Assessment of Peer-Based and Structural Strategies for Increasing Male Participation in an Antenatal Setting in Lilongwe, Malawi

Steve M. Mphonda, Nora E. Rosenberg, Esmie Kamanga, Innocent Mofolo, Gertrude Mwale, Edson Boa, Mwawi Mwale, Francis Martinson, Irving Hoffman, Mina C. Hosseinipour


In sub-Saharan Africa, although male involvement in antenatal care is associated with positive outcomes for HIV-infected women and their infants, men rarely accompany female partners. We implemented a project to increase the number of male partners attending an antenatal clinic at Bwaila Hospital in Lilongwe, Malawi. We evaluated changes in the proportion of women who came with a partner over three periods. During period 1 (January 2007 – June 2008) there was didactic peer education. During period 2 (July 2008 – September 2009) a peer-led male-involvement drama was introduced into patient waiting areas. During period 3 (October 2009 – December 2009) changes to clinical infrastructure were introduced to make the clinic more male-friendly. The proportion of women attending ANC with a male partner increased from 0.7% to 5.7% to 10.7% over the three periods. Peer education through drama and male-friendly hospital infrastructure coincided with substantially greater male participation, although further gains are necessary. Afr J Reprod Health 2014; 18[2]: 97-104).


Keywords: HIV, antenatal, male involvement, HIV counseling and testing, disclosure, prevention of mother to child transmission, couple



En Afrique subsaharienne, bien que la participation des hommes aux soins prénatals soit  associée à des résultats positifs pour les femmes atteintes du VIH et leurs nourrissons, les hommes accompagnent rarement les partenaires féminins. Nous avons mené un projet qui vise à augmenter le nombre de partenaires masculins fréquentant une clinique prénatale à l'hôpital Bwaila à Lilongwe, au Malawi. Nous avons évalué les changements dans la proportion de femmes qui sont venues avec un partenaire au cours des trois périodes. Au cours de la période 1 (janvier 2007 - juin 2008) il y avait l'éducation didactique destiné aux pairs. Au cours de la période 2 (juillet 2008 - septembre 2009) une pièce de théâtre qui engageait les hommes et dirigé par les pairs a été introduit dans les zones d'attente des patients. Pendant la période 3 (octobre 2009 - décembre 2009) on a apporté des changements au niveau de l'infrastructure clinique pour rendre la clinique plus respectueuse des hommes. La proportion des femmes fréquentent la CPN avec un partenaire masculin a augmenté de 0,7% à 5,7 % à 10,7 % au cours des trois périodes. L’éducation des pairs à travers le théâtre et l'infrastructure de l'hôpital qui est soucieux des hommes coïncidait avec une plus grande participation des hommes, bien que de nouveaux gains soient nécessaires. Afr J Reprod Health 2014; 18[2]: 97-104).


Mots-clés: prénatals,  participation des hommes,  conseil et dépistage du VIH,  divulgation, prévention de la transmission de la mère à l’enfant, couple 

Full Text:



UNAIDS. Global Report: UNAIDS Report on the Global Epidemic 2012.

WHO/UNAIDS/UNICEF. Global Response to HIV/AIDS: Epidemic Update and Progress towards Universal Access 2011.

Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr 2004; 37(5):1620-6.

Rosenberg NE, Pettifor AE, Bruyn GD, Westreich D, Delany-Moretlwe S, Behets F, et al. HIV Testing and Counseling Leads to Immediate Consistent Condom Use Among South African Stable HIV-Discordant Couples. J Acquir Immune Defic Syndr 2013;


Mbonye AK, Hansen KS, Wamono F, Magnussen P.

Barriers to prevention of mother-to-child transmission of HIV services in Uganda. J Biosoc Sci 2010; 42(2):271-83.

Lingappa JR, Lambdin B, Bukusi EA, Ngure K, Kavuma L, Inambao M, et al. Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial. PLoS One 2008;3(1):e1411.

Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet 2008;


Maman S, Mbwambo J, Hogan NM, Kilonzo GP, Sweat M. Women's barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing. AIDS Care 2001;13(5):595-603.

Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ 2004;


National Statistical Office and ICF Macro. Malawi Demographic and Health Survey 2010. Zomba, Malawi and Calverton, Maryland, USA: 2011.

