Involving men in prevention of mother-to-child transmission of HIV programs in Rwanda

In Rwanda, male partners play a key role in family decisions to use health services, especially when fee for services is required. Involving men in prevention of mother-to-child transmission (PMTCT) and other HIV prevention services has been a challenge, hindering disclosure of HIV test results within couples and use of PMTCT services by HIV-positive pregnant women.

Approach: IntraHealth Rwanda supports PMTCT services at 21 rural health facilities in Rwanda. In December 2002, IntraHealth began sending letters home with women attending prenatal consultations inviting their male partner to accompany them on their next visit for HIV counseling and testing (CT). Men are also encouraged to attend prenatal services with their partners through messages routinely disseminated by community health volunteers. Also, both partners receive counseling in family planning, safe motherhood, antenatal and postpartum care during the PMTCT session and develop a risk-reduction plan with a counselor who also makes home visits.

Major Results: Since the program began, 19,527 male partners have received CT. Rate of PMTCT service male participation in the facilities has increased from 9% to an average of 74% in December 2006. Many sites routinely receive over 90% of male partners (Kajevuba and Ntoma health centers reported 100% and 97%, respectively, in December 2006). Also, male involvement in PMTCT services at these sites has become routine: the majority of male partners participate without being prompted by an invitation letter. Letters and community outreach appear to have also impacted reproductive health service use such as deliveries at health facilities and utilization of modern contraceptive methods. According to the 2005 Rwanda Demographic and Health Survey, the national rate of deliveries at health facilities is 28%; yet, it is 48.6 % at Project-supported sites. Over 18 months, the delivery rate at Rukomo Health Centre increased from 21% to 72%; male involvement rate increased from 36.6% to 91%. The delivery rate at Munyinya Health Centre increased from 29% to 95% and the male involvement rate from 22.6% to 92%.

Recommendations: This approach and related strategies to involve male partners in PMTCT services may offer valuable models for replication in other PMTCT and reproductive health programs.