“The first thing that we did is that we looked at the differences when people enroll. We then said, ok, well, that explains some of it, but it doesn’t explain all of it. We’ve still got this 30 percent difference. Well, could it be because, as many people have suggested, men are more likely to be lost to a program and therefore that they are more likely to be dead. Because there’s a very high risk of death after being lost to a program. And we found that, yes, men were more likely to be lost to our system, but they were not more likely to be dead after being lost to follow-up. So that didn’t explain it. Maybe men are less likely to stick to their treatment? And we found that, in fact, there was absolutely no difference. No gender difference that we could find,” she said.

Researchers looked at other factors, such as whether there was a difference in suppression of HIV while on treatment. No answer was found there either.

“What is it? What could it be? Why? And I actually suddenly thought, well, why else do people die? Why do people die who don’t have HIV? And it was one of those I suppose eureka moments, where you suddenly realize you’ve been thinking inside a little box all this time. And you’ve been looking for all of the reasons within the antiretroviral program. But actually, possibly, the reasons lay outside it,” she said.

What she found was a much broader mystery with some stark facts.

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