Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators

Abstract

BackgroundMany reports point to the beneficial effect of male partner involvement in programs for the prevention of mother-to-child-transmission (PMTCT) of HIV in curbing pediatric HIV infections. This paper summarizes the barriers and facilitators of male involvement in prevention programs of mother-to-child-transmission of HIV.MethodsWe searched PubMed, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published in English from 1998 to March 2012. We included studies conducted in a context of antenatal care or PMTCT of HIV reporting male actions that affected female uptake of PMTCT services. We did not target any specific interventions for this review.ResultsWe identified 24 studies from peer-reviewed journals; 21 from sub-Saharan Africa, 2 from Asia and 1 from Europe. Barriers to male PMTCT involvement were mainly at the level of the society, the health system and the individual. The most pertinent was the societal perception of antenatal care and PMTCT as a woman’s activity, and it was unacceptable for men to be involved. Health system factors such as long waiting times at the antenatal care clinic and the male unfriendliness of PMTCT services were also identified. The lack of communication within the couple, the reluctance of men to learn their HIV status, the misconception by men that their spouse’s HIV status was a proxy of theirs, and the unwillingness of women to get their partners involved due to fear of domestic violence, stigmatization or divorce were among the individual factors.Actions shown to facilitate male PMTCT involvement were either health system actions or factors directly tied to the individuals. Inviting men to the hospital for voluntary counseling and HIV testing and offering of PMTCT services to men at sites other than antenatal care were key health system facilitators. Prior knowledge of HIV and prior male HIV testing facilitated their involvement. Financial dependence of women was key to facilitating spousal involvement.ConclusionsThere is need for health system amendments and context-specific adaptations of public policy on PMTCT services to break down the barriers to and facilitate male PMTCT involvement.Trial RegistrationThe protocol for this review was registered with the International prospective register of systematic reviews (PROSPERO) record CRD42011001703.

Male Partner Support and Associated Factor on PMTCT Option B+ among HIV Positive Pregnant and Lactating Mothers in South Wollo Zone, North East Ethiopia

“…Inviting men to the hospital for voluntary counselling and HIV testing and offering of PMTCT services to men at service sites other than antenatal care were key health system actions. Prior HIV testing and knowledge on HIV can also facilitate their involvement [12,14,15]. Social desirability and recall biases were possibly limitations of this study.…”

“…According to different studies [11,12], other reasons for low male partner involvement were long waiting times at the antenatal care clinic, the male unfriendliness of PMTCT services, lack of communication among couples, reluctance of men to know their HIV status, misconception by men that their spouse's HIV status was a proxy of theirs, and lack of willingness among women to get their partners involved due to fear of domestic violence, stigmatization or divorce. According to qualitative study done in Blantyre, Malawi [13] to explore the relevance of male involvement in the prevention of mother to child transmission of HIV, male partners involvement in PMTCT were associated with the uptake of interventions along the PMTCT cascade and education strategy.…”

“…In Africa, male partner involvement in prevention of mother to child transmission of HIV (PMTCT) service is generally low due to different resons. From those reasons low general utilization of health services, low level of knowledge among male partner on PMTCT as compared with women, male reluctance to Know their HIV status, clashes between ANC/PMTCT timings and men's working hours, and women's hesitation to get tested with their partners due to fear of domestic violence if found to be HIV positive are the commonest [6].…”

Uptake of Services for Prevention for Mother-to-Child Transmission of HIV in Lubumbashi (D.R. of Congo)

“…Some studies in Malawi, Tanzania and Kenya also report low male participation rates ranging from 3.5% to 16% [17][18][19].While male involvement in ANC and PMTCT of services resulted in increased uptake of antenatal care services in Nepal and United States of America [20][21][22], increase uptake and adherence to PMTCT interventions in Tanzania and Kenya [18,23] uptake of HIV testing by women in Tanzania and Uganda [24,25] an opportunity of male testing in Burkina Faso [26]. Recent systematic review has identified barriers to male involvement in PMTCT programs in sub-Saharan Africa [27,28]. In East, Central and West Africa common barriers cited were sociocultural in nature (including gender inequality and normative social roles that limited male participation), deficits in HIV or ANC knowledge, a health system infrastructure or culture that discouraged male engagement, or personal characteristics, including age or occupation associated with willingness to engage in PMTCT [28][29][30][31].…”

“…Recent systematic review has identified barriers to male involvement in PMTCT programs in sub-Saharan Africa [27,28]. In East, Central and West Africa common barriers cited were sociocultural in nature (including gender inequality and normative social roles that limited male participation), deficits in HIV or ANC knowledge, a health system infrastructure or culture that discouraged male engagement, or personal characteristics, including age or occupation associated with willingness to engage in PMTCT [28][29][30][31]. Several studies highlight cultural barriers related to gender power dynamics wherein men perceive ANC to be the sole responsibility of women and gender norms that disapprove of males engaging in antenatal care activities [18,25,28,32,33].…”