pregnant women with a written invitation to test for HIV for their male sexual
partners significantly increased the numbers of males attending HIV voluntary
counselling and testing at antenatal clinics (ANC) compared to those invited
for pregnancy information sessions (PIS) in Khayelitsha, a township with a high
HIV prevalence, in Cape Town, South Africa according to Boshishi K. F. Mohlala
and colleagues in a randomised controlled trial published in the advance online
edition of AIDS.
sensitisation activities encouraging male participation were conducted and
antiretroviral therapy was available.
in a Kenyan study the proportion of self-reported intimate partner violence was
small and did not differ between the two groups; for women: 4% (7) in the male
sexual partner voluntary counselling and testing arm (MSP VCT) compared to 7%
(10) in the male sexual partner pregnancy information session (MSP PIS),
p=0.207; for men: 0.5% (1) and 3% (4) for the MSP VCT and MSP PIS, respectively,
authors suggest these numbers may be due to under-reporting.
estimated 2.1 million children under the age of 15 are living with HIV; the
majority of whom were infected perinatally.
the sexual and perinatal transmission of HIV during pregnancy needs communication
and cooperation between partners, note the authors.
many prevention of mother-to-child transmission (PMTCT) programmes men and
their role, they add, isignored.
in many sub-Saharan communities men are the primary decision-makers regarding
health care. For expectant couples this can include the mode of delivery as
well as infant feeding.
counselling is considered an effective strategy to improve the uptake of PMTCT
interventions and minimise adverse outcomes associated with disclosure.
However, few studies have evaluated the effectiveness of engaging male partners
in PMTCT programmes in areas of high prevalence.
in a randomised controlled trial the authors chose to compare a pregnant
woman’s acceptance of a written invitation for VCT or PIS for their male sexual
partners and the consequent effect on the uptake of VCT.
November 2006 to December 2007 pregnant women attending the Site B Midwife and
Obstetrician Unit in Khayelitsha for their ANC booking visit were consecutively
screened for the study. The clinic was chosen because it had facilities for
interviewing men and provided ART.
for enrolment included being less than 30 weeks pregnant and being willing and
able to give informed consent.
the booking visit women were offered antenatal care, HIV group education and
individual VCT. Half were randomly assigned to the MSP VCT arm and the other
half to the MSP PIS.
woman in the MSP VCT and MSP PIS arms was given a written invitation to give to
her sexual partner inviting him the following week to attend ANC and VCT or ANC
and PIS with her, respectively,
couples were interviewed at weeks one and twelve of the two study visits.
in the VCT and PIS arms were offered VCT or PIS, respectively. Men in the PIS arm whose partners tested
positive were offered VCT at the first couple visit. VCT was available to all
who requested it throughout the study.
1000 women in the study accepted the letter and agreed to invite their
partner. No male partner attended the
(175/500) of women given VCT invites were accompanied by their male sexual
partners to ANC compared to 26% (129/500) given PIS invites (RR: 1.36, 95% CI:
(161/175) of male sexual partners who attended ANC because of the VCT invite
had HIV couples testing compared to 44% (57/129) of those who attended PIS.
the Kenyan study only 38% of male partners who went to ANC had couples testing.
Neither community sensitisation nor ART were available in this setting
prompting the authors to suggest these can play a role in increasing couples
a multivariate analysis the VCT invite and a woman’s HIV positive status were
positive predictors of a male sexual partner’s attendance.
their positive status, the authors suggest, may have motivated the women to
encourage their partners to attend. Conversely ART availability may have
motivated the men to take the opportunity to know their HIV status.
authors highlight the importance of their findings: increasing the number of
male sexual partners attending ANC and VCT by inviting them may encourage safer
behaviours; may reduce the number of males having multiple partners; and help
support HIV positive pregnant women to benefit from PMTCT interventions.
benefits include earlier diagnosis and treatment leading to viral load
suppression so reducing transmission.
authors suggest further studies look at whether ANC and VCT can be sustained in
future pregnancies and whether their results can be generalised.
Boshishi KFM et al. The forgotten half of the equation: randomised controlled
trial of a male invitation to attend couple VCT in Khayelitsha, South Africa. AIDS 25 xxx
xxx, doi: 10.1097/QAD.0b013e328348fb85, 2011.