BackgroundWhile poor countries have made progress attaining the The Joint United Nations Programme on HIV/AIDS (UNAIDS) goals for 2025, continued progress depends on continued accessibility of program services, as well as continued improvements in compliant behavior by HIV positive populations. This paper examines household survey data in four African countries pertaining to those critical behaviors and identifies the key population barriers for attaining UNAIDS goals. MethodsThis study used Population-based HIV Impact Assessment (PHIA) survey data for Zambia, Malawi, Eswatini, and Tanzania to examine household and other influences associated with effectively managing HIV-infected adults using three key outcomes: (i) self-awareness of HIV status, (ii) antiretroviral therapy adherence, and (iii) rate of viral load suppression (VLS). ResultsFactors found to increase HIV risk also posed barriers to awareness and viral suppression, such as being young, having multiple partners, and having a job outside the home. Additional barriers to awareness and viral suppression were low education, low wealth, low knowledge of HIV, and the HIV status and gender of the household head. The most consistent factor influencing awareness and viral load suppression was the gender of the individual. Women were much more likely to be aware of their HIV status and more likely to be virally suppressed at rates almost twice as high as comparable men. Our analysis shows that the gender differential for awareness seems primarily due the testing and other services provided for women giving birth. We also found that the VLS gender gap was not related birthing-related services. ConclusionsThe most substantial barrier to achieving UNAIDS goals appears to be poorer compliance by men regarding testing and sustained VLS. Routinely providing HIV testing and other HIV information during antenatal care (ANC) may have contributed to improved rates of HIV-status awareness of birthing-age women. New programs to routinely integrate HIV testing into men's health care in workplaces or other settings could improve men's awareness and compliance with treatment. Also needed are more effective interventions to target sectors of the population that are less likely to adhere to treatment regimens, such as persons with low-education levels, low wealth, and/or low knowledge of HIV.This study examines Population-based HIV Impact Assessment (PHIA) household survey data in four sub-Saharan African (SSA) countries to understand the personal, household and community factors that are associated with awareness of human immunodeficiency virus (HIV) status and continued viral load suppression (VLS) among HIV-positive individuals. The Joint United Nations Programme on HIV/ AIDS (UNAIDS) 95-95-95 cascade goals for 2025 depend critically on both accessibility of program activities as well as compliant behavior of households. 1 Specifically, current UNAIDS targets are the following:1. 95% of HIV positive persons should be aware of their positive status. This requires testing and ...