'Male involvement in PMTCT vital'

EVERY beautiful morning, husband and wife, Samuel and Natalie take turns jogging around an open field near their home in Kuwadzana Extension, a high density suburb in Harare.

They also take turns to watch Chiratidzo, their 12-month-old daughter, who is always a spectator to her parents’ daily practise.
“We take turns to jog as well as watch Chichi. Then we exercise together to stay fit,” said Natalie.

She added: “We are both HIV-positive and we practice together to stay fit and healthy. Exercising as well as eating a balanced diet is an important part of our lives as we are living positively with HIV.”

Natalie met Samuel two years ago when she went to Kuwadzana Council Clinic to take a pregnancy test. “After discovering that I was expecting, two nurses urged me to take an HIV test. Before the test, I was counselled by Samuel, who is an HIV/Aids activist, and in the process, we struck up a relationship that changed our lives,” she said.

Samuel chipped in: “When I first met Natalie, she was afraid to be HIV-positive. I spoke to her about how we could help her stay healthy. I also explained to her that the baby could be born HIV-negative.”

He added: “When the positive result came in, Natalie was put on the prevention of mother-to-child transmission of HIV (PMTCT) — an essential programme for reducing the risk of HIV infections, both for couples as well as their unborn babies.”

According to Samuel, Natalie was given antiretroviral prophylaxis (Option B) throughout her pregnancy as well as at delivery to reduce the risk of early mother-to-child transmission, and thank God, Chiratidzo was born healthy and HIV-negative.

Vimbainashe Changwara, a health practitioner, says the majority of pregnant women who test positive for HIV are provided with treatment to protect themselves and their babies during pregnancy as well as delivery.

“The PMTCT programme ensures babies born to HIV-positive mothers are born HIV-negative. Also, their mothers receive treatment to stay fit and healthy,” she said.

Changwara added: “HIV-positive women must adhere to the standard rules of PMTCT such as exclusive breastfeeding. They also need moral support from their partners.”
However, there are very few men like Samuel as male involvement in prevention of mother to child transmission is significantly lagging behind in Zimbabwe.

Nationwide, male involvement in PMTCT programmes stands at less than 30 percent, leaving most mothers without their partners’ support.

Sally Dura, a gender expert and women’s right activist, attributes this to negative perceptions about PMTCT. “There are still perceptions about PMTCT being a responsibility of women in terms of its title.

“ This presents a barrier to men taking interest. Mostly women when they go for antenatal clinic, their husbands are at work and in the end service providers engage with them only with their partners not being involved to understand and appreciate the concept of PMTCT,” she said.

The World Health Organisation (WHO) notes that barriers to men’s participation include fear of knowing one’s status, stigma and discrimination.

WHO notes: “Perhaps the most significant obstacles are the conceptual and policy barriers that inadvertently support men’s exclusion from PMTCT and other reproductive health services.
“The historic institutionalisation of reproductive health as women’s health has contributed to men’s perception of clinic spaces as “women’s spaces”, and reproductive health as women’s work, and has generally produced health services that are not welcoming of men and couples.”

Zimbabwe Association of Doctors for Human Rights chairperson Rutendo Gwendoline Bonde believes the government as well as institutions that provide health care, whether private or public, must do away with patriarchal perceptions and view men as constituent parts of reproductive health policy.

“Most policies reflect patriarchy, but it is time society sees men as partners as well as agents of change when it comes to PMTCT programmes. A radical re-orientation is, therefore, needed,” said the medical practitioner.

Echoing same sentiment, national co-ordinator for PMTCT and Pediatric HIV care and treatment in the ministry of Health and Child Care Angela Mushavi added that there was need to strategise and increase male participation in PMTCT programmes.

She said engaging traditional leaders is necessary to secure the involvement and support of men in all aspects of health as well as PMTCT programmes.

“Traditional leaders are critical stakeholders in the fight against HIV as they are integral in mobilising, raising awareness and encouraging people in their communities to take up HIV testing.
Accordingly, engaging them, especially at a rural set-up where their presence is felt, is essential in ending HIV,” she said.
To increase participation and involvement of men, Dura believes that there is need for research to ascertain the perceptions, challenges and barriers to men’s active and full participation in PMTCT programmes.

She added: “Government and other stakeholders should continue advocating that the title be “Prevention of Parent to Child Transmission”.

Dura also recommends the development of men friendly Information, Education and Communication materials
Chief of Party, Organisation for Public Health Interventions and Development (OPHID) Trust Patricia Mbetu says policies such as WHO guidelines and the Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe, govern the prevention of mother to child transmission and adherence at national level is high as comprehensive PMTCT services are currently provided in 95 percent of the 1 560 health facilities in the country.

She added that a toolkit has been developed to guide male involvement in PMTCT and paediatric care as well as to train male mobilisers.

According to Bonde, the ministry of Health and Child Care’s policies, strategies and guidelines such as the Zimbabwe National HIV and Aids Strategic Plan (ZNASP) — 2011-2015 and the National Health Strategy 2011-2015 are quite sound.
However, Bonde said, there is need for resources.

“Community mobilisation as well as supporting uptake of PMTCT services and promoting adherence to treatment also need to be ramped up in line with the 2013 WHO PMTCT guidelines,” Bonde said.

According to her, government needs to support organisations such as Padare/Enkundleni/Men’s Forum on Gender and MenEngage, among others, in their male engaging programmes. 
“Padare is leading the way in urging men to participate in social and health issues. Sadly, it is a lone voice. Therefore, the government needs not only to support Padare as well as MenEngage, but also to learn from its programmes,” she noted.
To eliminate new HIV infections among children, and at the same time keeping mothers alive, Bonde urged the government to continue supporting PMTCT as well as encouraging men to participate in such programmes.—Lazarus Sauti

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