Open Access Open Badges Research article

Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review

Adamson S Muula12*, Thabale J Ngulube3, Seter Siziya4, Cecilia M Makupe5, Eric Umar6, Hans Walter Prozesky7, Charles S Wiysonge8 and Ronald H Mataya9

Author Affiliations

1 Department of Community Health, University of Malawi, College of Medicine, Chichiri, Blantyre, Malawi

2 Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, North Carolina, USA

3 Center for Health and Social Research, Woodlands, Lusaka, Zambia

4 Department of Community Medicine, University of Zambia Medical School, Lusaka, Zambia

5 Department of Population Studies, Chancellor College, University of Malawi, Zomba, Malawi

6 Department of Community Health, University of Malawi,-College of Medicine, Chichiri, Blantyre, Malawi

7 Division of Infectious Diseases, Department of Medicine, University of Stellenbosch, Tygerberg, South Africa

8 UNAIDS, Geneva, Switzerland

9 Department of Global Health, Loma Linda University School of Public Health, Loma Linda, California

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BMC Public Health 2007, 7:63  doi:10.1186/1471-2458-7-63

Published: 25 April 2007



HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men.


A systematic review of the literature was carried out to describe the gender distribution of patients accessing highly active antiretroviral therapy (HAART) in Southern Africa. Data on number of patients on treatment, their mean or median age and gender were obtained and compared across studies and reports.


The median or mean age of patients in the studies ranged from 33 to 39 years. While female to male HIV infection prevalence ratios in the southern African countries ranged from 1.2:1 to 1.6:1, female to male ratios on HAART ranged from 0.8: 1 to 2.3: 1. The majority of the reports had female: male ratio in treatment exceeding 1.6. Overall, there were more females on HAART than there were males and this was not solely explained by the higher HIV prevalence among females compared to males.


In most Southern African countries, proportionally more females are on HIV antiretroviral treatment than men, even when the higher HIV infection prevalence in females is accounted for. There is need to identify the factors that are facilitating women's accessibility to HIV treatment. As more patients access HAART in the region, it will be important to continue assessing the gender distribution of patients on HAART.