Male partners of pregnant women influence the health seeking behaviour of their partners. An unsupportive partner may restrict a pregnant woman’s access to prevention of mother to child transmission services. Partner testing can lead to improvements in pregnant women with HIV engaging with prevention to mother to child transmission services as well as the reduced likelihood of future infant infections. Male partner testing also can identify serodiscordancy, where one partner is negative and the other positive, identifying this earlier on can prevent infections. However, partner testing is a challenging task especially in ante-natal settings which have not been developed to be male friendly.
A Tanzanian study found male partner involvement was increased through a number of interventions: written invitations to male partners for antenatal appointments; posters in clinics to encourage male partners to visit the clinic, couples receiving priority appointments, having couple friendly counselling rooms and couples trained counsellors.
Women with HIV worry that disclosing their status to their husband will lead to partner violence and divorce. Couple-oriented post-test HIV counselling provides pregnant women with tools and strategies to invite her partner to HIV counselling and testing. A couple-oriented post-test HIV counselling study done in four countries (India, Georgia, Dominican Republic and Cameroon) found women who underwent couple’s testing did not report more experiences of violence or union break-ups compared to women who had standard (i.e. without partner) HIV testing and counselling. The study did find that couple’s communication and relationship affected the uptake of testing.
Normally, a written invitation for HIV testing and counselling is given to pregnant women to take to their partners. However only less than a third of men who receive this invitation visit the clinic for testing. A study in Kenya found that home visits immediately after the woman’s antenatal appointment increased HIV testing in partners. Similar women in this study were no more likely to experience violence and also reported greater satisfaction in their relationship.
Self testing which is being trialled in Malawi is another initiative to increase testing. Couple self testing has been found to be acceptable and couples choose this option for a number of reasons: self testing can provide an opportunity to disclose a previously known status, mistrust or risky behaviour or to test whether a remedy (herbal or prayer) has been effective in “curing”.
The benefit of couples being aware of their status and sharing their results is they can support each other, whether one or both partners are HIV-positive, they can held each other adhere to treatment and or assist each other with engaging with prevention of mother-to-child transmission services.