Men are the hidden link in the spread of AIDS, and Africa faces a fatal gap.

Written by: Mohammed Omran

As medical efforts accelerate in the south Africa To combat HIV through advanced preventive treatments such as “Linakapavir”, the biggest challenge remains outside laboratories and clinics. While the most vulnerable groups are targeted with precise prevention programs, a hidden gap appears in the health landscape represented by a group of men who do not have easy access to services, despite their pivotal role in the chain of transmission of infection.

Men are the hidden link in the spread of AIDS, and Africa faces a fatal gap.

This gap is not only related to a lack of knowledge, but also to the mobile nature of work, complex social patterns, and difficulty accessing healthcare where they are located, making combating the virus more complicated than simply providing effective medication.

The first shipment of linacabavir, a long-acting injection that protects against HIV with two doses per year, arrived in South Africa from the United States in early April 2026. Clinical trials have shown efficacy close to 100%, and the drug is expected to be rolled out in June 2026, with priority given to adolescent girls and young women, pregnant and breastfeeding women, transgender people, sex workers, men who have sex with men, and people who inject drugs.

A hidden gap in prevention is undermining efforts to combat HIV.

These are the priority population groups in the initial phase, but one group that is still frequently overlooked is adult men working in mobile, male-dominated sectors, such as construction, who move between work sites and home, and between long-term relationships and casual or paid relationships.

In epidemiology, this category is called the “intermediate category,” a category whose sexual networks connect the higher and lower categories of virus transmission.

In 2017, the Joint United Nations Programme on HIV/AIDS (UNAIDS) highlighted this problem in its report “Blind Spots,” explaining that men in sub-Saharan Africa are less likely than women to get tested and treated, and are more likely to die from AIDS-related illnesses.

A 2022 meta-analysis of 168 studies also confirmed that men remain the weakest link in the HIV healthcare chain, and that the situation in South Africa, which has the highest burden of infections in the world, remains worrying, as they have lower rates of testing and treatment compared to women, and higher HIV-related death rates by 27%.

For decades, awareness campaigns in South Africa have focused on raising awareness, and have been very successful; studies show that most workers are well aware of how the virus is transmitted and the role of condoms, but the main problem is that this awareness does not always translate into consistent preventive behavior.

Researchers have been working since 2008 to study HIV-related behaviors in the South African construction sector, focusing on the psychological and social aspects of the disease. The construction sector, like the transport and mining sectors, is highly masculine and constantly mobile, with workers spending long periods away from their families, creating a complex environment for social and sexual relationships.

Studies have shown that condom use varies depending on the type of relationship; its use increases with casual relationships and sex workers, while it decreases with permanent partners. The decisive factor in use is not knowledge, but rather the sense of ability to make decisions and the level of risk awareness.

In the latest studies, it was observed that men’s attitudes towards condoms and their awareness of their ability to use them were more influential than mere awareness. This group often uses contraception in unstable relationships, but reduces its use within long-term relationships, even though this pattern increases the likelihood of transmission without direct awareness.

Evidence suggests that unstable relationships, particularly between migrant workers and their partners, contribute significantly to higher rates of virus transmission, as the virus may spread from casual relationships to permanent partners without either party being aware of it.

Social factors also play an important role, as the use of condoms within marriage or stable relationships may be associated with negative connotations such as infidelity, making negotiation about it difficult and sometimes leading to silence despite the existence of real health risks.

Studies also show that the age gap between young women and their older partners increases the likelihood of infection, due to the imbalance of power and the difficulty of negotiating protective measures.

In the context of introducing Linacabavir, experts emphasize that the success of any preventive program depends not only on the groups that are targeted, but also on the groups that transmit the infection without being within the scope of direct targeting.

While policies focus on the most vulnerable groups, men in the mobile sectors remain an invisible link in the transmission chain, despite their pivotal role in the spread of the virus.

Therefore, researchers suggest expanding prevention services to include men’s workplaces such as construction sites and transportation hubs, as well as including this group in national prevention strategies, as a key element in breaking the chain of transmission.

The report concludes that any strategy to combat HIV will remain incomplete unless it addresses the “hidden transmission chains” of infection, and not just the groups most visible in health plans.