Becker S, Mlay R, Schwandt HM, Lyamuya E. Comparing couples' and individual voluntary counseling and testing for HIV at antenatal clinics in Tanzania: a randomized trial. AIDS Behav


Byamugisha R, Astrom AN, Ndeezi G, Karamagi CA, Tylleskar T, Tumwine JK. Male partner antenatal attendance and HIV testing in eastern Uganda: a randomized facility-based intervention trial. J Int AIDS Soc 2011;14:43.

Mohlala BK, Boily MC, Gregson S. The forgotten half of the equation: randomized controlled trial of a male invitation to attend couple voluntary counselling and testing. AIDS 2011;25(12):1535-41.

Wall K, Karita E, Nizam A, Bekan B, Sardar G, Casanova D, et al. Influence network effectiveness in promoting couples' HIV voluntary counseling and testing in Kigali, Rwanda. AIDS 2012;26(2):217-27.

Wall KM, Kilembe W, Nizam A, Vwalika C, Kautzman M, Chomba E, et al. Promotion of couples' voluntary

HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents. BMJ Open 2012;2(5).

Early end for FEM-PrEP HIV prevention trial. AIDS Patient Care STDs 2011;25(6):383.

Auvinen J, Kylma J, Suominen T. Male Involvement and Prevention of Mother-to-Child Transmission of HIV in Sub-Saharan Africa: An Integrative Review. Curr HIV Res 2013;11(2):169-77.

Morfaw F, Mbuagbaw L, Thabane L, Rodrigues C, Wunderlich AP, Nana P, et al. Male involvement in prevention programmes of mother to child transmission of hiv: a systematic review to identify barriers and facilitators. Systematic Reviews 2013;2(1):5.

The Rose Project, accessed 04/23/2013. Available from:

Msuya SE, Mbizvo EM, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care 2008;20(6):700-9.

Desgrees-Du-Lou A, Brou H, Djohan G, Becquet R, Ekouevi DK, Zanou B, et al. Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV preventive attitude among couples. Abidjan, 2002-2005. AIDS Behav 2009;13(2):348-55.

Aarnio P, Olsson P, Chimbiri A, Kulmala T. Male involvement in antenatal HIV counseling and testing: exploring men's perceptions in rural Malawi. AIDS Care 2009; 21(12):1537-46.

Kelly JA. Popular opinion leaders and HIV prevention peer education: resolving discrepant findings, and implications for the development of effective community programmes. AIDS Care 2004;16(2):139-50.

Farquhar C, Mbori-Ngacha DA, Bosire RK, Nduati RW, Kreiss JK, John GC. Partner notification by HIV-1 seropositive pregnant women: association with infant feeding decisions. AIDS 2001;15(6):815-7.

Kalembo FW, Zgambo M, Mulaga AN, Yukai D, Ahmed NI. Association between Male Partner Involvement and the Uptake of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Interventions in Mwanza District, Malawi: A Retrospective Cohort Study. PloS One 2013;8(6):e66517.

Schouten EJ, Jahn A, Midiani D, Makombe SD,

Mnthambala A, Chirwa Z, et al. Prevention of motherto-child transmission of HIV and the health-related Millennium Development Goals: time for a public health approach. Lancet 2011;378(9787):282-4.

Kennedy CE, Medley AM, Sweat MD, O'Reilly KR. Behavioural interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis. Bull World Health Organ


Cohen MS, Chen YQ, McCauley M, Gamble T,

Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365(6):493-505.

Njunga J, Blystad A. 'The divorce program': gendered experiences of HIV positive mothers enrolled in PMTCT programs - the case of rural Malawi. Int Breastfeed J 2010;5:14.

Brusamento S, Ghanotakis E, Tudor Car L, vanVelthoven MH, Majeed A, Car J. Male involvement for increasing the effectiveness of prevention of mother-to-child HIV transmission (PMTCT) programmes. Cochrane Database Syst Rev 2012;10.

Rosato M, Laverack G, Grabman LH, Tripathy P, Nair N, Mwansambo C, et al. Community participation: lessons for maternal, newborn, and child health. Lancet 2008;372(9642):962-71.


  • There are currently no refbacks.