Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs

Abstract

This study aimed to describe the prevalence and predictors for male partner participation in HIV voluntary counselling and testing (VCT) at two primary healthcare clinics in Moshi urban, Tanzania as well as the effect of partner participation on uptake of HIV perinatal interventions. Pregnant women (n = 2654) in their third trimester, participating in a prevention of mother to child tranmission (PMTCT) program between June 2002 and March 2004 were encouraged to inform and invite their partners for HIV-VCT. Trained nurses conducted pre-test counselling, interviews, clinical examinations and blood sampling from the participating women and their partners. Test results were presented and post-test counselling was conducted individually or in couples, depending on the wishes of the participants. Three-hundred-and-thirty-two male partners (12.5%) came for HIV-VCT. A high proportion (131; 40%) came after the woman had delivered. HIV-seropositive women whose partners attended were three times more likely to use Nevirapine prophylaxis, four times more likely to avoid breastfeeding and six times more likely to adhere to the infant feeding method selected than those whose partners didn't attend. Women were more likely to bring their partner for VCT if they collected their own test results, were living with their partner, had a high monthly income and had expressed at enrolment the intention to share HIV results with their partner. Although PMTCT programs are presumably a good entry point for male involvement in prevention of sexual and perinatal HIV transmission, this traditional clinic-based approach reaches few men. Given the positive influence male participation has on the acceptance of perinatal interventions, a different approach for promoting male participation in VCT is urgently required. Within PMTCT programs, counseling should emphasize the advantages of partner participation to encourage women to inform and convince male partners to come for VCT. Also, promotion of couple VCT outside antenatal settings in male friendly and accessible settings should be given priority.

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

“…Previous efforts to improve male partner HIV testing through female-delivered invitations for men to test for HIV at antenatal clinics (ANC) have yielded conflicting results [9,10]. In most studies, less than 20% of men invited to ANC honored such invitations, with 20–40% of those honoring the invitations testing for HIV [10,11].…”

‘Unless you come with your partner you will be sent back home’: strategies used to promote male involvement in antenatal care in Southern Tanzania

“…Despite various efforts to promote male involvement, in many low- and middle-income countries, male participation in pregnancy and childbirth matters is disappointingly low [13–16]. For example, a Ugandan study reported that the majority (74%) of respondents had a low male involvement index and only 5% of men escorted their partners to the ANC clinic [13].…”

“…The common barriers include: socially constructed gender roles, lack of knowledge of maternal health matters [13,14,16–19], and health-system-related barriers such as low quality of services and negative attitudes of the health providers [16,17,19–23]. …”

Disclosure, Knowledge of Partner Status, and Condom Use Among HIV-Positive Patients Attending Clinical Care in Tanzania, Kenya, and Namibia

“…19 This proportion has been reported in both the general population and among women and their partners attending antenatal clinics. [20][21][22][23][24] PLHIV with untested partners may be unknowingly in a serodiscordant relationship, placing the HIV-negative partner at high risk for acquiring HIV. Alternatively, the partner may be HIV-positive and in need of HIV care and treatment services for their own health, highlighting the importance of knowing the HIV status of both partners.…”