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Open Access 01-12-2021 | Care | Research article

Men’s perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis

Authors: Tulani Francis L. Matenga, Joseph Mumba Zulu, Sharon Nkwemu, Perfect Shankalala, Karen Hampanda

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Although health care providers are beginning to focus on men’s roles as fathers and husbands, there is limited understanding of how men view their ability to promote sexual and reproductive health in families affected by HIV and their experiences with receiving education through antenatal care. This paper aims to explore men’s perceptions of the education they need regarding sexual and reproductive health within the family in the context of HIV.

Methods

We interviewed a convenience sample of 18 male partners of pregnant women living with HIV in Lusaka, Zambia. Atlas.ti was used to facilitate data management and content analysis.

Results

Men reported being the primary decision-makers regarding sexual and reproductive issues in the family; however, they admitted far-reaching unmet needs in terms of information on sexual and reproductive health in the context of HIV. Most men felt that antenatal care was not a conducive setting to fully educate men on sexual and reproductive health because it is a woman’s space where their health concerns were generally neglected. There was a strong desire for more education that was specific to men’s sexual and reproductive health, especially because all the couples were affected by HIV. Men especially requested education on sexual preparedness, safe sex, the use of condoms in sero-concordant and sero-discordant relationships and general health information. Although men stated they were the main decision-makers regarding sexual and reproductive issues such as pregnancy, most men were not confident in their ability to promote sexual and reproductive health in the family because of limited knowledge in this area.

Conclusion

There is need to change the environment and messaging of antenatal care, as well as offer relevant education opportunities outside health facility settings to empower men with essential information for meaningful involvement in sexual and reproductive health in the context of HIV.

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Chi BH, Rosenberg NE, Mweemba O, Powers KA, Zimba C, Maman S, et al. Involving both parents in HIV prevention during pregnancy and breastfeeding. Bull World Health Organ. 2018;96(1):69–71. https://doi.org/10.2471/BLT.17.200139.CrossRefPubMed

Chikovore J, Gillespie N, McGrath N, Orne-Gliemann J, Zuma T, On Behalf of the ANRS 12249 TasP Study Group. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa. AIDS Care. 2016;28(Suppl 3):74–82. https://doi.org/10.1080/09540121.2016.1178953.CrossRefPubMedPubMedCentral

Yargawa J, Leonardi-Bee J. Male involvement and maternal health outcomes: systematic review and meta-analysis. J Epidemiol Community Health. 2015;69(6):604–12. https://doi.org/10.1136/jech-2014-204784.CrossRefPubMed

Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr. 2011;56(1):76–82. https://doi.org/10.1097/QAI.0b013e3181fdb4c4.CrossRefPubMedPubMedCentral

Mweemba O, Dixey R, Bond V, White A. The influence of social constructs of hegemonic masculinity and sexual behaviour on acceptability of vaginal microbicides in Zambia. Glob Public Health. 2018;13(7):931–43. https://doi.org/10.1080/17441692.2017.1337800.CrossRefPubMed

Hensen B, Baggaley R, Wong VJ, Grabbe KL, Shaffer N, Lo YRJ, et al. Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider-initiated testing & counselling. Tropical Med Int Health. 2012;17(1):59–70. https://doi.org/10.1111/j.1365-3156.2011.02893.x.CrossRef

Kriel Y, Milford C, Cordero J, Suleman F, Beksinska M, Steyn P, et al. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africar. Reprod Health. 2019;16(1):89. https://doi.org/10.1186/s12978-019-0749-y.CrossRefPubMedPubMedCentral

Javadnoori M, et al. “Sexual and reproductive healthcare needs of Iranian men: A cross-sectional study.” Int J Reprod Biomed. 2018;16:12 ijrm.v16i12.3681. https://doi.org/10.18502/ijrm.v16i12.3681.

Hawkes S, Hart G. Men's sexual health matters: promoting reproductive health in an international context. Tropical Med Int Health. 2000;5(7):A37–44. https://doi.org/10.1046/j.1365-3156.2000.00594.x.CrossRef

10.

