Skip to main content

Advertisement

SpringerLink
Log in

Male Involvement for the Prevention of Mother-to-Child HIV Transmission: A Brief Review of Initiatives in East, West, and Central Africa

  • The Global Epidemic (S Vermund, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Current trends in HIV/AIDS research in sub-Saharan Africa (SSA) highlight socially and culturally sensitive interventions that mobilize community members and resources for universal access to HIV prevention, treatment, and care services. These factors are particularly important when addressing the complex social and cultural nature of implementing services for prevention of mother-to-child transmission of HIV (PMTCT). Across the globe approximately 34 % fewer children were infected with HIV through the perinatal or breastfeeding route in 2011 (est. 330,000) than in 2001 (est. 500,000), but ongoing mother-to-child HIV transmission is concentrated in sub-Saharan Africa, where fully 90 % of 2011 cases are estimated to have occurred. Recent literature suggests that PMTCT in Africa is optimized when interventions engage and empower community members, including male partners, to support program implementation and confront the social, cultural and economic barriers that facilitate continued vertical transmission of HIV. In resource-limited settings the feasibility and sustainability of PMTCT programs require innovative approaches to strengthening male engagement by leveraging lessons learned from successful initiatives in SSA. This review presents an overview of studies assessing barriers and facilitators of male participation in PMTCT and new interventions designed to increase male engagement in East, West, and Central Africa from 2000–2013, and examines the inclusion of men in PMTCT programs through the lens of community and facility activities that promote the engagement and involvement of both men and women in transformative PMTCT initiatives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. UNAIDS. Global report: UNAIDS report on the global aids epidemic: 2013. 2013. http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf Accessed 3 Mar 2014.

  2. Countdown to zero. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2011, Joint United Nations Programme on HIV/AIDS. http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110609_jc2137_global-plan-elimination-hiv-children_en.pdf Accessed 3 Mar 2014.

  3. The Inter-agency Task Team for Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and their Children. Preventing HIV and unintended pregnancies: strategic framework 2011–2015. In support of the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive. 2011. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/PreventingHIV_UnintendedPregnancies_SF2011_2015.pdf Accessed 3 Mar 2014.

  4. Stringer JS, Sinkala M, Maclean CC, et al. Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia. AIDS. 2005;12:309–15.

    Google Scholar 

  5. Stringer EM, Chi BH, Chintu N, et al. Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Bull World Health Organ. 2008;86:57–62.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Perez F, Orne-Gliemann J, Mukotekwa T, et al. Prevention of mother to child transmission of HIV: evaluation of a pilot programme in a district hospital in rural Zimbabwe. BMJ. 2004;329:1147–50.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.

    Article  CAS  PubMed  Google Scholar 

  8. Farquhar C, Kiarie JN, Richardson BA, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004;37:1620–6.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Painter TM. Voluntary counseling and testing for couples: a high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa. Soc Sci Med. 2001;53:1397–411.

    Article  CAS  PubMed  Google Scholar 

  10. Aluisio A, Richardson BA, Bosire R, et al. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr. 2011;56:76–82. This prospective cohort study found male antenatal attendance and testing to be associated with decreased rates of vertical HIV transmission among pregnant women in Nairobi, Kenya.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Auvinen J, Kylmä J, Suominen T. Male involvement and prevention of mother-to-child transmission of HIV in Sub-Saharan Africa: an integrative review. Curr HIV Res. 2013;11:169–77. This article reviews 18 studies on male involvement in PMTCT initiatives in sub-Saharan Africa and highlights common trends in barriers and strategies to improve these initiatives.

    Article  CAS  PubMed  Google Scholar 

  12. Nkuoh GN, Meyer DJ, Tih PM, et al. Barriers to men’s participation in antenatal and prevention of mother-to-child HIV transmission care in Cameroon, Africa. J Midwifery Womens Health. 2010;55:363–9.

    Article  PubMed  Google Scholar 

  13. Aarnio P, Olsson P, Chimbiri A, et al. Male involvement in antenatal HIV counseling and testing: exploring men’s perceptions in rural Malawi. AIDS Care. 2009;21:1537–46.

    Article  PubMed  Google Scholar 

  14. Small E, Nikolova SP, Narendorf SC. Synthesizing gender based HIV interventions in Sub-Sahara Africa: a systematic review of the evidence. AIDS Behav. 2013;17:2831–44.

