Background - The programme of prevention of mother- to-child transmission of
HIV (PMTCT) was rolled out to the entire country in November 2001 after its
launch in April 2000. The role of men had not been clearly defined.
According to the progress report of February 2002 from PMTCT national
coordination unit at family health division ministry of health, countrywide, out of
85% of pregnant women who came for antenatal care (ANC), less than 1% of
these women were accompanied by their partners. However, in Jwaneng, 81%
(526) of women agreed PMTCT counselling for HIV in 2003. Less than 5%
(6/526) of women who agreed to be counseled, were accompanied by their men
since the programme was launched in October 2001 in Jwaneng. In addition,
less than 1% (2/160) of women who tested for HIV came with their partners for
HIV test.
Out of them, 30.5% (160/526) women agreed and tested for HIV. This testing
rate was far less than the national targets of 70%.
Then, 33% (52 women) tested HIV positive and 108 tested HIV negative. Of the
52 HIV positive women, 70% (36 women) joined the PMTCT programme and 4
women did not adhere. Furthermore, of 52 HIV positive women, 60% (32) of
women agreed to receive AZT, adhered and chose one of the recommended
methods of infant feeding.
No study in Botswana had been done in a mining town to establish whether,
there was a need for men to play a role in PMTCT in Jwaneng.
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The researcher did not know whether Jwaneng pregnant women want their men
or family members to come with them for PMTCT services as a motive for easy
acceptance and increase of the programme uptake.
Objectives - The study purpose was to address the following questions: Do men
have a role to play in programme to prevent mother-to-child transmission of HIV?
Is the poor success of the PMTCT programme in Jwaneng due to nonparticipation
of men? To answer the questions, three specific objectives were
formulated. These were to: – 1. To determine men’s knowledge of and
experience with the PMTCT programme in Jwaneng. -2. To determine the
knowledge and experience of women in the PMTCT programme. - 3. To
ascertain men’s and women’s perception of what the role of men in the PMTCT
programme might be.
Design: - In order to achieve the study objectives, two phases were designed.
Phase 1 was descriptive quantitative and qualitative but phase 2 was purely
qualitative (the focus groups discussions). Part of qualitative data was collected
during focus group discussions, while other data from in-depth questions in the
questionnaires from respondents (men and pregnant women).
Settings: - Jwaneng Town at Ditsweletse clinic, Tshimologo clinic and shopping
centres.
Methods: After piloting the questionnaire in Sese village, this study first collected
data from 384 men in Jwaneng shopping centres and 326 pregnant women at
ANC of the local clinics who completed anonymously self-administered
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questionnaires. Data were collected from the socio-demographic characteristics,
knowledge about PMTCT, men’s and pregnant women’s experience, perception
of PMTCT and on what respondents should do to improve men’s involvement in
programme to prevent mother-to-child transmission of HIV in Jwaneng.
In the second phase, the researcher selected 60 men, 48 pregnant women and
18 community leaders who participated in focus groups discussions. 11 focus
groups discussions were conducted: five with men, four with pregnant women
and two with community leaders. Data from these focus groups discussions were
audiotaped, and then recorded.
Results: The findings of this study indicate that men’s and women’s knowledge
of PMTCT is high. That 82% (315/384) of men are aware about the mode of
transmission of HIV to an unborn baby during pregnancy. That, there is an
association between the level of education and men’s knowledge of PMTCT
programme (X2
= 15.09, df = 3, P = 0.001). Men’s knowledge is not all accurate
and perhaps the fact that they get it from media could mean that they do not
understand their involvement. For example, results have shown from
respondents who answered that they knew PMTCT that: only 39% (122/315)
chose artificial milk (formula) as the only method for infant feeding (X2 = 2.05, df
= 3, P = 0.56).
In all 11 focus groups discussions, participants agreed that men are poorly
involved in the programme to prevent mother-to-child transmission of HIV and felt
that men have a role to play. The role of men as perceived in the focus group
discussions was: agreeing to come for counseling, accompanying women for HIV
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results, agreeing to be tested as well for HIV, provide psychosocial and materials
support.
In general, the PMTCT national targets were not met in Jwaneng. 66.7% of
women (217/326) who underwent PMTCT counselling agreed to be tested for
HIV. In addition to that, 77.5% (255/326) women have identified a desire for men
to be involved while 75% (288/384) of men have also identified a desire to be
involved in PMTCT programme.
78% (255/326) of women would like to be accompanied by their partners. The
marital status of pregnant women does not influence their decision to ask their
partner to come (X2
=1.98, df=2, P=0.37). 7.6% of these women did come with
their men.
Both men and women face barriers that block men to get involved in PMTCT in
Jwaneng. Men face the following barriers: 1. Men do not come for PMTCT
services, partly because they are at work and partly because they are afraid of
HIV test and partly feel that government had excluded them in the past. 2. In
addition, Barriers to men’s participation are of different origins: lack of policy
encouraging use of PMTCT services by both partners during normal working
hours, lack of clear message on mutual benefits encouraged by power imbalance
in relationships; multiplicity of sexual partners and lack of support from employers
and labour policies. The success of PMTCT in Jwaneng depends on addressing
these barriers.
At the other hand, women face the following barriers: 1. fear of unpredictable
reactions from men, lack of men’s commitment to health issues and usual
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absence from one another have been blocking the willingness of women to
decide when exposed to PMTCT issues.
One of the much-neglected barriers found during the focus group discussions is
the type of languages used in the fight against the HIV infection by media.
Theses languages give the impression that those who are infected do carry the
enemy to the nation and ipso facto are enemies to everybody. For example:“our
enemy is HIV”, “war against HIV”, “accepting people with HIV”, “disease of
unfaithful people”.
Women lack autonomy to make decisions about HIV testing. Hence they resort to
seeking permission as supported by 20% of men (197) who want to be asked for
permission to test for HIV.
Despite the barriers faced, results showed that 84% (279/333) of men
acknowledged the importance of HIV test andthat men should participate in
PMTCT (OR=23.54, 95% CI: 2.57-8.43, P<0.01). Most interestingly, participants
in all focus groups discussions and 71% (272) of men felt that there would be a
negative impact if men do not participate in PMTCT. Therefore, men and women
should change their attitude towards PMTCT and employers and the government
of Botswana should help by finding solutions to the above-mentioned barriers.
Conclusion – From this study, the researcher has learned that men’s role in
programme to prevent mother-to-child transmission of HIV in Jwaneng needs to
cut across the disciplines and sectors (public, private and NGOs) . Having found
that men have a role to play is not sufficient to make lasting and sustained
improvements. In Jwaneng men, women and community leaders have
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expressed the desire to see fellow men play a participatory role in order to
improve the uptake of PMTCT. Risks of mother-to-child transmission of HIV can’t
be reduced unless barriers to services utilization are addressed through
combined approaches: medical, social, employer-labour regulations and policies.