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Working with Men to Improve PMTCT Outcomes - Emerging Approaches

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  • Medley, Garcia Moreno, Maman et al: 10 country study on VCT and disclosure. The proportion of women reporting violence as a reaction to disclosure ranged from 3.5% to 14.6%. The true incidence of violence related to HIV status disclosure was hard to determine from these studies, as there were no base rates of violence obtained at the beginning of the studies. Furthermore, most studies did not define violence or describe its severity, therefore making direct comparisons across studies difficult. Interestingly, several studies mentioned that fear of consequences such as abandonment, violence and discrimination were major barriers to disclosure. When the study participants were asked the outcomes of disclosure, however, these fears were seldom realized among women who chose to disclose their status. In Kilewo's study from the United Republic of Tanzania, 46.4% of women who did not disclose their HIV status to their partners reported that fear of divorce was a major barrier to disclosure, but 91.7% of women who did disclose their results reported that their relationship continued afterwards ( 11 ). Heyward found a similar trend in Kinshasa: 63% of women who did not disclose their HIV status reported fear of divorce as the major barrier, yet, 12 months after disclosure, no woman in the study reported divorce or separation ( 17 ). This finding can mean one of two things. It may mean that only women who are confident in the safety and strength of their relationship actually disclose their results, and women who are less confident choose not to. It could also mean that women perceive the risk of a negative outcome to be more likely than it is in fact.
  • Medley, Garcia Moreno, Maman et al: 10 country study on VCT and disclosure. The proportion of women reporting violence as a reaction to disclosure ranged from 3.5% to 14.6%. The true incidence of violence related to HIV status disclosure was hard to determine from these studies, as there were no base rates of violence obtained at the beginning of the studies. Furthermore, most studies did not define violence or describe its severity, therefore making direct comparisons across studies difficult. Interestingly, several studies mentioned that fear of consequences such as abandonment, violence and discrimination were major barriers to disclosure. When the study participants were asked the outcomes of disclosure, however, these fears were seldom realized among women who chose to disclose their status. In Kilewo's study from the United Republic of Tanzania, 46.4% of women who did not disclose their HIV status to their partners reported that fear of divorce was a major barrier to disclosure, but 91.7% of women who did disclose their results reported that their relationship continued afterwards ( 11 ). Heyward found a similar trend in Kinshasa: 63% of women who did not disclose their HIV status reported fear of divorce as the major barrier, yet, 12 months after disclosure, no woman in the study reported divorce or separation ( 17 ). This finding can mean one of two things. It may mean that only women who are confident in the safety and strength of their relationship actually disclose their results, and women who are less confident choose not to. It could also mean that women perceive the risk of a negative outcome to be more likely than it is in fact.
  • Transcript

    • 1. Working with men to improve PMTCT outcomes. Emerging Approaches International AIDS Society Meeting, Vienna, July 2010 Dean Peacock, Sonke Gender Justice Network
    • 2. Examples of emerging approaches
    • 3.
      • Solid evidence that interventions can bring about positive gender and HIV related changes amongst men and boys .
      • Stepping Stones: after two years men reported fewer partners, higher condom use, less transactional sex, less substance abuse and less perpetration of intimate partner violence
      • Programme H : participants between four and eight times less likely to report STIs and 2.4 times as likely to use condoms.
      • One Man Can Workshop : 27% tested for HIV soon after the workshop and 2/3rds increased use of condoms.
      • 2007 WHO study of 57 male involvement programmes: 53% of the programs classified as gender transformative were assessed as either promising or effective
    • 4. Men and PMTCT: What are the issues?
      • EngenderHealth Ethiopia: Men as Partners and PMTC (2009).
      • Comparison of pre- and post-intervention data shows that after three months of the male engagement intervention:
        • the number of men coming to the clinic with their partners to test for HIV with their partners jumped by nearly 46% at post-intervention (see Table 1).
        • 87.6% increase in the number of men joining their partners for PMTCT visits.
    • 5.  
    • 6. http://www.brothersforlife.org/video/original.html
    • 7. http://www.brothersforlife.org/video/pmtct_1.html Brothers for Mothers
    • 8. Men and PMTCT: What are the issues?
      • Conclusion:
      • Effective PMTCT requires engagement of men
      • Evidence shows that men can be effectively involved in ways that are good for women, children and men.
      • It is time to act on the evidence and develop interventions and take them to scale.