Male involvement in PMTCT remains low in Africa

Lazarus Sauti

Male involvement in prevention of mother to child transmission (PMTCT) of HIV and Aids remains very low in African countries, underscoring the need to develop plans, strategies as well as policies to trigger participation.

Low involvement of men in health issues and PMTCT programmes lessens the chances of women engaging with prevention of mother to child transmission services, says the World Health Organisation (WHO), a specialised agency of the United Nations (UN) that is concerned with international public health.

“Lack of partner support reduces the likelihood of women engaging with services and makes it difficult to adhere to PMTCT guidance,” the international health organisation noted in a 2014 research.

The WHO adds: “Non-disclosure makes it more difficult for women to adhere to prevention of mother to child transmission guidance, as opposed to situations where partners are aware.”

Dr Frida Mokiti, Tanzanian physician, concurs: “Lack of male involvement in prevention of mother to child transmission programmes is a key barrier to uptake and retention in care.

“When male partners are involved in PMTCT education and counseling, they listen carefully, understand the instructions and are therefore able to support their partners’ efforts to protect their babies from HIV infection, even going as far as suggesting condom use.”

Head of Communication and Knowledge Management for Southern Africa HIV and Aids Information Dissemination Service (SAFAIDS), Tariro Makanga says that men’s support in most African states is limited due to how the prevention of mother to child transmission programmes were introduced.

“PMTCT was designed with women in mind than men,” she said.

She added that the gap is also created due to social and cultural practices where men are not expected to play any role in child birth.

The World Health Organisation (WHO) notes that barriers to men’s participation include fear of knowing one’s status, stigma and discrimination.

The WHO also said perhaps the most significant obstacles are the conceptual and policy barriers that inadvertently support men’s exclusion from PMTCT and other reproductive health services.

“The historic institutionalisation of reproductive health as women’s health has contributed to men’s perception of clinic spaces as “women’s spaces”, and reproductive health as women’s work, and has generally produced health services that are not welcoming of men and couples,” added the WHO.

However, in a research paper titled “Male Partners’ Involvement in the Prevention of Mother-to-Child Transmission of HIV and Associated Factors in Arba Minch Town and Arba Minch Zuria Woreda, Southern Ethiopia”, Marelign Tilahun and Shikur Mohamed, note:

“Male partners play a role not only in women’s risk of acquiring HIV, but also in terms of her utilisation of the PMTCT programme: for the mother to test for HIV, for the mother to return for the result, for the couple to use condoms, for the mother to receive medication, and for her to follow the infant feeding advice given.”

Julie Karfakis, Global Health Corps Fellow, mothers2mothers – a nonprofit organisation that trains, employs and empowers mothers living with HIV as Mentor Mothers to be part of health care teams at understaffed health centers, urges men to be involved in PMTCT programmes as “there is considerable evidence that a male partner’s involvement in a woman’s pregnancy and HIV treatment can help her stay in treatment and have a healthy, HIV-free baby.”

She added: “Benefits of male involvement in prevention of mother to child transmission include increased communication between partners about HIV and its risks, as well as increased contraceptive use.

“Men who are supportive make it easier for their partners to seek treatment, stay in care and adhere to medical regimens; additionally, men’s involvement in PMTCTC positively impacts infant feeding practices and decreases infant mortality.”

Karfakis also said educating male partners about HIV in general and how it is transmitted is essential to successful, long-term approaches to eliminating HIV/AIDS.

“Educating men about HIV in general as well as involving them in PMTCTC can be an effective tool towards reducing the risks of vertical transmission and infant mortality by more than 40 per cent compared with no involvement,” she said.

To increase male involvement in PMTCT, Tilahun and Mohamed urge government sectors in Africa to improve geographical accessibility of health facility as well as male’s knowledge on PMTCT.

Zimbabwe Association of Doctors for Human Rights chairperson, Dr Rutendo Gwendoline Bonde, says there is need for mindset change.

She believes African governments as well as institutions that provide health care, whether private or public, must do away with patriarchal perceptions and view men as constituent parts of reproductive health policy.

“Most policies reflect patriarchy, but it is time society sees men as partners as well as agents of change when it comes to PMTCT programmes. A radical re-orientation is, therefore, needed,” said the medical practitioner.

Echoing same sentiments, Makanga says all stakeholders must promote open conversations about gender roles as well as male involvement in PMTCT.

She believes traditional leaders can play a crucial role in encouraging men to become involved in their partners’ care, a notion supported by the national co-ordinator for PMTCT and Pediatric HIV care and treatment in the ministry of Health and Child Care in Zimbabwe, Angela Mushavi.

Mushavi said that there is need to strategise and increase male participation in PMTCT programmes, and engaging traditional leaders is necessary to secure the support of men.

“Traditional leaders are critical stakeholders in the fight against HIV as they are integral in mobilising, raising awareness and encouraging people in their communities to take up HIV testing,” said Mushavi.

Sally Dura, a gender expert and women’s right activist, believes there is need for research to ascertain the perceptions, challenges and barriers to men’s active and full participation in PMTCT programmes.

She added: “Governments and other stakeholders should continue advocating that the title be “Prevention of Parent to Child Transmission” not “Prevention of Mother to Child Transmission”.

In order to eliminate pediatric AIDS, effective strategies that include men must be identified and put into action in all African countries.

Government sectors must also conscientise men for them to realise that efforts to protect children from HIV infection keep families healthy, both in their own homes as well as in the continent as a whole, and succeeding in this endeavor cannot be the responsibility of women alone, but requires their participation as well.