplan-Meier test was used to see the association of variables with time of ART initiation and follow up. Life table and log rank test was used to compare survival curves. Cox proportional-hazards regression model was used to compare independent determinants of time to death between male and female. Results: A total of 520 HIV infected patients who were on highly active antiretroviral therapy (HAART) in the antiretroviral therapy clinic of Arba Minch hospital and health centre from Feb.1, 2006 to Jan.30, 2014 were included in the analysis. Men initiated ART with lower CD4 cell counts compared to women (median baseline CD4 175 cells/mm3, inter quartile range (IQR): (130-201) versus 181 cells/mm3, inter quartile range (IQR): 146–247, P-value < 0.009). Substance abuse, fear of stigma and low awareness to HIV/AIDS were among the reasons that lead men to initiate ART late. Men were at an increased risk of death compared to women (adjusted hazard ratio: 2.05, 95% CI: 1.33–3.15 at P-value < 0.001). Conclusion and recommendation: In this study there is a marked increase in risk of mortality for men than women and it might be attributed to their late engagement in to HIV/AIDS care. Therefore, more effort is required to engage men in HIV/AIDS care in a timely manner.