Mistrust in marriage-Reasons why men do not accept couple HIV testing during antenatal care- a qualitative study in eastern Uganda

Abstract

BackgroundA policy for couple HIV counseling and testing was introduced in 2006 in Uganda, urging pregnant women and their spouses to be HIV tested together during antenatal care (ANC). The policy aims to identify HIV-infected pregnant women to prevent mother-to-child transmission of HIV through prophylactic antiretroviral treatment, to provide counseling, and to link HIV-infected persons to care. However, the uptake of couple testing remains low. This study explores men's views on, and experiences of couple HIV testing during ANC.MethodsThe study was conducted at two time points, in 2008 and 2009, in the rural Iganga and Mayuge districts of eastern Uganda. We carried out nine focus group discussions, about 10 participants in each, and in-depth interviews with 13 men, all of whom were fathers. Data were collected in the local language, Lusoga, audio-recorded and thereafter translated and transcribed into English and analyzed using content analysis.ResultsMen were fully aware of the availability of couple HIV testing, but cited several barriers to their use of these services. The men perceived their marriages as unstable and distrustful, making the idea of couple testing unappealing because of the conflicts it could give rise to. Further, they did not understand why they should be tested if they did not have symptoms. Finally, the perceived stigmatizing nature of HIV care and rude attitudes among health workers at the health facilities led them to view the health facilities providing ANC as unwelcoming. The men in our study had several suggestions for how to improve the current policy: peer sensitization of men, make health facilities less stigmatizing and more male-friendly, train health workers to meet men's needs, and hold discussions between health workers and community members.ConclusionsIn summary, pursuing couple HIV testing as a main avenue for making men more willing to test and support PMTCT for their wives, does not seem to work in its current form in this region. HIV services must be better adapted to local gender systems taking into account that incentives, health-seeking behavior and health system barriers differ between men and women.

Pregnant women's experiences of male partner involvement in the context of prevention of mother-to-child transmission in Khayelitsha, South Africa

“…The high reported levels of HIVrelated communication are encouraging and suggest the normalisation of HIV (Zuch & Lurie, 2012). Consistent with previous published research, we observed higher levels of MPI among participants who reported higher levels of communication with partners (Ditekemena et al, 2012;Kalembo et al, 2012;Reece et al, 2010) and stable relationship status (Ditekemena et al, 2012;Larsson et al, 2010;Morfaw et al, 2013). The high reported levels of MPI overall indicate that gender norms may be shifting, with men becoming more involved in pregnancy.…”

“…Discussion around antenatal care and pregnancyrelated financial support, however, was reported as the most prevalent form of involvement, as observed in other contexts (Byamugisha et al, 2010;Nkuoh et al, 2010). Being able to attend antenatal visits depends on a variety of factors (Montgomery et al, 2011), and our research found that men who were forced to wait outside questioned the necessity of accompanying their partners to the clinic, as reported elsewhere (Larsson et al, 2010). Given these constraints, interventions to increase MPI in pregnancy more generally may be more beneficial than attempting to increase rates of male attendance at antenatal visits (Jones et al, 2013).…”

“…Documented barriers to MPI include poor communication within couples (Ditekemena et al, 2012;Kalembo, Yukai, Zgambo, & Jun, 2012;Reece, Hollub, Nangami, & Lane, 2010), less stable relationship status (Larsson et al, 2010;Morfaw et al, 2013) and traditional gender roles (Nkuoh et al, 2010;Reece et al, 2010;Theuring et al, 2009), including the belief that antenatal care is purely a women's responsibility.…”

Couple VCT clients in Ethiopia: A heterogeneous HIV risk group

“…In the Tanzanian randomized VCT study, there were significant differences between women assigned to couple VCT who completed it and those who did not, and the authors attributed the higher rates of risk reduction in the couple VCT arm to its selectivity of committed individuals (Becker et al, 2010). Likewise, in a qualitative study, Ugandan men believed that couple VCT participants had solid, caring relationships (Larsson et al, 2010), which is likely the type of relationship needed to implement risk reduction strategies. Couple counseling is also selective in that both partners have to be available at the same time to use the service.…”

“…Couple counseling is also selective in that both partners have to be available at the same time to use the service. Job responsibilities or time constraints can make this difficult for some couples (Kebaabetswe et al, 2010;Larsson et al, 2010;Mlay, Lugina, & Becker, 2008).…”