    Article  PubMed  Google Scholar 

  15. Ditekemena J, Matendo R, Koole O, et al. Male partner voluntary counselling and testing associated with the antenatal services in Kinshasa, Democratic Republic of Congo: a randomized controlled trial. Int J STD AIDS. 2011;22:165–70. This randomized controlled trial conducted in the Democratic Republic of Congo found a significantly higher proportion of male participation in VCT associated with antenatal services in non-health facilities, such as bars and churches.

    Article  CAS  PubMed  Google Scholar 

  16. Ditekemena J, Koole O, Engmann C, et al. Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review. Reprod Health. 2012;9:32. This study highlights three levels of determinants to male involvement in maternal and child health services in Sub-Saharan Africa: 1.) Socio-demographic factors (education, income) 2.) Health services factors (space, operating hours) and 3.) Sociological factors (beliefs, attitudes, communication).

    Article  PubMed Central  PubMed  Google Scholar 

  17. Chandisarewa W, Stranix-Chibanda L, Chirapa E, et al. Routine offer of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ. 2007;85:843–50.

    PubMed Central  PubMed  Google Scholar 

  18. Msuya SE, Mbizvo EM, Hussain A, et al. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care. 2008;20:700–9.

    Article  CAS  PubMed  Google Scholar 

  19. Katz DA, Kiarie JN, John-Stewart GC, et al. Male perspectives on incorporating men into antenatal HIV counseling and testing. PLoS One. 2009;4:e7602.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Falnes EF, Moland KM, Tylleskär T, et al. “It is her responsibility”: partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania. J Int AIDS Soc. 2011;14:21. This study used mixed methods across rural and urban areas in Tanzania and found that major barriers to male involvement in PMTCT initiatives was associated with perceptions of antenatal care being a woman’s domain.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Byamugisha R, Åstrøm AN, Ndeezi G, et al. Male partner antenatal attendance and HIV testing in eastern Uganda: a randomized facility-based intervention trial. J Int AIDS Soc. 2011;14:43. This randomized controlled design found no difference in the effectiveness of an intervention to promote male attendance to antenatal care and HIV testing in Uganda.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Kalembo FW, Zgambo M, Mulaga AN, et al. Association between male partner involvement and the uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Mwanza district, Malawi: a retrospective cohort study. PLoS One. 2013;8:e66517. This retrospective cohort study from Malawi found that male invovlement in PMTCT initiatives led to better uptake of condom use and higher rates of completion of follow-up.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Homsy J, Kalamya JN, Obonyo J, et al. Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr. 2006;42:149–54.

    Article  PubMed  Google Scholar 

  24. Sherr L, Croome N. Involving fathers in prevention of mother to child transmission initiatives–what the evidence suggests. J Int AIDS Soc. 2012;15:17378. This systematic review found that the involvement of men in PMTCT initiatives is limited to HIV testing with little efforts to treat and care for HIV-positive fathers.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kizito D, Woodburn PW, Kesande B, et al. Uptake of HIV and syphilis testing of pregnant women and their male partners in a programme for prevention of mother-to-child HIV transmission in Uganda. Trop Med Int Health. 2008;13:680–2.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Morfaw F, Mbuagbaw L, Thabane L, et al. Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators. Syst Rev. 2013;2:5. This systematic review based largely on studies of male involvement in PMTCT in Sub-Saharan Africa found many trends in barriers and facilitators at the individual, societal and health systems level.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Auvinen J, Kylmä J, Välimäki M, et al. Barriers and resources to PMTCT of HIV: Luba-Kasai men’s perspective in Lusaka, Zambia. J Assoc Nurses AIDS Care. 2013;24:554–68. This qualitative study interviewed 21 men on perspectives of PMTCT in Zambia and found various barriers (poverty, refugee status, HIV stigma, gendered ideas of ANC) and resources (spirituality, HIV knowledge, advanced health services, satisfaction of basic needs) to male involvement in PMTCT.

    Article  PubMed  Google Scholar 

  28. Mrisho M, Obrist B, Schellenberg JA, et al. The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy Childbirth. 2009;9:10.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Iliyasu Z, Abubakar IS, Galadanci HS, et al. Birth preparedness, complication readiness and fathers’ participation in maternity care in a northern Nigerian community. Afr J Reprod Health. 2010;14:21–32.

