Perspectives of pregnant women living with HIV on their partner’s involvement with antenatal care
Study in Haiti finds that half the women living with HIV said their partner supports them during pregnancy, but only one in four men attend antenatal appointments
For pregnant women living with HIV, the involvement of partners in antenatal care, which includes prevention of mother-to-child transmission (PMTCT) of HIV services, can help women take up and stay on antiretroviral treatment (ART). This not only benefits the woman’s health, it can prevent HIV passing to their baby. But despite the benefits of involving men, many PMTCT programmes focus on women.
Most studies examining male involvement in PMTCT programmes have focused on African countries. But in 2018 researchers carried out a study on the issue in Saint-Marc, Haiti. They asked 128 pregnant women living with HIV attending antennal care to answer a questionnaire on how involved their partner was in their pregnancy, and 102 completed it. Six of the women were also interviewed about why men might or might not get involved.
The level of involvement of male partners was measured against six activities. Around half (47%) had a high level of involvement, which means they were involved in at least four out of six of these activities.
The activity that had the highest score for partner involvement was providing financial support during pregnancy. This includes paying for medicine or transport to the clinic. 90% of women said their partner did this.
Around 82% of women said their partner was aware of antenatal appointments, 73% discussed topics relating to the pregnancy (such as delivery), and 61% showed an interest in what happened during antenatal visits. But only 25% of men actually went with their partner to appointments.
Lack of time was the main reason interviewees gave on why men tended not to go to antenatal appointments. Clinic hours often clashed with men’s work schedules, and waiting times for appointments were too long.
Another reason for a lack of support was the view that antennal care is ‘women’s business’. Interviewees said some health professionals reinforced this view by not inviting men to appointments or excluding them during visits.
Haitian men’s reluctance to go to hospital was also seen as a reason why men might not go to an antenatal clinic. Interviewees said men tended to go to hospital only when they were very ill. Attending hospital at the request of a partner was unlikely.
An important finding is that four out of five couples (81%) did not routinely use a condom when having sex while pregnant. This increases the risk that a treatment-resistant strain of HIV could be transmitted between partners if either or both is living with HIV but is not on effective treatment. It also increases the risk of mother-to-child transmission.
Partners who were living with HIV were more likely to be involved in antenatal care than other men. Being married was also associated with male involvement, as was a woman telling her partner she was living with HIV.
This study has some limitations. Most notably, it presents male involvement from the perspective of women rather than men. The sample size is also small. It is possible that the women who participated had a better experience of partner involvement than those who declined to take part.
Despite these limitations, the findings may help PMTCT programmers in Haiti develop initiatives that encourage more men to support their pregnant partners. Encouraging men to accompany their partners to antenatal appointments and using condoms will improve health outcomes for each partner and their unborn child.