Male Involvement in Preventing Pediatric HIV Transmission: AQualitative Analysis of Men's Roles in Sexual and ReproductiveHealth as told by Men and Women Living with HIV in Lilongwe, Malawi Open Access

Abstract

Background:

Given that men often dominate decision-making about sexual and reproductive matters within sexual partnerships in resource-limited settings, positive male involvement and participation in the effort to prevent vertical and horizontal HIV transmission is critical. There is a strong evidence base that male involvement in family planning, voluntary HIV counseling and testing, and antenatal care improves the uptake of and increases adherence to PMTCT strategies in sub- Saharan Africa. Gender inequality is the most salient barrier to male involvement and has been studied very limitedly from a male perspective.

Methods:

Qualitative data analysis was conducted on secondary data from 15 focus group discussions conducted on men and women of reproductive age living with HIV and attending ART clinics in Lilongwe, Malawi. Despite being situated in a capital city, these ART clinics serve both urban and rural Malawians. Participants were asked about their reproductive knowledge, attitudes, and practices.

Results:

The five major themes that emerged from the data were: condoms; contraception; pregnancy and antenatal care; voluntary HIV counseling and testing; and ART. All five are components of comprehensive PMTCT programs. Gender norms and roles were found to strongly influence all themes. Within couples, men controlled condom use, family planning decision-making, and abortion decision-making, while also influencing HIV status disclosure.

Discussion:

This study's findings revealed disagreement between men and women and among men themselves on men's roles in sexual and reproductive health. This dissonance challenges public health providers to structure interventions that function effectively within these multiple realities while also striving to improve them. Programs that incorporate these different beliefs, attitudes, and behaviors and also balance the knowledge that men often control decision-making within sexual partnerships with the rights of women to control their own reproductive health behaviors and work to break down harmful gender norms may effectively improve male involvement in sexual and reproductive health and subsequently reduce pediatric HIV infections.

Table of Contents

Chapter 1: Introduction 1

1.1 Introduction and rationale 1

1.2 Problem statement 5

1.3 Purpose statement and aims 6

1.4 Research questions 6

1.5 Significance statement 7

Chapter 2: Review of the Literature 8

2.1 The emergence of male involvement in sexual and reproductive health (SRH) 8

2.2 Gender roles and norms 10

2.3 Male involvement in the avoidance of unwanted pregnancy 11

2.4 Male involvement in antenatal care/PMTCT and VCT 14

2.5 Summary 18

Chapter 3: Methods 19

3.1 Introduction 19

3.2 Population and sample 19

3.3 Instruments 21

3.4 Data preparation and analysis 22

3.5 Limitations 23

3.6 Ethical considerations 24

Chapter 4: Results 26

4.1 Condoms 26

Expectations of condom use 26

The meaning of "protection" 28

Promiscuity and stigma 30

Condom acceptability, negotiation, and partner refusal 33

4.2 Contraception 35

Decision-making around contraceptive use 35

Cultural shift 39

Men's roles in family planning 41

Permanent methods of contraception 44

Independent and covert use of contraception 45

Family planning acceptability 47

4.3 Pregnancy and Antenatal Care 51

Fear of HIV-positive pregnancy 51

Undesired pregnancy and abortion 54

Dissemination of information 57

4.4 Voluntary HIV Counseling and Testing (VCT) 60

Covert and independent testing vs. couples' and family testing 60

Communication 62

Delayed testing and forced testing 64

4.5 Antiretroviral Therapy (ART) and Antiretroviral Drugs (ARVs) 66

ART & ARV interactions 67

Use of ART while in a relationship 68

ART acceptability 69

4.6 Summary Tables 73

Chapter 5: Discussion and Recommendations 81

5.1 Summary of Findings 81

5.2 He Said, She Said 82

Condoms 82

Contraception 85

Voluntary HIV counseling and testing (VCT) 87

5.3 Variation Among Men 88

Partner refusal of condoms 88

The evolution of family planning 89

Men's role in family planning 90

Undesired pregnancy and abortion 91

5.4 Recommendations for Lighthouse Trust 91

5.5 Strengths and Limitations 95

Bibliography 97

Appendix 1 102

Appendix 2 104

Appendix 3 114

Appendix 4 115

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV PMTCT sexual and reproductive health male involvement
Committee Chair / Thesis Advisor	Andes, Karen, Emory University
Committee Members	Haddad, Lisa, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International governmental organization (e.g., Agency for International Development, etc.) University, college or educational institution (other than Emory)

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