    PubMed  Google Scholar 

  30. Mbonye AK, Hansen KS, Wamono F, et al. Barriers to prevention of mother-to-child transmission of HIV services in Uganda. J Biosoc Sci. 2010;42:271–83.

    Article  CAS  PubMed  Google Scholar 

  31. Desgrées-Du-Loû A, Brou H, Djohan G, et al. Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV preventive attitude among couples. Abidjan, 2002–2005. AIDS Behav. 2009;13:348–55.

    Article  PubMed  Google Scholar 

  32. Theuring S, Mbezi P, Luvanda H, et al. Male involvement in PMTCT services in Mbeya Region, Tanzania. AIDS Behav. 2009;13:92–102.

    Article  PubMed  Google Scholar 

  33. Tonwe-Gold B, Ekouevi DK, Bosse CA, et al. Implementing family-focused HIV care and treatment: the first 2 years’ experience of the mother-to-child transmission-plus program in Abidjan, Cote d’Ivoire. Trop Med Int Health. 2009;14:204–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Nkuoh GN, Meyer DJ, Nshom EM. Women’s attitudes toward their partners’ involvement in antenatal care and prevention of mother-to-child transmission of HIV in Cameroon, Africa. J Midwifery Womens Health. 2013;58:83–91. This qualitative study involved interviews of pregnant women in Cameroon. The authors found that while a high proportion of women supported their partner’s involvement in ANC, they perceived men’s primary role as paying for the obstetric care.

    Article  PubMed  Google Scholar 

  35. Chimbiri AM. The condom is an ‘intruder’ in marriage: evidence from rural Malawi. Soc Sci Med. 2007;64:1102–15.

    Article  PubMed  Google Scholar 

  36. Auvinen J, Kylmä J, Välimäki M, et al. Midwives’ perspectives on male participation in PMTCT of HIV and how they can support it in Lusaka, Zambia. Midwifery. 2014;30:17–27. This qualitative study in Zambia found that to improve barriers to male involvement in PMTCT initiatives, midwives could work to influence individuals, communities, employers and personnel, intervene in risk behaviors, and provide disease intervention services.

    Article  PubMed  Google Scholar 

  37. Ramirez-Ferrero E, Lusti-Narasimhan M. The role of men as partners and fathers in the prevention of mother-to-child transmission of HIV and in the promotion of sexual and reproductive health. Reprod Health Matters. 2012;20:103–9. This article argues that the role of men in PMTCT should be expanded beyond being considered as mere facilitators but as a vital part of reproductive health practices and policies.

    Article  PubMed  Google Scholar 

  38. Theuring S, Nchimbi P, Jordan-Harder B, et al. Partner involvement in perinatal care and PMTCT services in Mbeya Region, Tanzania: the providers’ perspective. AIDS Care. 2010;22:1562–8.

    Article  PubMed  Google Scholar 

  39. Reece M, Hollub A, Nangami M, et al. Assessing male spousal engagement with prevention of mother-to-child transmission (pMTCT) programs in western Kenya. AIDS Care. 2010;22:743–50.

    Article  PubMed  Google Scholar 

  40. Betancourt TS, Abrams EJ, McBain R, et al. Family-centred approaches to the prevention of mother to child transmission of HIV. J Int AIDS Soc. 2010;13:S2.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Bajunirwe F, Muzoora M. Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: a cross-sectional survey in rural and urban Uganda. AIDS Res Ther. 2005;2:10.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Baiden F, Remes P, Baiden R, et al. Voluntary counseling and HIV testing for pregnant women in the Kassena-Nankana district of northern Ghana: is couple counseling the way forward? AIDS Care. 2005;17:648–57.

    Article  PubMed  Google Scholar 

  43. Maman S, Mbwambo J, Hogan NM, et al. Women’s barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing. AIDS Care. 2001;13:595–603.

    Article  CAS  PubMed  Google Scholar 

  44. Watson-Jones D, Balira R, Ross DA, et al. Missed opportunities: poor linkage into ongoing care for HIV-positive pregnant women in Mwanza, Tanzania. PLoS One. 2012;7:e40091.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Msellati P. Improving mothers’ access to PMTCT programs in West Africa: a public health perspective. Soc Sci Med. 2009;69:807–12.

