Male involvement in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Kasama district, Zambia
Background: There is ample evidence that male involvement in prevention of mother-to-child transmission (PMTCT) programmes results in positive health outcomes and as a result it has been recognised as a priority area of intervention within this woman-centred approach. When male partners arc involved, both partners get tested for HIV, know their status, and therefore improve the baby's chances of being free from HIV. However, despite all the positive outcomes associated with this, male partner involvement in PMTCT programmes, remains low in Kasama urban clinic. This study assessed what factors influence male partner participation in PMTCT of HIV in Kasama urban clinic in Kasama district, Zambia. Methods: This study used a descriptive, cross-sectional study design to describe perceived factors associated with male involvement in PMTCT. Three groups of participants were selected, using convenience and purposive sampling: men who accompanied their partners for ANC (hereafter referred to as the male participants); women who attended ANC without their partners (hereafter referred to as female participants); and health care workers providing ANC (hereafter referred to as key informants). A total of 80 males, 18 females and 3 health providers were interviewed. This study utilised a questionnaire survey for partners of antenatal care clients (ANC) which was administered through a face-to-face interview. It also utilised semi-structured interviews with women attending the ANC clinic but not accompanied by their partners; and semi-structured interviews with Kasama urban clinic facility staff providing PMTCT services. All data collection tools focussed on identifying barriers to male participation in PMTCT programmes. Results: The men had high levels of knowledge about Mother-To-Child Transmission (MTCT) and they seemed willing to participate in PMTCT activities. They also considered ANC as male friendly and were satisfied with the treatment from the health providers. The results also showed that the majority of male respondents did not think that there was lack of confidentiality during ANC clinics. However, some barriers to participation were mentioned among them the PMTCT programmatic/health systems factors and societal/sociocultural factors. Tight work schedules and long queues at the clinic were cited as one of the major barriers to male participation in PMTCT/ANC. This was associated with human resource (HR) constraints at the clinic which resulted in providing the service only twice a week. This was cited by the health providers as one of the contributing factors for long queues. It was perceived that the current schedule of ANC does not seem to be accommodative to those who were employed with tight schedules. Other barriers identified by female respondents included the belief that it was the duty of women and not men to go for ANC; the belief that men were jealous if they accompanied their wives to the clinic; and fear of knowing their HIV results. Conclusion: Almost all men interviewed had a better understanding of PMTCT and were ready to provide support to their female partners in any PMTCT interventions. Doing an HIV test was perceived as a motivating factor for HIV positive and negative people alike to adopt safer sexual behaviour. The study revealed that a combination of poor knowledge and also some socio-cultural and health system related factors affected the participation of males in ANC/PMTCT programmes. As a way of responding to some of the barriers identified, and also to enco urage men to participate in A C/PMTCT programmes, recommendations were proposed. One of the key recommendations was to increase or spread the number of days dedicated to ANC service provision during the week. The flexibility in the provision of ANC was perceived as an opportunity to improve male involvement. It was also recommended that increasing the number of staff at the facility would reduce the time spent at the clinic. Other recommendations included prioritising women who come with their partners so that they spend less time at the clinic. It was also recommended that couple counselling and testing should be encouraged because men believed that it was important for the coupl e to know one's serostatus.