Social determinants of male partner involvement in women's Prevention of Mother to Child Transmission care Program in Malawi

Abstract

Background Male partners are rarely present during PMTCT (Prevention-Mother-To-Child-Transmission) services in Sub-Saharan Africa (SSA). Men’s involvement is increasingly recognised as an important element of women’s access to care. This study aims to identify the socio-demographic characteristics, HIV-Knowledge, Attitude and Practice (KAP) among women accompanied and not accompanied by their male partners. Methods We included pregnant women enrolled in PMTCT programme between August 2018 and November 2019 in the Southern Region of Malawi. Eligible women were aged 18 years or older, living with a male partner, enrolled for the first time in one of the four selected facilities. We provided a KAP survey to women and their partners attending the facilities. Our primary objective was to assess and analyse the proportion of women who were accompanied by their partner at least once. We applied descriptive statistics and logistic regressions to study the association between being accompanied and explanatory variables. Results We enrolled 128 HIV-positive women: 82 (64.1%) were accompanied by their male partners and 46 (35.9%) were alone. Women’s unemployment and possession of a vehicle are negatively associated with male attendance (respectively adjusted OR 0.32 [95% CI, 0.13-0.83] and 0.23 [95% CI, 0.07-0.77]), whereas high women’s level of knowledge of HIV is positively associated with male attendance (adjusted OR 2.33 [95% CI, 1.01-5.40]). Level of attitude and practice toward HIV were not significantly associated to our study variable. Conclusions Our study shows a high male involvement in Malawi compared to other studies performed in SSA. This study highlights the factors affecting male attendance which are women’s level of knowledge on HIV, economic condition (employment and means of transport) and healthcare system inequality including geographical accessibility. Moreover, the study points out that gender power relationships and stringent gender norms play a crucial role thus they should be considered to enhance male involvement.