Despite the positive attitudes of men about preventing mother-to-child transmission of HIV, their engagement in HIV care and treatment remains low. In part, this is due to the long-held cultural view that reproductive health is a women’s issue. In Uganda, men often perceive antenatal clinics as spaces for women and reproductive healthcare as a career for women. However, the high rate of “vertical” transmissions of HIV from mother to child, coupled with an increasing burden of HIV on women in Sub-Saharan Africa, requires the involvement and support of men in all aspects of the Prevention of Mother-to-Child Transmission of HIV (PMTCT) and paediatric care and treatment interventions to ensure service access and client retention.
The USAID Strengthening Uganda’s Systems for Treating AIDS Nationally (USAID/SUSTAIN) project works with the Uganda Ministry of Health to support 13 public healthcare facilities throughout Uganda to provide anti-retroviral treatment (ART) for HIV-infected pregnant and lactating mothers, and provide HIV-exposed infants with an early diagnosis of HIV and subsequently appropriate management interventions. Part of the activities of the USAID/SUSTAIN project is to support hospital teams to proactively encourage pregnant mothers and their male partners to access services at antenatal clinics within hospitals. Mbale Regional Referral Hospital is one of the hospitals supported by the Project that provides reproductive health services.
At 9:00am, Annet and Michael are at the Mbale Regional Referral Hospital Antenatal Care Clinic (ANC), waiting to have their six-week-old baby tested for HIV. Michael has been carrying the baby during a health education talk session, right from the registration/triage desk. There are six other couples before them in the queue and many clients are still arriving. Attendance is at a peak and nurses are taking clients’ vitals, assessing nutrition, and providing HIV testing and counselling (HTC) service. Senior Nursing Officer Sr. Hellen Okwir announces to the audience, “If you have not come with your husband, please call and ask him to come or come with him next time.’’
Couples waiting to receive health education talks. In the background are healthcare workers ready to offer antenatal services. Bernadeta M. Nagita @USAID/SUSTAIN 2014
Michael is one of the males present today. Since Annet tested HIV-positive in her first trimester of pregnancy, Michael has been diligent about coming to the ANC with her and has been at the centre of giving her support.
“I did an HIV test a day after Annet disclosed her status to me. Although I was found free of the virus, I have been attending the clinic together with Annet. I was motivated to come regularly after listening to the health education talks that assured us an HIV-free baby was possible if we took all precautions,” Michael says.
A volunteer at Mbale RRH Antenatal Clinic giving a health education talk to couples. Bernadeta M. Nagita @ USAID/SUSTAIN 2014
Michael pays for their transport cost to and from hospital and helps remind Annet to take her medication. He takes note of all the clinic appointments and understands healthcare worker advice instructions regarding breastfeeding their baby. Michael’s encouragement to Annet during this time when she has had to cope with being pregnant, treatment for her condition and looking after the baby after delivery has been invaluable.
“He supports me a lot. He is always available,” Annet says.
Mbale RRH Antenatal Clinic Manager and Senior Nursing Officer, Sr. Hellen Okwir counselling Michael and Annet at the Antenatal Clinic. Bernadeta M. /SUSTAIN 2014
According to Sr. Okwir, Michael’s support has eased communication between the couple and influenced their decision to enrol in family planning.
As part of efforts to providing quality and effective elimination of mother-to-child transmission of HIV, Sr. Okwir sends notes to all women who arrive at the ANC without their male partners. These notes explain that husbands’ and partners’ participation in the process creates an environment conducive to seeking treatment, following up with medication and clinical appointments and remaining in care both during pregnancy and after delivery. She adds that having an involved, supportive partner can help ensure ongoing good health for both individuals, their baby, as well as reduce chances of transmission of HIV to the baby (if any or both of the partners has/have HIV infection).
Male partners need to be viewed and treated not only as powerful, influencing factors, but as active participants in reproductive health who can no longer be excluded from any debate surrounding issues like pregnancy or HIV/AIDS.
 World Health Organization (2012) on Male Involvement in the elimination of mother to child transmission on HIV, Accessed 10/10/2014
 UNAIDS (2011) on the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Accessed 10/10/2014
 Theuring S. et al. (2009), Male involvement in PMTCT services in Mbeya region, Tanzania; AIDS and Behavior. Accessed 10/10/2014