Women's attitudes toward their partners' involvement in antenatal care and prevention of mother-to-child transmission of HIV in Cameroon, Africa.

INTRODUCTION: Although the HIV epidemic has stabilized worldwide, it remains a public health challenge in sub-Saharan Africa. The key strategy to prevention and control of HIV remains voluntary counseling and testing. In sub-Saharan Africa, 76% of pregnant women have at least one antenatal visit. Therefore, antenatal care is a venue through which women can access HIV testing, and, if infected, obtain care for prevention of mother-to-child transmission (PMTCT). Public health organizations have promoted increasing HIV testing of men by incorporating partner testing into antenatal care. Recent studies have shown that African women may not be receptive to their partner's involvement in obstetric care secondary to cultural attitudes and traditional beliefs. METHODS: A quality improvement project surveyed women to identify their attitudes and beliefs concerning antenatal care, PMTCT, and partner's participation in antenatal care and testing. RESULTS: Women viewed antenatal care as important to having a positive pregnancy outcome and the primary venue through which they accessed HIV testing. Most women (83.8%) were receptive to their partners' involvement in antenatal care and identified increased partner participation over the past 5 years. Women (98.2%) said men's primary role was payment for obstetric care. Cultural and gender-based attitudes and beliefs were identified as barriers to HIV testing of men. DISCUSSION: Women viewed antenatal care as important to a positive pregnancy outcome with access dependent on their families' finances and their partners' ability and willingness to pay for their care. Although pregnancy has traditionally been viewed as a women's affair, the majority of women wanted their partners to participate in their care, including receiving HIV counseling and testing. Women identified men's involvement as an individual belief, saying that many in their community were not supportive of male participation in antenatal care. Multiple options, including couples testing in antenatal clinics, should be available to increase HIV testing in men.

Barriers to men's participation in antenatal and prevention of mother-to-child HIV transmission care in Cameroon, Africa.

INTRODUCTION: Men's role in HIV prevention is pivotal to changing the course of the epidemic. When men participate in Prevention of Mother-to-Child Transmission (PMTCT) programs, their knowledge of HIV increases, their behavior becomes supportive, and their receptiveness to HIV testing increases. In Cameroon, Africa, multiple efforts have been implemented that encourage men to "follow" their wives to obstetric/PMTCT care and to undergo HIV testing. However, only 18% of men have participated in this care. METHODS: As a quality improvement initiative, a survey was administered to identify men's knowledge and attitudes regarding antenatal care (ANC), PMTCT, and HIV. The survey consisted of a questionnaire with an emphasis on identifying barriers to men's participation in PMTCT programs and obtaining HIV testing. A convenience sampling method was used, and no participant identifying information was collected. RESULTS: Men's participation in ANC/PMTCT is affected by sociocultural barriers centered in tribal beliefs and traditional gender roles. The barriers identified included the belief that pregnancy is a "woman's affair"; the belief that a man's role is primarily to provide financial support for the woman's care; the man's perception that he will be viewed as jealous by the community if he comes to clinic with his pregnant wife; and cultural gender-based patterns of communication. DISCUSSION: Most men consider accompanying their wife to ANC/PMTCT a good practice. Yet fewer men actually do this, because they feel that the provision of finance for ANC registration and delivery fees is their most important role in supporting their wife's pregnancy. Health care workers should encourage individuals and community leaders to build upon the traditional value of financial responsibility, expanding a man's involvement to include supportive social roles in obstetric care, PMTCT, and HIV testing.