EVIDENCE ALONG THE PATHWAY: WHAT GENDER-RESPONSIVE INTERVENTIONS WORK?

Literature on gender-responsive interventions along the pathway

On the prevention of hypertension through management of overweight/obesity: A systematic review on the management of obesity in men examined gender-sensitive community weight-loss programs implemented in settings such as professional and non-professional sports clubs, workplaces and commercial organisations and leveraged camaraderie and peer support. These interventions were shown to enhance the participation and engagement of men in weight-loss efforts (1).

On the prevention of hypertension through management of smoking: A study on smoking cessation interventions targeting young men found that quit-smoking campaigns that promote quitting as a masculine choice and highlight positive role models, such as involved fatherhood, were effective in encouraging smoking cessation (2).

On the prevention of hypertension through management of alcohol use disorder: a) A study examining gender differences in treatment engagement for alcohol dependence found that while women are generally less likely than men to enter treatment, gender does not significantly predict treatment retention, completion, or outcomes once they are enrolled. This suggests interventions should focus on accessing care in the first place (3). b) A study on residential treatment of alcohol dependence for women with children found that facilities allowing women to participate in treatment with their children improve retention (but not completion) rates compared to programs that do not offer such services (4).

On the prevention of hypertension through management of alcohol use disorder: A study revealed that alcohol dependence treatment programs that incorporate prenatal and childcare, and address co-occurring psychological issues improved outcomes for women seeking care (5).

References

1. Robertson, C., Archibald, D., Avenell, A., Douglas, F., Hoddinott, P., van Teijlingen, E., Boyers, D., Stewart, F., Boachie, C., Fioratou, E., Wilkins, D., Street, T., Carroll, P., & Fowler, C. (2014). Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technology Assessment, 18(35), v–vi, xxiii–xxix, 1–424. https://doi.org/10.3310/hta18350

2. VicHealth. (2017). Young men urged to stop stalling and quit [Press release]. VicHealth. https://www.vichealth.vic.gov.au/media-and-resources/media-releases/young-men-urged-to-stop-stalling-and-quit

3. (a) Green, C. A., Polen, M. R., Dickinson, D. M., Lynch, F. L., & Bennett, M. D. (2002). Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program. Journal of Substance Abuse Treatment, 23(4), 285–295. https://doi.org/10.1016/S0740-5472(02)00278-7

(b) Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., Lincoln, M., Hien, D., & Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21. https://doi.org/10.1016/j.drugalcdep.2006.05.012

4. (a) Brady, T. M., & Ashley, O. S. (2005). Women in substance abuse treatment: Results from the Alcohol and Drug Services Study (ADSS). U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. https://www.ojp.gov/ncjrs/virtual-library/abstracts/women-substance-abuse-treatment-results-alcohol-and-drug-services

(b) Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., Lincoln, M., Hien, D., & Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21. https://doi.org/10.1016/j.drugalcdep.2006.05.012 5. McCrady, B. S., Epstein, E. E., & Fokas, K. F. (2020). Treatment interventions for women with alcohol use disorder. Alcohol Research: Current Reviews, 40(2), 08. https://doi.org/10.35946/arcr.v40.2.08

Literature on gender-responsive interventions along the pathway

On the prevention of HIV/AIDS: Interventions aimed at improving self-efficacy and empowerment for women living with HIV focus on enhancing their ability to make informed sexual and reproductive health decisions. These interventions often include components that address gendered power inequalities in intimate relationships and emphasise negotiation skills with male partners. They highlight the need for female-controlled methods and the inclusion of men in prevention efforts. These interventions aim to shift norms of masculinity towards more gender-equitable attitudes. They have been effective in increasing protective sexual behaviors and preventing partner violence (1).

On diagnosis of HIV/AIDS: A study showed promising results with the use of small incentives to encourage men to test for HIV (2). Cash transfers and other similar social protection interventions also show promise (3).

On diagnosis of HIV/AIDS: A systematic review showed community-based approaches, including home (self-testing or outreach), index, mobile, campaign, and workplace testing, usually outperform facility-based testing in terms of both coverage and uptake. HIV self-testing, as part of community-based interventions, is emerging as a particularly important strategy for increasing men’s access to and uptake of HIV testing (4).

On diagnosis of HIV/AIDS: Studies have shown several models for strengthening facility-based HIV counseling and testing, including linking with men through their partners (either during pregnancy or partner index testing), couples testing, provider-initiated testing and counseling, and improving the involvement of men in prevention of mother-to-child transmission or antenatal services, have shown promising results (5, 6).

On treatment of HIV/AIDS: Developing health services that are more responsive to men’s needs includes creating environments where men feel comfortable and supported in accessing HIV services. Interventions should also focus on reducing practical barriers, such as long wait times, which can deter men from accessing services.Other strategies include offering HIV testing and care in male-centered clinics, workplaces, and sports programs, which are more aligned with men’s lifestyles and can reduce the stigma associated with seeking HIV services (7).

On treatment of HIV/AIDS: A systematic review on gender transformative approaches in HIV management found that an HIV diagnosis can undermine men’s core identities—threatening their sense of self-reliance, strength, sexual success, and social respect. The fear of losing these valued roles, along with the psychological impact of an HIV-positive label and the challenges of seeking treatment, reinforces the need for gender transformative programmes. One study reported that interventions which reestablished traditional masculine roles—emphasizing hard work, the role of provider, committed partnership, and physical strength—were associated with improved adherence to antiretroviral therapy in men (8).

