Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
BMC Public Health. 2010 Dec 17;10:769. doi: 10.1186/1471-2458-10-769.
A policy for couple HIV counseling and testing was introduced in 2006 in Uganda, urging pregnant women and their spouses to be HIV tested together during antenatal care (ANC). The policy aims to identify HIV-infected pregnant women to prevent mother-to-child transmission of HIV through prophylactic antiretroviral treatment, to provide counseling, and to link HIV-infected persons to care. However, the uptake of couple testing remains low. This study explores men's views on, and experiences of couple HIV testing during ANC.
The study was conducted at two time points, in 2008 and 2009, in the rural Iganga and Mayuge districts of eastern Uganda. We carried out nine focus group discussions, about 10 participants in each, and in-depth interviews with 13 men, all of whom were fathers. Data were collected in the local language, Lusoga, audio-recorded and thereafter translated and transcribed into English and analyzed using content analysis.
Men were fully aware of the availability of couple HIV testing, but cited several barriers to their use of these services. The men perceived their marriages as unstable and distrustful, making the idea of couple testing unappealing because of the conflicts it could give rise to. Further, they did not understand why they should be tested if they did not have symptoms. Finally, the perceived stigmatizing nature of HIV care and rude attitudes among health workers at the health facilities led them to view the health facilities providing ANC as unwelcoming. The men in our study had several suggestions for how to improve the current policy: peer sensitization of men, make health facilities less stigmatizing and more male-friendly, train health workers to meet men's needs, and hold discussions between health workers and community members.
In summary, pursuing couple HIV testing as a main avenue for making men more willing to test and support PMTCT for their wives, does not seem to work in its current form in this region. HIV services must be better adapted to local gender systems taking into account that incentives, health-seeking behavior and health system barriers differ between men and women.
2006 年，乌干达出台了一项夫妻艾滋病咨询和检测政策，敦促孕妇及其配偶在产前护理期间进行艾滋病联合检测。该政策旨在发现感染艾滋病毒的孕妇，通过预防性抗逆转录病毒治疗预防艾滋病毒母婴传播，提供咨询，并将感染艾滋病毒的人纳入护理。然而，夫妻检测的参与率仍然很低。本研究探讨了男性对产前护理期间夫妻艾滋病检测的看法和经验。
该研究分两个时间点在乌干达东部的伊甘加和马尤盖地区进行，共开展了 9 次焦点小组讨论，每次约有 10 名参与者，以及对 13 名男性进行了深入访谈，他们都是父亲。数据以当地语言卢索加语收集，进行了录音，然后翻译成英语，并进行了内容分析。
男性完全了解夫妻艾滋病检测的可用性，但提到了他们使用这些服务的几个障碍。男性认为他们的婚姻不稳定，不信任，认为夫妻检测不可取，因为这可能引发冲突。此外，他们不明白为什么如果他们没有症状就应该接受检测。最后，艾滋病毒护理的污名化性质以及卫生机构工作人员的粗鲁态度，使他们认为提供产前护理的卫生机构不欢迎他们。我们研究中的男性对如何改进当前政策提出了一些建议：对男性进行同伴宣传，使卫生机构减少污名化，更有利于男性，培训卫生工作者满足男性的需求，以及在卫生工作者和社区成员之间进行讨论。
总之，在该地区，目前夫妻艾滋病检测作为促使男性更愿意接受检测并支持其妻子接受预防母婴传播的主要途径，似乎并不奏效。艾滋病毒服务必须更好地适应当地的性别体系，考虑到激励措施、寻求医疗的行为和卫生系统障碍在男性和女性之间存在差异。
