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 Pediatric HIV infections are numerous and worrisome especially in Africa. 2.5M children<15 years infected in 2009, 2.3M Africa 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.

METHODS

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

ARTICLE

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. Dr Thabane is a clinical trials mentor for CIHR under the RCT Mentorship Programme and supervisor of Frederick Morfaw. Lawrence Mbuagbaw is co-mentoring F. Morfaw

THANKS FOR YOUR KEEN ATTENTION