Male involvement in antenatal HIV counseling and testing: exploring men's perceptions in rural Malawi

Abstract

Antenatal care can act as an excellent tool to improve access to HIV counseling and testing services. This paper investigates an issue that may weaken its potential, namely lack of male involvement. We explored married men's perceptions of HIV in pregnancy and male involvement in antenatal HIV testing and counseling in Southern Malawi through 11 focus group discussions and a cross-sectional survey (n=388). The main findings were that men were largely unaware of available antenatal HIV testing and counseling services, and perceived it overall problematic to attend female-oriented health care. Most men supported provision of antenatal HIV testing. They perceived husbands to participate in the process indirectly through spousal communication, being faithful during pregnancy, and supporting the wife if found HIV-positive. Involvement of husbands was compromised by men's reluctance to learn their HIV status and the threat that HIV poses on marriage. Men stressed the importance of prior spousal agreement of antenatal HIV testing and considered HIV testing without their consent a valid reason for divorce. We suggest that male involvement in antenatal HIV testing requires refocusing of information and health services to include men. To avoid negative social outcomes for women, comprehensive and early involvement of men is essential.

Keywords:

• prenatal care
• pregnancy
• HIV
• voluntary counseling
• men
• Malawi

Acknowledgements

The authors are thankful for the Academy of Finland for supporting the study. We owe our gratitude to the research assistants and staff at the College of Medicine Mangochi Office, who have been invaluable for carrying out the study. We thank Annika Launiala and Johanna Sarlio for their valuable comments and support throughout the study process. We thank the staff at the University of Tampere for their support and help in arrangements.

Notes

A meeting abstract has been presented at the First Nordic Seminar in Global Health-Emerging Trends in Sexual and Reproductive Health, September 10–12, 2007, Nordic School of Public Health, Göteborg, Sweden.