References

1. Gay J, Hardee K, Croce- Galis M, Kowalski S. (2010). What works for women and girls: Evidence for HIV and AIDS interventions. New York: Open Society Institute. https://www.opensocietyfoundations.org/uploads/546b3075-a617-4119-884c-21221544176d/what-works-for-women-and-girls-20100811_0.pdf

2.  Nglazi MD, van Schaik N, Kranzer K, Lawn SD, Wood R,Bekker L-G. An incentivized HIV counseling and testing program targeting hard-to-reach unemployed men in Cape Town, South Africa. J Acquir Immune Defic Syndr 2012; 59: e28–34. DOI: 10.1097/QAI.0b013e31824445f0

3. Toska E, Gittings L, Hodes R, et al. Resourcing resilience: social protection for HIV prevention amongst children and adolescents in eastern and southern Africa. Afr J AIDS Res 2016; 15: 123–40. DOI: 10.2989/16085906.2016.1194299

4. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature 2015; 528: S77–85. DOI: 10.1038/nature16044

5. Yeganeh N, Simon M, Mindry D, et al. Barriers and facilitators for men to attend prenatal care and obtain HIV voluntary counseling and testing in Brazil. PLoS One 2017; 12: e0175505. https://doi.org/10.1371/journal.pone.0175505

6. Cherutich P, Bunnell R, Mermin J. HIV testing: current practice and future directions. Curr HIV/AIDS Rep 2013; 10: 134–41.

6. Colvin C. J. (2019). Strategies for engaging men in HIV services. The lancet. HIV, 6(3), e191–e200. https://doi.org/10.1016/S2352-3018(19)30032-3 7. Sevelius JM, Dilworth SE, Reback CJ, Chakravarty D, Castro D, Johnson MO, McCree B, Jackson A, Mata RP, Neilands TB. Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV. J Acquir Immune Defic Syndr. 2022 Aug 15;90(5):508-516. doi: 10.1097/QAI.0000000000003014. Epub 2022 Mar 5. PMID: 35502891; PMCID: PMC9259040. DOI: 10.1097/QAI.0000000000003014

Literature on gender-responsive interventions along the pathway

Overweight/obesity as a risk factor for diabetes among women: Studies show that women, especially from minority groups, often face unique sociocultural barriers in diabetes management. Culturally adapted interventions that consider specific dietary habits, family roles, and community dynamics have successfully enhanced engagement and improved health outcomes among women (1).

Overweight/obesity as a risk factor for diabetes among men: An extensive series of reviews on the management of obesity in men found that integrating physical activity into weight‐loss programs yielded greater benefits compared with women. Reducing diets produced more favorable weight loss than exercise alone (mean weight change at one year: –3.2 kg, 95% CI –4.8 kg to –1.6 kg), irrespective of the specific diet type. The review highlighted that men respond best to interventions offering clear, fact‐based guidance and a strong emphasis on physical activity, delivered in social rather than traditional healthcare settings. Group‐based programs, which leveraged peer support among men with similar health challenges, along with individualized advice, enhanced engagement and outcomes. Moreover, programs set in a sporting context—where camaraderie and a sense of affiliation were prominent—demonstrated low dropout rates and high satisfaction (2).

Overweight/obesity as a risk factor for diabetes among men: A systematic review on gender-sensitive interventions indicates that men face a slightly higher global risk of diabetes, with diagnoses occurring at younger ages and at lower levels of overweight or obesity. In Scotland, a weight-loss and healthy living program—designed around a social identity approach and delivered through football clubs—demonstrated notable success. In a pragmatic randomized controlled trial, the intervention group lost nearly 5 kg more over one year compared with the control group. Additionally, participants experienced significant reductions in blood pressure and body fat percentage, along with improvements in diet and overall quality of life. Such male-specific initiatives offer promising strategies for addressing obesity among men, particularly given their under-representation in traditional, gender-sensitive weight-loss programs (3).

Smoking as a risk factor for diabetes. A study on smoking cessation interventions targeting young men found that quit-smoking campaigns that promote quitting as a masculine choice and highlight positive role models, such as involved fatherhood, were effective in encouraging smoking cessation (4).

References

1. Harreiter J, Kautzky-Willer A. Sex and Gender Differences in Prevention of Type 2 Diabetes. Front Endocrinol (Lausanne). 2018 May 4;9:220. doi: 10.3389/fendo.2018.00220. PMID: 29780358; PMCID: PMC5945816. DOI: 10.3389/fendo.2018.00220

2. Robertson C, Archibald D, Avenell A, Douglas F, Hoddinott P, van Teijlingen E, Boyers D, Stewart F, Boachie C, Fioratou E, Wilkins D, Street T, Carroll P, Fowler C. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess. 2014 May;18(35):v-vi, xxiii-xxix, 1-424. doi: 10.3310/hta18350. PMID: 24857516; PMCID: PMC4781190. DOI: 10.3310/hta18350

3. Hunt K, Wyke S, Gray CM, Anderson AS, Brady A, Bunn C, et al. A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial. Lancet (2014) 383(9924):1211–21. doi:10.1016/S0140-6736(13)62420-4. DOI: 10.1016/S0140-6736(13)62420-4

4. Quit Victoria. (2017, April 10). Young men urged to stop stalling and quit [Media release (https://www.cancervic.org.au/about/media-releases/2017-media-releases/april-2017/young-men-urged-to-stop-stalling-and-quit.html.)