CHAPTER ONE

                                                      INTRODUCTION

1.1Background to the Study

Since the early 1980s when the first case of HIV infection was diagnosed in the United States of America, HIV has grown into a serious global pandemic. The World Health Organisation, (WHO) (2004), says that HIV and AIDS is a serious threat to mankind and its impact will extend to future generations. In the year 2003, about 33 million adults and children were living with AIDS in the world, of which 2.7 million were recorded in 2002 alone, (WHO, 2004).  According to the joint United Nations programme on HIV and AIDS (UNAIDS) and WHO (2004:2), young people, particularly the female ones are at the centre of the global epidemic. A study conducted by the United Nations Population Fund (UNFPA, 2006), indicated that over 1 billion youths (aged 15 to 24 years) worldwide are living with HIV infection.

Among the many ways in which HIV and AIDS is transmitted is from an infected mother to her unborn child – Mother-To-Child-Transmission (MTCT). In Africa about 8 percent of the adult population aged between 15 to 49 years are HIV positive, with estimates of MTCT rates in the range of 25 to 45 percent (UNAIDS/WHO, 2001).

According to the Integrated Biological and Behavioral Surveillance Survey 2010, the HIV prevalence rate in the Nigerian armed forces was 2.5%. Risk factors in the military population include a social climate that is relatively permissive of risky sexual behaviors, deployment demanding frequent travel, during which some soldiers engage in unprotected sex with sex workers or strangers; and injuries and illnesses that risk exposure through blood transfusions.18 The Nigerian Ministry of Defence (NMOD) has 4 components: Army, Navy, Air Force, and civilian NMOD employees. The NMOD medical facilities serve active-duty members, their families, retired members, and civilians in the surrounding communities. Total catchments of patients are estimated at 1.2 million individuals (NMOD, unpublished data). During fiscal year 2010, the collaboration between NMOD and the US Department of Defense HIV Program in Nigeria (DODHPN) continued PMTCT activities at all 20 military facilities supported by the program. A total of 7,256 pregnant women received CT during this reporting period. In addition, 440 of the HIV-positive pregnant women received ARVs to reduce risk of mother-to- child transmission.

1.2 Statement of the problem

According to Global Fund (WHO 2009), HIV transmission from mother-to-child contributes largely to HIV prevalence among children.  The problem has been attributed to lack of male involvement in maternal care, (Msuya et al. 2008). As primary decision makers, men are supposed to be incorporated so that women do not refrain from seeking important health care needs when pregnant, as many believe that issues of HIV counselling and testing should be consensual among couples (NAC, 2009). By being a part of their spouses’/partners antenatal care and HCT programmes, men would learn more and adhere to the health needs of their

families.

Since men are decision makers in most households and relationships, especially marriage; their involvement in antenatal care for their partners would foster a positive adherence to

Knowledge hence treatment of HIV among pregnant women (Rouw, 2002). According to the ZDHS (2007), men have knowledge about PMTCT, but nothing is known about their involvement in practices concerning PMTCT. Hence the importance of this study aimed at assessing levels of male involvement in PMTCT in Nigeria.

One of the reasons of low PMTCT uptake is lack of male involvement (Mutale et al. 2010). This was found out during the study in Cameroun through a campaign to encourage men to accompany their spouses for HIV testing and counselling during their antenatal visits. Examples of Tanzania and Cameroun which show documentation on this subject indicate that where men are fully involved in their spouses’ antenatal care there has not been a challenge in uptake of PMTCT services compared to those women whose men have shunned accompanying their wives for antenatal. According to the World Health Organization, male involvement has been recognized as a priority area of intervention within this woman centered approach (WHO, 2012). Though not fully investigated in Nigeria, in countries where this investigation has been done, data indicate that where PMTCT programmes have involved men positive results have been obtained. Robey et al. (1998), reports that men are accustomed to making reproductive health decisions even without the permission from their wives; for example when to have sex, how many children to have and how many wives to marry. At the community level men have an influence on cultural norms that guide individual and community behavior, such as sexual cleansing and how information about HIV and AIDS is interpreted (ZDHS, 2007). Despite the key roles males have, there is limited documentation to show that men are involved in PMTCT services in Nigeria. It is on this premise that the study was carried out to investigate factors that influence male involvement towards PMTCT in antenatal care of their spouses.

1.3 Research objectives  

1.3.1 General objective

The general objective of this study was to investigate factors that influence men in PMTCT in Uyo metropolis.

1.3.2 Specific objectives

To address the general objective the following specific objectives were examined among others;

1.      To ascertain knowledge of men towards antenatal care of their partners in Lusaka

district.

2.      To examine attitudes of men about PMTCT services in Uyo metropolis.

3.      To establish current levels of male involvement in PMTCT practices in Uyo Metropolis. 

4.      To identify the socio-cultural factors that may influence men’s involvement in

PMTCT practices in Uyo metropolis.

