Reducing the risk of HIV infection during pregnancy among South African women: A randomized controlled trial

Abstract

Mpumalanga Province, South Africa has one of the highest HIV/AIDS diagnosis rates among pregnant women (~29.4%). This study sought to enhance male involvement in pregnancy to increase HIV disclosure, sexual communication, HIV knowledge and reduce unprotected sex. Participants attending Antenatal Clinics (ANC) completed HIV counselling and testing and were enrolled with male partners (n = 239 couples, 478 individuals). Twelve ANCs were randomly assigned to provide a prevention of mother-to-child transmission (PMTCT) intervention or the standard of care, health education sessions plus PMTCT. Participants were assessed at baseline and post-intervention (approximately 6–8 weeks post-baseline) on demographics, sexual behaviour, HIV-related knowledge, and conflict resolution strategies. Experimental participants increased HIV knowledge, use of negotiation, and decreased intimate partner violence. Additionally, they were more likely to have increased condom use from baseline to post-intervention (OR = 5.1, 95% CI = (2.0, 13.3)). Seroconversions in the control condition exceeded experimental (6 vs. 0). HIV serostatus disclosure to partner did not increase over time for men or women within the experimental or control condition. Male involvement in pregnancy may be an important strategy to reduce sexual risk behavior and HIV transmission. Results support the utility of group interventions to enhance communication and HIV knowledge among pregnant couples.

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

“…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).…”

Increasing HIV serostatus disclosure in low and middle-income countries

“…All but one intervention either targeted only women or had a majority of female participants. Five interventions targeted pregnant women [32, 34, 35, 37, 41]; of these, four focused on HIV-positive pregnant women [32, 35, 37, 41], while one included both positive and negative women and their partners [34]. Six interventions targeted HIV-infected adults, including newly diagnosed people living with HIV (PLHIV) [31, 33], HIV-infected women [29, 40], people initiating ART [39], and adults living with HIV generally [36, 38].…”

“…There were three randomized controlled trials (RCTs) [34-36] and five additional studies that included control groups but did not randomize participants to the intervention [32, 37, 39-41]. One study used a cross-sectional design to compare individuals who received the intervention to those who did not [38], while three studies used a before/after design just among intervention participants [29, 30, 42].…”

Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa

“…Limitations of our study include the use of a non-probability sample, which may limit the generalizability of our findings. However, by being community-based, our sample is comparatively more inclusive than the majority of the existing literature on this population (Becker, Mlay, Schwandt, & Lyamuya, 2010; Jones et al, 2013). Second, participant’s HIV serostatus was self-reported.…”