Health care facilities have achieved limited HIV testing and treatment coverage in men, with barriers including confidentiality concerns, distance to the facility, inconvenient hours, and perceptions that facilities provide women-centered services. Other barriers to male engagement include stigma, poverty, and feelings of compromised masculinity associated with seeking health care.
Community-based HIV interventions can overcome barriers associated with facilities and increase men’s engagement in care. Social and livelihood interventions can reduce stigma and poverty.
Community-based testing interventions (particularly home and mobile) have high acceptability and reach more men than health care facility-based approaches. For men testing HIV positive, providing immediate antiretroviral therapy (ART) is associated with high retention and viral suppression. This strategy of “collapsing the cascade” provides streamlined services and reduces loss to follow-up.
Community-based interventions should be tailored to the needs of men to maximize uptake, including flexible hours, multiple follow-up visits, and convenient and private access to care. Integrating HIV testing into screening for chronic disease can reduce stigma and increase program efficiency. More research is needed on male-centered approaches to increase men’s engagement in HIV services, particularly later in the cascade. Interventions targeted to men who have sex with men are urgently needed.
The current state of evidence strongly suggests that community-based test-and-treat strategies can reduce the gender disparity in HIV testing and treatment by achieving higher levels of ART coverage and viral suppression in HIV-positive men.
Denial can be very strong in the male mind. Throw in a little machismo, a busy schedule, and one or two more rationalizations, and it's easy to understand why men often avoid or delay seeking medical care. In my 28 years of family practice, I'd estimate that about 75 percent of my adult patients are female.
A man reading with his child on a couch
In fairness to men, they have some legitimate reasons for being less engaged in their health. They don't have a monthly menstrual cycle that puts adolescent girls and women more in touch with their bodies. Young women are also encouraged to begin Pap tests at a young age, and need to see a physician to obtain birth control. Typically, cancer screenings (and cardiac testing) for men don't begin until about age 50.
With males, we often see them as patients when they are children or teens, but the 18 to 30 group don't come in unless they have the flu, an orthopedic injury or are too sick for work. They feel young and strong, almost invincible. Yet despite the feeling of invincibility, a healthy 18 to 30 year old should come in for a physical every two or three years. And if we detect any early signs of disease, they will be asked to follow up more regularly. By age 50, the American Academy of Family Practice recommends annual checkups. As physicians, we always prefer to find things early. Whether it's high blood pressure, elevated blood glucose or an irregular heartbeat, we can minimize the impact and possibly slow the progression of we catch them early.
Since many conditions don't have symptoms in the early stages, we shouldn't wait until we have symptoms to go for a checkup. That might sound like simple advice. Yet for many men, it presents a challenge because they are often no internally motivated to go to the doctor. Usually it takes external prompting from a spouse or significant other to get them to make an appointment.
Sometimes it's okay to wait a few days before deciding to call the doctor's office. If you have cold symptoms, a sore throat, or a mild sprain there is usually no harm in giving yourself a few days. But if you are experiencing chest pains, numbness or blood in your urine, you want to seek care quickly. I have had men come in and tell me they have had concerns or symptoms for months. By putting off going to the doctor, men put themselves at greater risk and might be delaying needed treatment.
You might think that male physicians would know better and seek care in a timely manner. Yet many don't. When I served in the military, I had a mentor who eventually admitted to me that he had been peeing blood for months. He was an experienced internal medical physician who certainly understood that he might have a serious medical condition. Like so many men, he was in denial.
Let Men's Health Month be a reminder to each of us (males) that we should get regular checkups and seek care when we notice symptoms that might indicate a serious medical condition. Don't ignore chest pain, shortness of breath, muscle weakness, a chronic cough or blood in your urine. You will be doing yourself, and those you love, a favor by seeing a physician. If it's not serious, you'll get peace of mind. If it is serious, you will likely have a better outcome because you sought care early.
It's important to remember that these changes will happen differently for each teen. Some teens may experience these signs of maturity sooner or later than others. And being smaller or bigger than other boys is normal. Each child goes through puberty at their own pace.
What changes will happen during puberty?
Sexual and other physical maturation that happens during puberty result from hormonal changes.
In boys, it's hard to know exactly when puberty is coming. There are changes that happen, but they occur slowly over a period of time rather than as a single event.
There are certain stages of development that boys go through when developing secondary sex characteristics. Here is a brief overview of the changes that happen:
In boys, the first puberty change is the enlargement of the scrotum and testes. At this point, the penis does not enlarge.
As the testes and scrotum continue to grow, the penis grows.
The first growth of pubic hair produces long, soft hair that is only in a small area around the genitals.
This hair then becomes darker and coarser as it continues to spread.
The pubic hair eventually looks like adult hair, but in a smaller area. It may spread to the thighs and sometimes up the stomach.
The following changes may also happen to a boy as he goes through puberty:
Body size will increase. Sometimes the feet, arms, legs, and hands may grow faster than the rest of the body. This may cause a teen to feel clumsy.
Some boys may get some swelling in the breast area. This is a result of the hormonal changes that are happening. This is common among teenage boys and is often a short-term or temporary condition. Talk with your son's healthcare provider if this is a concern.
Voice changes may happen, as the voice gets deeper. Sometimes the voice may "crack" during this time. This is a temporary condition and will improve over time.
Hair will start to grow in the genital area. Boys will also have hair growth on their face, under their arms, and on their legs.
As the puberty hormones increase, teens may have an increase in oily skin and sweating. This is a normal part of growing. It's important to wash daily, including the face. Acne may develop.
As the penis enlarges, the teen boy may begin to have erections. This is when the penis becomes hard and erect because it is filled with blood. This is due to hormonal changes and may happen when the boy fantasizes about sexual things. Or it may happen for no reason at all. This is normal.
During puberty, a boy's body also begins making sperm. Semen, which is made up of sperm and other body fluids, may be released during an erection. This is called ejaculation. Sometimes this may happen while the teen is sleeping. This is called a wet dream (nocturnal emission). This is a normal part of puberty. Once sperm is made and ejaculation happens, teen boys who have sex can get someone pregnant.