5.      To examine the level of couple counselling in PMTCT.

1.3.3 Research questions

1.      How much do men know about HIV transmission from the mother to her child?

2.      What are the attitudes of men concerning PMTCT services?

3.      To what extent are men involved in PMTCT services in Uyo metropolis?

4.      What social-cultural factors influence men’s involvement in PMTCT?

5.      To what extent do men accompany their spouses for antenatal care and HIV             Counselling and Testing?

1.4 Significance of the study

NAC (2009) reports that one out of 10 new infections of HIV occurs in children aged 0-14 years; of which most are vertical transmissions from mother-to-child. It is argued that some pregnant women do not adhere to PMTCT services when they test positive due to fear of victimisation and abandonment by their spouses and partners alike (Chomba et al. 2011). It is therefore justified that  knowledge on PMTCT must not only be limited to pregnant women who access health facilities during antenatal care, but also improve dissemination of information on MTCT  in order to encourage men access health facilities and thereby encourage their spouses in utility of PMTCT services.

 This study is important in that it sought to investigate knowledge, attitude and practices of men towards PMTCT of HIV. This is because one of the prominent ways of transmission of HIV among infants and children is through vertical transmission from mother-to-child. 

It is with a view that the study will contribute knowledge to the government and health fraternity, and help in influencing the government, stakeholders and partners in framing policies that encourage male participation in PMTCT services as they are very critical. They could start by making Maternal and Child Health (MCH) an all inclusive family health facility so that men fully participate in antenatal care for their spouses. A report by the World Health Organisation (2012:58) says, ‘Perhaps the most significant obstacles are the conceptual and policy barriers that inadvertently support men’s exclusion from PMTCT and other reproductive health services’. With this in place the rate of HIV transmission from mother to child will be reduced or better still halted. This would overall reduce HIV infection in the country.

1.5 Hypotheses

•      Involving men in Prevention of Mother-to-Child-Transmission of HIV will improve utilization of PMTCT services. 

•      Male involvement in Prevention of Mother-to-Child-Transmission will foster positive attitudes towards HIV couple counselling and testing (HCCT) in PMTCT services.

•      Knowledge of HIV transmission among men would encourage their involvement in       

PMTCT services.

1.6 Operational definitions of factors influencing male involvement in PMTCT

In assessing male involvement in PMTC the study assessed different factors as variables. The interplay of these variables has influence on how the men respond to issues pertaining to PMTCT in antenatal of their spouses/partners.

1.6.1 Attitude as a factor influencing male involvement in PMTCT

Socioeconomic status has influence on one’s attitude; these include level of education attained, place of residence and income earned. People exposed to certain environments and those who dwell among the affluent in society would have a different perspective about PMTCT compared to those that are of low socioeconomic status. They could be influenced either negatively or positively as income and education play a very critical role in one’s life. When one has advanced education their understanding of issues in life is different from those with low education (Falnes, et al., 2011). Their thinking is broader whether right or wrong. Similarly, high income levels determine the how, when, where and what kind of health services to acquire compared to not having a choice or alternative due to low or poor income status.

Socio-cultural characteristics are attributes of one’s attitude. How society strives to survive in their environment has to do with their norms and beliefs in life; especially to sex roles and responsibilities. Questions of who should go to antenatal clinic and obtain such services will arise. Some communities view antenatal care and maternal health care as a woman issue and any male involvement would raise suspicion or questions about the man’s behaviour. For some it could be that he is jealous and others would think he is under his wife’s submission.

These too are bound to bring about influence on how society appreciates the utilization of PMTCT. 

1.6.2 Knowledge as a factor influencing male involvement in PMTCT

Knowledge of information is cardinal to PMTCT programmes. People have acquired knowledge about PMTCT from health workers, media and other forms of literature, and this, in some ways, affects their attitudes and practices. One’s age, level of literacy and residence could play a significant role in how they receive and understand this information. Peer influence plays a very important role here. How exposed are they and what is the level of their understanding of issues pertaining to PMTCT? Are they willing to learn more and share, or are they encouraging or discouraging their peers and/or the community to learn more and be positive towards the programme? The government and stakeholders alike, have made efforts to disseminate information to the public in various forms; Information Education

Communication, (IEC) materials. Basing on one’s age, residence and level of literacy one would both learn and adhere or not at all, to the importance of such programmes.

Dr Francois Venter, head of the South African HIV and AIDS clinician’s society, makes the point that government has a critical role to play in increasing men’s use of HIV services

(WHO, 2004). This was in view of the cultural norms that societies seem to still hold on to that maternal health care is a woman issue. NGO’s alone cannot fight the barrier that holds back many men in reproductive and maternal health programmes. As such knowledge, attitude and practices are fundamental to achieving success in male involvement in PMTCT. The efforts of civil society and government are necessary to breaking barriers and achieving success in this programme.

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