Barcelona 2013
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| Abstract #620 - Pregnancy and Childbearing | ||||
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Session: 34.5: Pregnancy and Childbearing (Parallel) on Tuesday @ 14.30-16.00 in Raval Chaired by Victorio Torres, Malega Kganakga Authors: Presenting Author: Miss Annabelle Gourlay - London School of Hygiene and Tropical Medicine, United Kingdom |
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| Additional Authors: Dr. Jordi Casabona, | ||||
| Aim: Partner testing is encouraged in some prevention of mother-to-child transmission (PMTCT) of HIV guidelines in sub-Saharan Africa, although levels of male involvement in PMTCT are still very low and further research is needed on the implementation and effectiveness of this approach. This study explored perceptions and experiences of male involvement in PMTCT services in rural Tanzania from the perspectives of fathers, HIV-positive and HIV-negative mothers, and health providers. | ||||
| Method / Issue: A qualitative study was conducted in 2012 in Kisesa, north-west Tanzania. Participatory group activities were held with 3 male and 3 female groups of community members. In-depth interviews were conducted with 16 HIV-positive and 5 HIV-negative mothers, 3 partners/ relatives of HIV-positive mothers, and 9 health workers and officials. Observations were also made in Kisesa antenatal and child clinics. Data was transcribed, translated (into English) and analysed (using a thematic approach) with the aid of NVIVO 9 software. | ||||
| Results / Comments: Findings show that there is low male involvement in maternal health services in the study area. Lack of partner support was ranked as one of the greatest barriers to using PMTCT services by all three women's discussion groups, and was considered a substantial challenge to delivering PMTCT services by providers. Lack of partner support manifested itself in negative reactions (including disbelief, blame, violence, and abandonment) to a woman's HIV-positive test results, discouragement or controlling actions, or withdrawal of financial support. Male groups recognised the issue, but did not rank it as highly. Lack of partner support impacted negatively on women's clinic attendance, adherence to antiretroviral drugs, place of delivery, and infant care. Support from relatives, friends or health workers often helped women to overcome these barriers. Barriers for men being involved in the PMTCT programme included cultural norms, fear of HIV testing or disclosing results, shame, feeling healthy, lack of time, and facility regulations. Providers suggested, or claimed to be implementing, strategies to increase male involvement such as priority for couples in queues, education, and sensitisation of men towards attending clinics with their wives. Pregnant women regarded involvement of partners in HIV counselling and testing as important, though many had experienced or anticipated refusals. Men generally perceived their involvement in PMTCT as important. Examples of male support during pregnancy, delivery and after birth included encouragement, advice, shared decision-making, reminders (eg. for taking antiretroviral treatment), financial assistance, clinic attendance, and partner HIV testing. | ||||
| Discussion: Lack of male involvement in the study area is determined by community-based factors (social norms, HIV stigma, perceptions about wellbeing) and facility-based factors (such as facility regulations). Solutions must be carefully implemented, taking care not to alienate single mothers, or those whose partners remain uncooperative. Shifting cultural norms around men's participation in maternal health may take a long time, and opportunities exist to capitalise on other sources of support such as relatives. HIV testing and treatment may provide an entry point for men's more supportive and long-term involvement throughout pregnancy, delivery and post-partum. | ||||
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