After a 24-fold surge in HIV cases over 35 years, The Gambia has reached a pivotal “controlled decline” in its epidemic, with AIDS-related deaths now surpassing new infections for the first time. However, a major new study led by Gambian-born US-based epidemiologist Dr. Amadou Barrow warns that deep gender gaps—particularly men’s poor engagement in care—could derail the country’s path to ending AIDS by 2030.
Published in BMC Infectious Diseases, the comprehensive analysis tracks the HIV epidemic from 1990 to 2024 using UNAIDS data. People living with HIV (PLHIV) rose dramatically from about 1,035 in 1990 to over 25,000 in 2024, while adult prevalence settled at around 1.3%. The epidemic has become increasingly feminized, with women now comprising 61% of cases and the female-to-male prevalence ratio climbing from 1.06 to 1.57.
Dr. Barrow, a researcher at the University of Florida, described the findings as a historic turning point tempered by fragility. “Deaths exceeding new infections mark real progress driven by treatment scale-up, but the gains remain uneven and vulnerable to reversal,” he noted.
The study’s most alarming revelation is the pronounced “male disadvantage” across the HIV treatment cascade. Overall, only 64% of PLHIV are diagnosed, 44% are on antiretroviral therapy (ART), and 35% are virally suppressed—far short of UNAIDS 95-95-95 targets. The widest gap appears at treatment initiation: while 76-77% of diagnosed women start ART, just 51.5% of diagnosed men do. Men also lag behind women in diagnosis (53% vs. 72%) and overall ART coverage (27% vs. 55%).
“Women are entering care more effectively through antenatal services, but men are being left behind,” Dr. Barrow explained.
“This bottleneck leaves thousands of fathers, brothers, and sons undiagnosed or untreated, perpetuating transmission and driving higher mortality.”
Projections to 2030 paint a clear picture of a crossroads. Under the current trajectory, new infections would fall modestly to around 1,055. An optimistic scenario with 10% annual improvements in service delivery could prevent over 1,374 new infections and roughly 1,000 deaths. A pessimistic scenario, however, warns of a 13% rise in infections.
To close the gap, the researchers recommend urgent male-focused strategies: workplace and community-based testing, HIV self-testing kits, same-day ART initiation, and outreach beyond clinic walls. Gender-stratified monitoring and tackling barriers such as stigma, work-related mobility, and socioeconomic challenges are also critical.
Dr. Barrow, who maintains deep connections to The Gambia while conducting research in the United States, emphasized: “Male engagement is not a side issue—it is the key to accelerating progress and ensuring no one is left behind in our national and global fight against HIV.”
The full open-access paper is available here: https://link.springer.com/article/10.1186/s12879-026-13115-x.
Health authorities in The Gambia are expected to examine the recommendations as they update national strategies. With focused action on men’s health, the country could turn fragile gains into sustainable epidemic control.
