Feb 13

Involving Men in PMTCT

One of the most important steps in creating an AIDS-free generation is the prevention of mother-to-child transmission of HIV, referred to as PMTCT. Mother-to-child transmission of HIV can occur during pregnancy, delivery, or breastfeeding. Without the proper treatment, about 15 to 30 percent of infants may become infected during pregnancy or labor, and 5 to 20 percent may later become infected through breastfeeding.

In 2010, studies found that nearly 390,000 children under the age of 15 had become infected with HIV, largely due to mother-to-child transmission. However, with proper prevention, the rate of transmission can drop from 15 to 45% down to less than 5%.  Prevention plans can occur on multiple levels, using medication, counseling, and psychological support for mothers. Despite the availability of these programs, organizations and hospitals have found a low response and retention rate. Many women fail to get tested to see if they qualify for the PMTCT services, and of those that do, few actually participate in the full treatment cycles. In examining the possible reasons for the low completion rates, some studies suggest that the answer can be found in the limited male partner involvement.

In Ethiopia, nurses find that less than 10% of pregnant women attend with their partners. However, a 2010 study found that male partner involvement reduced the chances of MTCT by 40%. Some suggest that the largest problem is getting women tested in the first place. In regions where the male partner may control important family decisions such as medical care, women are unable or unwilling to determine if they require PMTCT services without partner consent. And those who do manage to obtain testing without consent are faced with difficult task of hiding a diagnosis and taking medications without the knowledge of their partners. As a result, women may have a hard time following through on medical treatments. A further problem lies in the lack of knowledge surrounding the importance of PMTCT. If male partners are unaware of the necessity for these services, then they will be much less likely to support the extra expense or efforts.

In a new push by the Ethiopian government, several different treatment programs are being offered, with the goal of reaching more women, and ensuring that those women stay in the treatment programs. As part of their new efforts, the government will employ “health development armies” or community groups that will work to convince the public of the need for testing and help create support for PMTCT in both men and women.

While male involvement in PMTCT is an increasingly popular aim of prevention programs, some suggest that there may be downsides to male involvement. In some cases, having a partner involved may be dangerous for women. While some studies have reported positive support from male partners, others also find increased domestic abuse. In relationships where the male is HIV-negative and the woman HIV-positive, chances of mistreatment, discrimination, and abandonment are much higher. As a result, women may be wary of involving their partners, out of fear of the potential fallout. In some cases, nurses report women abandoning treatment when told to bring their husbands in. Further, having both partners present during treatment and counseling sessions may lead to a lack of disclosure about crucial medical information, such as histories of sexually transmitted diseases.

Does this mean that the new movement towards male involvement is misguided? While studies have documented the potential benefits of having both partners working together, there’s also a chance that women will face discrimination and abuse from their partners and families. Some organizations suggest that finding a way to involve men and still protect women provides the greatest chance of a positive outcome. Health clinic can find ways to integrate men more fully in the antenatal clinics, providing clear information that targets a male audience, and becoming more sympathetic to the needs and concerns of men. Peer health groups have also proven effective in ensuring greater male support. Discussing the importance of treatment with other men in a similar situation has helped to convince more men to join the PMTCT programs. While these programs in no way prevent abuse or erase stigma, they do increase the chances that women and infants will be able to get the treatment they need.

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