Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Brian W. Forsyth

Subject Area(s)

Medicine, Public health

Abstract

Programs for the prevention of mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa have focused overwhelmingly on women, to the unintended exclusion of their male partners. Greater involvement of men may improve HIV-related outcomes through increased adherence to PMTCT, but a stronger understanding of the factors impeding male-partner HIV testing and disclosure is needed. A cross-sectional study using mixed methods was conducted in Tshwane, South Africa. In-depth interviews were held with men whose partners were recently pregnant while PMTCT was in effect, and focus group discussions were conducted with health-care workers and community representatives. Of 124 men who participated, 94% believed male HIV testing was important, but 40% had never been tested. Of those tested, only 31% were tested during the pregnancy, while 37% were tested afterward. A man's likelihood of getting tested during his partner's pregnancy was associated with prior discussion with his partner about testing, knowing she had already been tested, and her disclosure of the test result (all p < 0.05). Qualitative analysis revealed formidable structural and psychosocial barriers to men's participation: the perception of PMTCT as not "male-friendly," a narrow focus at clinics on HIV testing instead of health promotion, and few opportunities for fathers to share decision-making roles. Three-quarters of the fathers reported that they would accept an invitation from their partners to attend the clinic for PMTCT; based on emergent themes, six partner invitation cards were designed, and 158 men and 409 women evaluated the cards. One invitation card depicting the themes of fatherhood and the baby was selected by 41% of men and 31% of women as the most likely for women to give to their male partners and the most successful at encouraging men to be tested. This is the first study to address barriers to HIV testing in PMTCT from the perspective of male partners. Improved partner communication and clinic attendance using a partner invitation card intervention could facilitate more robust male-partner participation and help PMTCT programs in resource-poor settings to achieve their full potential.

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