Gender Factors Influencing Participation in the Elimination of Mother-to-Child Transmission of HIV Program in Uganda under Option B+

Author(s): Yourkavitch J, Flax VL, Okello ES, Katahoire AR

Year: 2017

Abstract:

In Uganda and other sub-Saharan African countries, women’s gender roles center on marriage and motherhood. According to these roles, women’s duties include caring for other members of the household, tending to household chores, and caring for the sick. Women are expected to consult with their husbands and obey their husbands’ decisions in all matters. A man’s primary role is to be the head of the family. Men are expected to bring in income to pay for shelter, food, and school, and they are expected to represent the family. Unlike women, who are expected to be faithful or monogamous, men are expected to have multiple partners (wives or girlfriends), thus signaling their masculinity. As other investigators have observed, these gender roles interfere with HIV prevention efforts. Gender roles may also constrain women’s access to health services, including those for the prevention of mother-to-child transmission of HIV (PMTCT).

Globally, all countries are working toward achieving the goal of having 90 percent of people diagnosed with HIV on sustained antiretroviral therapy (ART) by 2020. PMTCT programs in sub-Saharan Africa have had difficulty pursuing this goal, owing to countries’ weak health systems and a variety of individual, interpersonal, and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma, fear of divorce or abandonment upon HIV disclosure, side effects of ART, lack of funds for transport to the clinic, negative interactions with health workers, and lack of male involvement. Most studies of barriers to PMTCT were conducted prior to the implementation of Option B+, which places HIV-positive pregnant or breastfeeding women on lifelong ART at diagnosis. By examining how gender interacts with individual, interpersonal, health system, and community factors that cause people to discontinue PMTCT, this study fills an important gap in knowledge about Option B+ programs.

In partnership with the Child Health and Development Centre at Makerere University, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Fund for AIDS Relief (PEPFAR)—conducted qualitative research at eight health facilities (four urban and four rural) and their surrounding communities from 2015 to 2016. The purpose of this study was to describe gender-related factors at the individual, interpersonal, and programmatic or systemic levels that influence women’s participation in the elimination of mother-to-child transmission of HIV (EMTCT) program in Uganda. We used in-depth interviews and focus group discussions (FGDs) to obtain data from women participating in EMTCT (n=32), women who were lost to follow-up (LTFU) (n=16), health workers involved in providing EMTCT services (n=8), stakeholders in organizations supporting EMTCT services (n=8), and men in the community (8 focus group discussions (FGDs), n=73 participants).