Male partner involvement in the prevention of mother-to-child transmission (PMTCT) of HIV: a mixed methods study of the Gokwe North District, Zimbabwe.

Abstract

The aim of this study was to shed insight into male partner involvement in the prevention of mother to child transmission (PMTCT) of HIV programmes in the Gokwe North district in Zimbabwe. The study was motivated by the fact that the number of pregnant women who tested for HIV in the antenatal care centres has been increasing since the inception of PMTCT in the country. Most of the men, however, were not being tested for HIV along with their pregnant spouses, yet the success of the PMTCT programmes was routed in the concerted efforts of both partners. The study utilised mixed research methods: qualitative and quantitative data collection and analysis. The qualitative data came from focus group discussions and key informant interviews and the quantitative data came from a survey, using self-administered questionnaires to collect the data. The use of methodological triangulation enabled the research to benefit from the different strengths inherent in quantitative and qualitative methods in a single study, while at the same time offsetting the biases associated with each of the methods. A total of 331 men and women who had had a child in the last five to 10 years participated in the survey. In addition, eight focus group discussions, seven key informant interviews and eight follow-up interviews were conducted. Studies revealed the benefits associated with male partners’ involvement in PMTCT programmes, yet little is known about their attitudes and the factors influencing their involvement. It was essential to explore the meanings and understandings attached to the concept of male partner involvement as this is likely to have a bearing on the attitudes, behaviours, as well the expectations of the male partners in the PMTCT initiatives. It is widely agreed that the concept of male partner involvement is complex in terms of definition and measurement; literature revealed varying meanings of male partner involvement, as well as the complications associated with measuring it. Male partner involvement was dominantly described as when the male partner accompanied their pregnant spouse to the antenatal care centre for HIV couple counselling and testing. Results show approximately 45.7% of males in the survey had tested for HIV as a couple with partner. The male partner was also expected to test for HIV and disclose their HIV status to their partner. Participants in this study considered counselling sessions provided at the health care centre as crucial, and male partner involvement was seen when the males followed the health care worker’s advice in practising safe sex during breastfeeding and when the appropriate infant feeding practices were adhered to. Inter-spousal communication facilitated male partners’ taking part in PTMCT services. HIV and sexual and reproductive health were identified as sensitive topics which male partners would not feel comfortable discussing in public; hence discussions that couples conducted in private enabled the male partners to cooperate with their partners. Traditional chiefs and village headmen also played a key role in mobilising male partners to take part in HIV intervention programmes, however, challenges such as shortages of male peer educators and the lack of maleoriented services within health care settings were associated with a low uptake of PMTCT services by men. Additionally, due to traditional gender roles that denoted child care as a woman’s role, men who took part in antenatal care activities were stigmatised and labelled as jealous and over-protective, and this further hindered their participation in PMTCT initiatives. The male partner involvement index suggested that the level of male partner involvement was generally high. Using this index, male partner involvement was high (94.6%) among men who accompanied their partners to antenatal care, and relatively high (94%) among men who were counselled on HIV prevention during infant feeding. In addition, HIV testing for males was 88.8%. However, in comparison with qualitative results, male partners were not willing to go for HIV due to various personal, cultural and structural inhibitors. This was reported as one of the major challenges in dealing with HIV prevention. In a traditional setting steeped in culture and gender roles it was challenging to engage male partners in issues of child health care, such as interventions for the prevention of mother-to-child HIV infection. In light of these findings, it was recommended that local organisations collaborate with local traditional leaders in working towards increasing men’s involvement in PMTCT interventions. In order to ensure that male partners took part in PMTCT and that their health needs were addressed in the process; health institutions could provide male-oriented health services within their ANC and PMTCT centres.