Consequences of male partner engagement policies on HIV care-seeking in three African countries: Findings from the SHAPE UTT study

Abstract

We explored how strategies to promote male partner engagement influenced HIV care-seeking among men and women living with HIV. Indepth interviews were conducted with 25 health workers, 66 female service users and 10 male partners in Ifakara (Tanzania), Karonga (Malawi) and uMkhanyakude (South Africa) to elicit experiences of offering, providing or receiving HIV care in the context of antenatal care. Data were coded inductively and analysed thematically. Participants reported benefits of couple testing during antenatal care, including facilitated HIV status disclosure and mutual support for HIV care-seeking. However, unintended consequences included women attending without partners, being refused or delayed access to antenatal services. Some women were required to obtain letters from village leaders to justify the absence of their partners, again to delaying or disrupting care-seeking. When partners attended antenatal care, consultations were reportedly more likely to focus on HIV testing, and less on antenatal or neonatal care. Strategies to increase men's attendance at HIV clinics with their partners can promote mutual support within couples for HIV care engagement, but may risk undermining engagement in pregnancy and HIV care for some women if over-stringently applied. Efforts are needed to address the underlying pervasive stigma associated with HIV care, both alone and as a couple.

Male engagement guidelines in antenatal care: unintended consequences for pregnant women in Tanzania

“…Our study supports others in raising questions about whether male engagement is being used to its full advantage of bringing in men as partners in maternal health [19]. Several women in our study expressed dissatisfaction with the extent to which their partners were engaged in their ANC.…”

“…These unintended consequences could outweigh the benefits that male engagement in ANC is meant to offer. This study adds to evidence that the implementation of male engagement in ANC in Tanzania could create inequities in care and disadvantage women who are not in stable relationships [19,20,22,30].…”

“…While the benefit of male engagement has been demonstrated, there is also emerging evidence that policies that enforce male engagement can have unintended consequences. Studies from East Africa suggest that the engagement of male partners in ANC may have a negative impact on women's access to ANC services due to strategies used to implement the policy, such as denying care for women without partners and preferential treatment for women accompanied by partners [19][20][21][22]. Within the context of Tanzania's national guidelines on male engagement, the objective of this paper is to explore how male partner engagement in ANC impacts women's decision making to present to ANC, and their subsequent experience in ANC in urban health facilities in northern Tanzania.…”

Co-creation of HIVST delivery approaches for improving urban men’s engagement with HIV services in eThekwini District, KwaZulu-Natal: nominal group technique in intervention development

“…There are substantial gaps in HIV service use and coverage for men and boys in South Africa [ 7 ]. There is evidence to suggest that, overall, men have lower levels of engagement and retention in HIV care [ 8 , 9 ] and higher mortality on ART than women [ 10 ]. The observed differences in mortalities may be best explained by background differences in mortality between men and women may be related to other factors including men’s poor usage of facility-based health services.…”

Understanding the health systems impacts of Universal Test and Treat in sub-Saharan Africa: The Shape UTT study

“…In the fourth article Dube and colleagues examined the consequences of male partner engagement in the context of Option B+ in the three countries (Dube et al, 2020). They reported that couple's testing facilitated HIV status disclosure and promoted HIV care-seeking.…”