Male participation in prevention programs of Mother to child transmission of HIV: A systematic review to identify barriers, facilitators. by F Morfaw, L. Mbuagbaw, L. Thabane et al. Afri -Can Forum, 18 th January 2013, Entebbe, Uganda. BACKGROUND.
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Male participation in prevention programs of Mother to child transmission of HIV: A systematic review to identify barriers, facilitators.by F Morfaw, L. Mbuagbaw, L. Thabane et al. Afri-Can Forum, 18th January 2013, Entebbe, Uganda
BACKGROUND • Pediatric HIV infections are numerous and worrisome especially in Africa. • 2.5M children<15 years infected in 2009, 2.3M Africa. • 260.000 HIV related deaths in children <15 years, 88% in Africa • MTCT of HIV accounts for 90% childhood HIV infections. • The virtual elimination of MTCT of HIV is possible!!
BACKGROUND • PMTCT programs are part of the solution. • Reproductive health services + ANC are tailored for womens’ needs. • Many reports point to the beneficial effect of male involvement in PMTCT activities.
BACKGROUND • “Men are indeed the forgotten half of this equation” (Mohlala et al 2011).
BACKGROUND • Achieving male involvement in PMTCT is challenging • Reason: lack of evidence based strategies to effectively engage men in women’s health. • Possible solution: Identify facilitators and barriers of male partner involvement in PMTCT.
OBJECTIVE • Identify the facilitators of and barriers to male involvement in PMTCT activities in order to inform programs aimed at enhancing male partner participation in PMTCT.
RESULTS 1:Barriers to male PMTCT participation • Societal/cultural barriers: • Perception of ANC as a woman’s place • Cultural norm, men should not participate: pregnancy is a woman’s affair. • Male individual factors • Reluctance to learn one’s status • Time conflict for ANC/PMTCT • Avoidance of the burden of care
RESULTS 2:Barriers to male PMTCT participation • Information/Knowledge barriers: • Misconception that your partner’s HIV status is a proxy of yours • Unawareness of antenatal VCT by men • Health System barriers • Long waiting times • ANC services are male unfriendly • Distrust in health system confidentiality
RESULTS 3:Barriers to male PMTCT participation • Female factors: • Women avoiding to involve their spouses due to numerous fears (infidelity, domestic violence, stigma, divorce) • Relationship dynamics • Weaker relationships • Fidelity within the relationship.
RESULTS 4:Barriers to male PMTCT participation • Disagreement with PMTCT teachings: • PMTCT encourages condom use within couples • Prenatal HIV testing is a late event.
RESULTS 5: Facilitators of male PMTCT participation • Health system facilitators: • Invitation letters from health services to men • Offering routine voluntary couple counselling • Provision of services during non-working hours • Offering of counselling and testing at sites other than ANC • Community sensitization activities • Availability of ARV in health centre.
RESULTS 6: Facilitators of male PMTCT participation • Relationship dynamics factors: • Monogamous marriage/co-habitation of partners • Discussing PMTCT within the couple • Sero-concordance for HIV • Male individual factors • Previous male HIV testing • Providing time to consider PMTCT recommendation • Increased male knowledge on HIV and PMTCT.
RESULTS 7: Facilitators of male PMTCT participation • Female individual factors • Lack of financial independence • Positive attitudes of women towards result disclosure.
KEY MESSAGES • Socio-cultural factors, individual factors and health system factors constitute the main barriers to male involvement in PMTCT • Most pertinent: the societal perception of antenatal care and PMTCT as a woman’s activity.
KEY MESSAGES • Demonstrated facilitators are health system actions or factors directly tied to the individual. • Most pertinent: active outreach inviting men to ANC/PMTCT, Male partner and community sensitization, and offering PMTCT services to men at sites other than antenatal care.
KEY MESSAGES • There 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.
FUTURE PROSPECTS • Scale Assessing Male Participation in PMTCT programs (SAMP-PMTCT) • Pioneer testing of SAMP-PMTCT in a cross-sectional study in Cameroon. • RCT
ACKNOWLEDGEMENTS • This project is supported by the CIHR Canadian HIV Trials Network (CTN) in the form of an international postdoctoral research fellowship awarded to Frederick Morfaw. • DrThabane is a clinical trials mentor for CIHR under the RCT Mentorship Programme and supervisor of Frederick Morfaw. • Lawrence Mbuagbaw is co-mentoring F. Morfaw