2012 GLOBAL REPORT
10 Box 10.1. Improving integration and increasing the involvement of men in reproductive, maternal, child and newborn health services The involvement of men in the health of their families, whether as fathers or sexual partners, is now acknowledged to have beneficial effects (13–15). Providing services jointly to partners, instead of separate individuals, is associated with behaviour change to protect the uninfected partner and can significantly reduce the risk of HIV transmission (15). Many countries are therefore experimenting with various strategies to strengthen opportunities for engaging men within service delivery (16,17). Efforts are being made in numerous situations to integrate services for men into reproductive, maternal, newborn and child health services. Increasing the number of male health personnel providing HIV services, offering men’s services in parallel with reproductive, maternal, newborn and child health services and providing services for couples are all examples of innovative and promising initiatives. Studies in Rwanda and Zambia (18,19) have shown that the engagement of men was associated with a two thirds reduction in the number of people newly infected with HIV. Where couples counselling is offered, it must be sensitive to the needs of the women who may be deterred by the “requirement” that their husbands or partners attend with them. Similarly, programmes need to be sensitive to the fact that some pregnant women may not have partners. In an effort to improve HIV services for men while expanding services to prevent mother-to-child transmission, Rwanda has developed a family package of support. The integrated package of services is in accordance with national strategies to prevent children from acquiring HIV infection but also emphasizes the participation of men and encourages male partners to participate in HIV counselling and testing. Elements of the campaign include: •
promoting HIV counselling and testing for couples as a national strategy;
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mobilizing communities with local authorities and community health-care workers;
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building the capacity of health care personnel on HIV counselling and testing for couples;
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organizing weekend HIV counselling and testing sessions for partners who are not available on weekdays; and
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introducing invitation letters for male partners.
The family package approach has been credited with a dramatic increase in couple testing, from a national average of 33% of male partners being tested in 2005 to 78% in 2008. The number of couples tested through the programme for preventing mother-to-child transmission increased from 58 700 in 2005 to 229 200 in 2008. Within the programme, HIV testing coverage increased from 10% of the total number of expected pregnant women in 2002 to 50% in 2005 and 75% in 2008. The prevalence of HIV among pregnant women and their male partners also declined: from 9.1% in 2003 to 3.0% in 2008 among pregnant women and from 10.2% in 2003 to 3.1% in 2008 among male partners (20). A study of 456 pregnant women living with HIV and 140 partners in Kenya (21) showed that the women with a male partner attending at antenatal care had a 45% lower combined risk of the infant acquiring HIV infection or dying among compared with those with no male partner attending.
Integration
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