It is 9:00 in the morning and an announcement rings out in the corridors of Mbale Regional Referral Hospital Antenatal Care (ANC) Clinic: “If you have not come with your husband, please call and ask him to come. If he is unable now, come with him next time.” The announcement was made by Sr. Helen Okwii, the ANC Clinic In-charge speaking to expectant mothers before her health education talk on reproductive health, which included a session on HIV emphasizing the prevention of mother-to-child transmission (PMTCT) of HIV.
Despite the positive attitude of men in Uganda towards 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.
Sr. Okwii is one of the health workers who has led her team in efforts to increase male involvement in antenatal services to ensure better treatment outcomes for HIV-positive mothers and their unborn babies. At the ANC Clinic, Sr. Okwii works to ensure that clients who visit the clinic as couples receive priority attention, including HIV counselling, testing and linkage to care for first-time attendants and vital check-ups for male partners, such as of blood pressure and nutritional status.
As part of the effort to provide high quality and effective PMTCT services, Sr. Okwii provides all women who arrive at the ANC Clinic alone with an invitation letter to give to their partners. She explains,
“A supportive partner can help reduce chances of transmission of HIV to the baby, if one or both partners have the infection. They will remind each other about breastfeeding practices for the exposed infant and the importance of taking their medicine on time. The support ensures good health for both individuals and their baby.”
During the two years she has headed antenatal services at the Mbale’s ANC Clinic; Sr. Okwii’s efforts have spurred an increase in male attendance from 7% in October 2012 to 85% by September 2014, as reflected in the USAID/SUSTAIN project reports. An interview with one couple attending the clinic revealed that the male partner attended all the antenatal appointments with his partner, pays for their transport fares to the clinic and reminds his partner to take her HIV treatment. Accordingly, male involvement enhances treatment support and influences retention into HIV care and treatment. At Mbale, appointment keeping measured as a proxy for retention of HIV-infected pregnant and lactating mothers, improved to 78% in September 2014, up from 61% in June 2013.
Through its PEPFAR grant, the USAID Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) project works with the Uganda Ministry of Health to support 13 public healthcare facilities; mainly high volume Regional Referral hospitals to provide anti-retroviral treatment (ART) for HIV-infected pregnant and lactating mothers. HIV-exposed infants are provided with an early infant diagnosis of HIV and the project supports the health workers like Sr. Okwii to provide appropriate paediatric care and treatment regardless of the diagnosis. The USAID/SUSTAIN project also supports hospital teams to proactively encourage pregnant mothers and their male partners to access services at the antenatal care clinics within the hospitals. Mbale Regional Referral Hospital is one of the hospitals supported by the project that provides reproductive health services.
 World Health Organization (2012) on Male Involvement in the elimination of mother to child transmission of HIV, accessed 4/11/2014