Involving men is increasingly being promoted as a key element in the prevention of mother-to-child transmission of HIV, and while its benefits are well-documented - in one Kenyan study it reduced the risks of vertical transmission and infant mortality by more than 40 percent compared with no involvement - it can occasionally lead to domestic discord and even violence.
Silvia*, a 33-year-old mother of six, now living at her mother's home in western Kenya, says her 14-year marriage was doomed the minute she followed her healthcare worker's advice to bring her husband for an antenatal visit after she tested HIV-positive. "I was tested and I was told I was positive; I asked if I could go ahead and just carry the pregnancy and the nurse assured me it was fine," she said. "She, however, asked me to bring my husband when coming for the next visit and I agreed."
She convinced her husband to accompany her on her next visit, but when he tested HIV-negative, he accused her of cheating on him. "He left me at the hospital... When I got home, he beat me up and said the child I was carrying wasn't his and he chased me away," she added. "The nurse thought she was helping us but it turned out to be a curse for me."
There is limited research into the area of gender-based violence following HIV-testing, but a presentation by the NGO, the Sonke Gender Justice Network, at the 2010 International AIDS Society conference in Vienna, Austria, reported that women's experiences upon disclosing their status to their male partners were often "complex and positive": some studies reported violence levels of up to 14 percent, while others stated that about half of HIV-positive women said their partners reacted supportively to the disclosure.
According to Beatrice Misoga, PMTCT programme officer with the AIDS Population Health Integrated Assistance (APHIA Plus), gender-based violence is more common in discordant relationships where the man is HIV-negative. "Male involvement has helped realize success with PMTCT programmes where it has been applied because prevention of mother to child transmission is a family issue, but yes, there have been challenges in certain aspects like the possibility of gender-based violence targeting women and more so in a situation where the male partner is not willing to be part of it."
Tensions
 A woman comes to the facility but the moment you mention her man, she disappears and might resurface to give birth - some go to traditional birth attendants |
In 2009, Human Rights Watch (HRW) cautioned the Kenyan government to ensure that human rights were protected during a large-scale home-based counselling and testing programme; HRW noted that HIV-positive mothers - among them girls under the age of 18 - sometimes suffered violence, mistreatment, disinheritance, and discrimination from their husbands, in-laws, or their own families.
Some women, too fearful of the repercussions of revealing their HIV status to their husbands, opt out of PMTCT programmes altogether. "A woman comes to the facility but the moment you mention her man, she disappears and might resurface to give birth - some go to traditional birth attendants," said Julie Miseda, a nurse at Nyanza Province's Siaya District Hospital. "Some will tell you they are not married but the day they give birth, a man appears and claims he is the father.
"At times, involving both of them creates tension between them and they tend to keep very crucial information, for example, a history of a sexually transmitted infection, to themselves," she added.
Supporting men
According to APHIA Plus's Misoga, to preserve the benefits of male involvement in PMTCT, health clinics had to become more aware of the counselling needs of men. "Despite the disadvantages, the benefits of male involvement are immense and what needs to be done is to make these antenatal clinics male friendly. It is also important to give constant information and messages targeting men on the need to be part of prevention of mother to child transmission programmes," she said.
Christopher Mukabi, a local peer educator, says male support groups have proved useful in improving the way couples deal with an HIV diagnosis. "Bringing men together in male support groups and then using these groups to convince them to get into PMTCT programmes can help deal with some of the challenges, but stigma and alcoholism are still problems in getting men involved."
