UGANDA: Unfriendly Nurses and Culture Hinder Male Involvement in HIV Prevention

By MBALE, Uganda
Wambi Michael, Aug 26 (IPS) Irene Wangolo was advised to take an HIV test
during her antenatal visit and to return to the clinic with her husband so
they could be counselled on preventing HIV transmission to their unborn
baby.

But her husband refused to accompany her saying it was not his business
and Wangolo never returned to the clinic in Bungokho in eastern Uganda. So
she missed all the services, including the prevention of mother-to-child
transmission (PMTCT).

But Wangolo’s experience is similar to what many other pregnant
women in Uganda face when it comes to accessing PMTCT services.
Robina Kaitirimba from the NGO National Coordinator of Uganda National
Health Users/Consumers Organisation told IPS that failure to reach sexual
partners of HIV-positive women still remains the biggest barrier to PMTCT
in Uganda.
Male participation in PMTCT in Uganda stands at just five percent
according to Kaitirimba.

Dr. Robert Byamugisha, lead author of the study "Determinants of male
involvement in the prevention of mother-to-child transmission of HIV
programme in Eastern Uganda", said reasons for men not attending
antenatal clinics with their spouses included cultural beliefs and
economic reasons.

Accepted for publication in the Reproductive Health journal in June, the
study also found that men felt the set up of antenatal clinics were not
male user-friendly. Men had also been reluctant to attend because they
found the midwives impolite.
"Nurses and midwives should become friendlier to the mothers in
antenatal clinics than they are at the moment," one man had
suggested.

Titus Namanda only ever accompanied his wife once to an antenatal clinic
during her first pregnancy. He vowed never to go back because of the way
midwives treated his wife and other pregnant women.
"I love my wife and I always ride her to the clinic up to now. They
made me wait for three hours and I witnessed them abusing my wife and
other women. I decided not go back," said Namanda, who lives in
Bunghokho village in Mbale district, eastern Uganda.

Byamugisha acknowledged that midwives were rough with pregnant mothers.
"In some instances they did not allow men to enter with their
pregnant wives to the clinics," Byamugisha said.

Uganda was one of the pioneers of PMTCT programmes in Africa in 2000.
Services are now available at most county-levels in over 80 districts. But
statistics from the country’s health ministry indicate that while
almost all women who attended clinics agreed to HIV testing and
counselling, only two-thirds returned for their results. Of those who
tested HIV-positive, only 17 percent returned to hospitals to deliver.

Uganda currently has over 110,000 children living with HIV/AIDS and
continues to register about 25,000 new infections annually. Most children
are infected at birth according to Dr. Zainab Akol, the health
ministry’s head of HIV/AIDS programmes.
"That is why we want the mothers to test with their partners.
Sometimes they get infected later on during the pregnancy. During
counselling and testing, we are able to inform both parents on responsible
behaviour in order to save their unborn (child)," she said.

"In our cultures, when a woman is pregnant, men tend to go out
(cheat) not knowing they risk not only themselves, but also the lives of
their wives and the unborn child," explained Akol.

But financial constraints were also a reason for men not being involved in
PMTCT services. While the study found that 97 percent of men interviewed
provided financial support so their spouses could attend antenatal
clinics, many said they lacked either time or money to become involved in
PMTCT programmes themselves.

Mutwalibu Wambete a husband and father of two told IPS that he would
rather spend his time earning an income for his family then attending an
antenatal clinic.
"I hire this motorcycle from a rich man to carry passengers and earn
money. The owner requires me to pay five dollars a day. So if I spend time
at the clinic then we shall go hungry and the children will not go to
school," he explained.

Dr. Wilfred Ochan, head of Strategic Planning and Management at the Baylor
College of Medicine Children’s Foundation agreed that men play a
major role in reproductive health decisions in Uganda.
He explained that men have the power to determine which clinic their wives
will go to but added that many PMTCT services were focused mostly at
women.
"Traditionally, sexual and reproductive health services that include
PMTCT have focused mostly on women, yet many observers have emphasised
that the knowledge, attitudes, behaviours and health of men often play a
critical role in determining the reproductive health of women."

Ochan told IPS that the number of children being infected by their mother
would have been lower if all pregnant women who tested positive returned
to deliver in hospitals.
Dr Phillipa Musoke, the chairperson of the Department of Paediatrics and
Child Health, at Uganda’s Makerere University told IPS that cultural
beliefs, social stigma and poor health services have been some of the
factors why women preferred delivering at home despite this being a risk
to the life of their unborn child.

But not all men have turned down the call to escort their wives to
antenatal clinics. At Tororo Regional Hospital in eastern Uganda, Salim
Kato sat besides his wife amidst 40 other pregnant women.
Kato told IPS that he believed he had a responsibility to ensure that his
wife gives birth to a healthy baby.

"The good thing with midwives here is that they handle my wife first
whenever I come with her. So I save my wife from sitting for too long when
I come along with her," said Kato.

Kato and his wife initially tested negative for HIV but have returned for
a confirmation test as recommended by the country’s PMTCT
guidelines.

A senior nurse at the hospital who asked for anonymity because she was not
authorised to speak to journalists told IPS that most of the men attend
the clinic with their wives want to be attended to in privacy
"So on top giving them priority when they come with their wives, we
have improvised a room where we talk to the couple in privacy. And it
seems to be working" she said.