Research Department of Infection & Population Health, Royal Free and UC Medical School, University College London, United Kingdom.
J Int AIDS Soc. 2012 Jul 11;15 Suppl 2(Suppl 2):17378. doi: 10.7448/IAS.15.4.17378.
The current UNAIDS goal towards virtual ending or elimination of infants acquiring HIV by 2015 is perhaps the most achievable goal to date. Yet, models show that delivery of antiretroviral compounds alone will not suffice to achieve this goal, and a broader community-based approach to pregnancy, families and HIV is needed. Such an approach would highlight the important role of men in reproduction. Although early studies have shown it is cost-effective to include males, very few interventions have proceeded to involve men.
This review utilized systematic review techniques to explore the literature on effective interventions for the inclusion of men in the prevention of HIV to infants. A key word search of literature sources generated 248 studies for hand sorting and interrogation. Of these, 13 were found to contain some information on involvement of males in some form of provision. Data were abstracted from these and form the basis of this review.
Background descriptive studies painted a picture of low male involvement, poor male inclusion and barriers to engagement at all stages. Yet, pregnancy intentions among men affected by HIV are high and the importance of fathers to family functioning--from relationships, through conception, pregnancy and parenting--is well established. Search strategies for interventions for males in HIV and pregnancy were used to generate studies of sufficient quality to inform strategies on the future of male involvement. Of the 317,434 papers on pregnancy and HIV, only 4178 included the term male (paternal or father). When these were restricted to intervention studies, only 248 remained for hand sorting, generating 13 studies of relevance for data extraction. The results show that all these interventions were concentrated around male partner HIV testing. In general, male partner testing was low and was amenable to change by offering voluntary counselling and testing (VCT) information, providing couple-based testing facilities and encouraging male attendance. All interventions used indirect approaches to men via their pregnant spouse. Non-health facility (clinic or hospital)-based provision (such as testing facilities in the community in bars and churches) were more effective than healthcare facilities in attracting male participation.
In conclusion, the review showed that approaches to men are limited to HIV testing with little innovative planning and provision for male treatment and care. As such, initiatives run the risk of alienating rather than including males. Direct approaches and the provision of male-specific facilities and benefits should be explored.
目前，联合国艾滋病规划署（UNAIDS）的目标是到 2015 年让所有接受母婴阻断的婴儿都不再感染艾滋病毒，这或许是迄今为止最有可能实现的目标。然而，模型显示，仅提供抗逆转录病毒药物并不能实现这一目标，还需要采取更广泛的以社区为基础的方法来关注妊娠、家庭和艾滋病毒问题。这种方法将突出男性在生殖方面的重要作用。尽管早期的研究表明，让男性参与的做法具有成本效益，但很少有干预措施真正让男性参与进来。
本综述采用系统综述技术，对纳入男性参与预防母婴艾滋病毒传播的有效干预措施的文献进行了检索。通过关键词搜索文献来源，共生成了 248 项研究供手工筛选和查询。其中，有 13 项研究包含了某种形式的男性参与。从这些研究中提取数据，并以此为基础进行综述。
背景描述性研究描绘了男性参与度低、男性包容性差以及在各个阶段都存在参与障碍的情况。然而，受艾滋病毒影响的男性怀孕意愿较高，父亲对家庭功能的重要性——从人际关系、受孕、妊娠到育儿——已得到充分证实。针对男性在艾滋病毒和妊娠方面的干预措施的搜索策略，产生了足够高质量的研究结果，为未来男性参与策略提供了信息。在关于妊娠和艾滋病毒的 317434 篇论文中，只有 4178 篇论文包含“男性”（父亲或父亲）一词。当这些论文仅限于干预研究时，只有 248 篇论文可供手工筛选，从中提取了 13 篇相关研究。结果表明，所有这些干预措施都集中在男性伴侣的艾滋病毒检测上。总的来说，男性伴侣检测率较低，可以通过提供自愿咨询和检测（VCT）信息、提供夫妻检测设施和鼓励男性参与来改变这种状况。所有干预措施都是通过其怀孕的配偶以间接的方式针对男性。非医疗机构（诊所或医院）提供的服务（如在酒吧和教堂等社区设立检测设施）比医疗机构更能吸引男性参与。
总之，本综述表明，针对男性的方法仅限于艾滋病毒检测，几乎没有创新的规划和提供男性治疗和护理。因此，这些举措有可能疏远而不是包容男性。应该探索直接的方法以及提供专门针对男性的设施和福利。