    Article  PubMed  Google Scholar 

  46. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18588. This systematic review shows that trends at the health system and community level have changed little over time and have consistently acted as barriers to PMTCT intiatives in Sub-Saharan Africa.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Delvaux T, Elul B, Ndagije F, et al. Determinants of nonadherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Rwanda. J Acquir Immune Defic Syndr. 2009;50:223–30.

    Article  CAS  PubMed  Google Scholar 

  48. Bolu OO, Allread V, Creek T, et al. Approaches for scaling up human immunodeficiency virus testing and counseling in prevention of mother-to-child human immunodeficiency virus transmission settings in resource-limited countries. Am J Obstet Gynecol. 2007;197:S83–9.

    Article  PubMed  Google Scholar 

  49. Kyomuhendo GB. Low use of rural maternity services in Uganda: impact of women’s status, traditional beliefs and limited resources. Reprod Health Matters. 2003;11:16–26.

    Article  PubMed  Google Scholar 

  50. Kinuthia J, Kiarie JN, Farquhar C, et al. Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma. J Int AIDS Soc. 2011;14:61.

    Article  PubMed Central  PubMed  Google Scholar 

  51. de Paoli MM, Manongi R, Klepp KI. Factors influencing acceptability of voluntary counselling and HIV-testing among pregnant women in Northern Tanzania. AIDS Care. 2004;16:411–25.

    Article  PubMed  Google Scholar 

  52. Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359:2233–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Cotton MF, Violari A, Otwombe K, et al. Early time-limited antiretroviral therapy versus deferred therapy in South African infants infected with HIV: results from the children with HIV early antiretroviral (CHER) randomised trial. Lancet. 2013;382:1555–63.

    Article  PubMed  Google Scholar 

  54. Saul K. ProVIC “Champion Communities”: preventing mother-to-child transmission of HIV in the Democratic Republic of Congo. Case Study Series, A.-O. USAID’s AIDS Support and Technical Assistance Resources, Task Order 1, Editor. 2012: Arlington, VA. This case study highlights a PEPFAR funded intervention, ProVIC, that engages communities across 5 sites in the Democratic Republic of Congo to promote self-sustaining plans for community-level PMTCT intiatives.

  55. Osoti AO, John-Stewart G, Kiarie J, et al. Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya: a randomized clinical trial. AIDS. 2014;28:95–103. This RCT found improved male involvement in PMTCT when partners were invited to participate in couples VCT by a health care worker at home as compared to an invitation to ANC for VCT via letter.

    Article  PubMed  Google Scholar 

  56. The World Bank. World development indicators: gross domestic product 2012. 2013. http://databank.worldbank.org/data/Databases.aspx. Accessed 3 Mar 2014.

Download references

Acknowledgments

This publication was made possible in part by support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health, grant number R01HD075075. The findings and conclusions are those of the authors and do not necessarily represent the official position of the National Institutes of Health.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Julie Dunlap, Nia Foderingham, Scottie Bussell, C. William Wester, Carolyn M Audet, and Muktar H. Aliyu declare that they have no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, USA

    Julie Dunlap

  2. School of Medicine, Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA

    Nia Foderingham & Scottie Bussell

  3. Vanderbilt Institute for Global Health, 2525 West End Avenue, Suite 750, Nashville, TN, 37203-1738, USA

    C. William Wester, Carolyn M. Audet & Muktar H. Aliyu

  4. Department of Medicine, Vanderbilt University, Nashville, TN, USA

    C. William Wester & Muktar H. Aliyu

  5. Department of Health Policy, Vanderbilt University, Nashville, TN, USA

    Carolyn M. Audet & Muktar H. Aliyu

Authors
  1. Julie Dunlap
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nia Foderingham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scottie Bussell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. William Wester
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carolyn M. Audet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Muktar H. Aliyu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muktar H. Aliyu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dunlap, J., Foderingham, N., Bussell, S. et al. Male Involvement for the Prevention of Mother-to-Child HIV Transmission: A Brief Review of Initiatives in East, West, and Central Africa. Curr HIV/AIDS Rep 11, 109–118 (2014). https://doi.org/10.1007/s11904-014-0200-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-014-0200-5

Keywords

Search

Navigation