Missed doses also increase drug resistance – a serious threat in the fight against HIV, particularly in Africa’s poorest countries, where treatment options are limited.
It also means thousands of men go without knowing their status, or without facing up to it.
“Most of the men who test positive are usually only picked up in the ward, because they are already in the hospital sick,” Jacqueline explained.
*Manisha, a 32-year-old woman who tested positive last September, told The Telegraph that her marriage ended when her husband learned of her HIV status.
Weighing just 38kg, she walks four hours each way to the clinic. “I’d like to take the mini-bus, but it costs 2,500 kwacha [$1.44],” she said.
Manisha doubts she’ll remarry due to her diagnosis, despite the fact her daily medication means she cannot pass the virus on.
Part of the stigma attached to an HIV diagnosis is its financial consequences, a major factor in why men might choose to leave their wives if they test positive so they don’t have to economically support them.
Men avoid hospital – until they get really sick
Though treatment for HIV/AIDS is free, there are steep costs attached to the management of the disease.
In Malawi, a visit to an HIV clinic costs around $2.15 for transport alone – more than double most daily wages.
For those who cannot afford it, journeys on foot, often lasting days, not only mean a loss of income but the added expense of essentials, like food, along the way.
To add insult to injury, Malawi’s under-resourced healthcare system relies on ‘guardians’ – friends or family who care for patients’ basic needs during hospital stays.
Without a guardian, a patient’s most basic needs – including being fed – won’t be met, meaning guardians must sacrifice days or even weeks off work to care for a family member.
The Telegraph saw hundreds of guardians camped outside of Nkhoma, many begging passers-by for food to feed their loved ones.
For men, they might avoid testing or treatment because of the knock-on effects on employment. “Sometimes the assumption is that people with HIV are too weak to work,” a student health worker at Nkhoma said.
“It’s really difficult for the men to open up and come to the hospital until they get really sick,” Jacqueline added.
The Telegraph only saw one male patient over two days at Nkhoma.
Jacqueline said this is common. In some of her rural outreach clinics, the divide between female and male patients can be upwards of 90/10.