Magister Public Health - MPH / Background: Although great strides have been made in reducing mother-to-child transmission of HIV (MTCT) in Namibia, the universal target of less than 5% by 2015 has not yet been achieved. In an effort to scale-up services in the programme, a comprehensive family centred approach which broadens HIV prevention activities and considers HIV as a family disease was instituted. However its success has been affected by low male partner participation in the programme. Study aim: To investigate factors influencing male partner involvement in MTCT-plus programme in Gobabis District, Omaheke Region, Namibia. Study design and data collection: This was a cross sectional descriptive study that wasconducted using a qualitative research methodology. Data was generated through focus group discussions (FGDs) and in-depth interviews. Four same sex FGDs were conducted with men and pregnant women. The study participants were HIV positive pregnant women and HIV positive women in their postnatal period purposefully selected from the PMTCT clients. A few male participants were partners of the female participants and other men conveniently sampled from the community. Seven in-depth interviews were conducted to gather information from key informants who were programme managers and midwives. Thematic analysis was used for the data analysis. Results: Men were generally knowledgeable and appreciated the importance of participating in the MTCT-plus programme but the majority of them did not participate. They cited several barriers to actively supporting their partners. Men‘s participation in the MTCT-plus programme was affected by lack of trust in the health workers and cultural practices that shift the role of taking care of their partners to the biological parents. The other barriers included HIV related stigma, unfriendly environment at the antenatal care clinics, time and work related constraints, having many sexual partners and gender and power imbalances in relationships that affect patterns of communication on HIV related matters. Discussion: Participation in the MTCT-plus programme is well supported by men. However, few men put this into practice because of complexities surrounding their specific role in women reproductive health issues, as well as cultural practices and health facilities organizational structures that preclude men from participation in the MTCT-plus programme. Given the positive attitude by men towards participation in this programme, creating a male friendly space within the MTCT-plus programme and empowering men to participate in them should be prioritized for the programme to achieve its goals.

Thesis advisor: Shanta Pandey / A growing body of literature, particularly from low and middle-income countries, has focused on the role of male involvement in maternal care as a crucial strategy to improve maternal and neonatal health outcomes. The purpose of this three-paper dissertation is to add to this evidence base within the context of India, and to gain an in-depth understanding of one aspect of male involvement – that is, male partner attendance in antenatal care. This dissertation utilized data from the National Family Health Survey (NFHS-3, 2005-06 and NFHS-4, 2015-16) and was framed using the Social Ecological Model, Connell’s Theory of Gender and Power and a Gender-Transformative lens. Paper 1 summarized the levels of male partner attendance in antenatal care and assessed changes over time. Further, multivariable logistic regression models were used to examine the factors influencing male partner attendance in antenatal care. The results show an overall increase in male partner attendance in India during the period of 2005-06 to 2015-16, with the Southern region reporting the highest level of male partner attendance in both years. Higher level of education and household wealth, increased knowledge of pregnancy-related complications, older age at marriage, and women’s autonomy were positively associated with male partner attendance in antenatal care. Paper 2 examined the association between male partner attendance in antenatal care and maternal health service utilization. Controlling for all socio-demographic variables and adjusting for report of pregnancy complications, the results showed that women who were accompanied by a male partner for antenatal care reported increased odds of maternal health service utilization (early initiation of antenatal care, frequency of antenatal care contacts and institutional delivery). While the place of residence (rural/urban) did not influence the association between male partner attendance and maternal health service utilization, region had a significant moderating effect. Paper 3 examined the association between antenatal care and infant birth weight, adjusting for gestational age. Further, the analysis also assessed whether the relationship between antenatal care and infant birth weight varied by male partner attendance. Findings indicate that early initiation of antenatal care and maternal immunization was associated with reduced odds of low birth weight among infants. The results showed that male partner attendance in antenatal care did not have a moderating influence. Taken together, the findings of the three papers have implications for policy and practice; further, they provide support for interventions that aim for a more inclusive and gender-transformative approach to maternal and neonatal health. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social work.

Background: Non-disclosure of HIV positive status to a partner threatens to reverse gains made in prevention of mother-to-child transmission (PMTCT) in resource limited settings. Determining the association between non-disclosure and infant HIV acquisition is important to justify focussing on disclosure as a strategy in PMTCT programmes. Objective: To determine the association between non-disclosure of HIV positive status to a partner and mother-to-child transmission (MTCT). Methods: Using a matched case-control design, we compared 34 HIV positive infants to 146 HIV negative infants and evaluated whether the mothers had disclosed their HIV status to their partner. Results: Non-disclosure was more frequent among cases (overall, 16.7%; cases, 52.8%; controls 7.6%), p<0.001 and significantly associated with MTCT (aOR 8.9 (3.0-26.3); p<0.0001), with male partner involvement partially mediating the effect of non-disclosure on MTCT. Conclusions: There is a need for PMTCT programs to focus on strategies to improve male partner involvement and partner disclosure without compromising the woman’s safety. / Health Studies / M. (Public Health)

Background: Non-disclosure of HIV positive status to a partner threatens to reverse gains made in prevention of mother-to-child transmission (PMTCT) in resource limited settings. Determining the association between non-disclosure and infant HIV acquisition is important to justify focussing on disclosure as a strategy in PMTCT programmes. Objective: To determine the association between non-disclosure of HIV positive status to a partner and mother-to-child transmission (MTCT). Methods: Using a matched case-control design, we compared 34 HIV positive infants to 146 HIV negative infants and evaluated whether the mothers had disclosed their HIV status to their partner. Results: Non-disclosure was more frequent among cases (overall, 16.7%; cases, 52.8%; controls 7.6%), p<0.001 and significantly associated with MTCT (aOR 8.9 (3.0-26.3); p<0.0001), with male partner involvement partially mediating the effect of non-disclosure on MTCT. Conclusions: There is a need for PMTCT programs to focus on strategies to improve male partner involvement and partner disclosure without compromising the woman’s safety. / Health Studies / M. (Public Health)