Kululanga LI, Sundby J, Malata A, Chirwa E. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study. Reprod Health. 2011;8(1):36. https://doi.org/10.1186/1742-4755-8-36.CrossRefPubMedPubMedCentral

11.

Collumbien M, Hawkes S. Missing men’s messages: Does the reproductive health approach respond to men’s sexual health needs? Cult Health Sex. 2000;2(2):135–50. https://doi.org/10.1080/136910500300769.CrossRefPubMed

12.

van den Berg W, Brittain K, Mercer G, Peacock D, Stinson K, Janson H, et al. Improving Men’s participation in preventing mother-to-child transmission of HIV as a maternal, neonatal, and child health priority in South Africa. PLoS Med. 2015;12(4):e1001811. https://doi.org/10.1371/journal.pmed.1001811.CrossRefPubMedPubMedCentral

13.

WHO. Male Involvement in the Prevention of Mother- to-Child Transmission of HIV; 2012. p. 30.

14.

Stern E, et al. Lessons learned from engaging men in sexual and reproductive health as clients, partners and advocates of change in the Hoima district of Uganda. Cult Health Sex. 2015;17(sup2):S190–205.CrossRef

15.

Ramirez-Ferrero E, Lusti-Narasimhan M. The role of men as partners and fathers in the prevention of mother-to-child transmission of HIV and in the promotion of sexual and reproductive health. Reprod Health Matters. 2012;20(sup39):103–9.CrossRef

16.

Hajizadeh M, Javadnoori M, Javadifar N. Educational needs of adult men regarding sexual and reproductive health in Ahvaz, Iran. J Midwifery Reprod Health. 2015;3(3):385–93.

17.

Ampt F, Mon MM, Than KK, Khin MM, Agius PA, Morgan C, et al. Correlates of male involvement in maternal and newborn health: a cross-sectional study of men in a peri-urban region of Myanmar. BMC Pregnancy Childbirth. 2015;15(1):122. https://doi.org/10.1186/s12884-015-0561-9.CrossRefPubMedPubMedCentral

18.

Pulerwitz J, Michaelis A, Verma R, Weiss E. Addressing gender dynamics and engaging men in HIV programs: lessons learned from horizons research. Public Health Rep. 2010;125(2):282–92. https://doi.org/10.1177/003335491012500219.CrossRefPubMedPubMedCentral

19.

Muloongo H, Sitali D, Zulu JM, Hazemba AN, Mweemba O. Men’s perspectives on male participation in antenatal care with their pregnant wives: a case of a military hospital in Lusaka, Zambia. BMC Health Serv Res. 2019;19(1):463. https://doi.org/10.1186/s12913-019-4294-8.CrossRefPubMedPubMedCentral

20.

Hampanda K, Matenga TFL, Nkwemu S, Shankalala P, Chi BH, Darbes LA, et al. Designing a couple-based relationship strengthening and health enhancing intervention for pregnant women living with HIV and their male partners in Zambia: Interview findings from the target community. Soc Sci Med. 2021:114029. https://doi.org/10.1016/j.socscimed.2021.114029.

21.

Matenga, T.F.L., et al., Improving family-centered HIV care during pregnancy in Zambia: men's sexual and reproductive health needs. Journal of abstracts and conference reports from international workshops on infectious diseases and Antiviral Therapy 2020.

22.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.CrossRef

23.

Kura S, Vince J, Crouch-Chivers P. Male involvement in sexual and reproductive health in the Mendi district, southern highlands province of Papua New Guinea: a descriptive study. Reprod Health. 2013;10(1):46. https://doi.org/10.1186/1742-4755-10-46.CrossRefPubMedPubMedCentral

24.

Nkuoh GN, Meyer DJ, Tih PM, Nkfusai J. Barriers to Men’s participation in antenatal and prevention of mother-to-child HIV transmission Care in Cameroon, Africa. J Midwifery Women’s Health. 2010;55(4):363–9. https://doi.org/10.1016/j.jmwh.2010.02.009.CrossRef

25.

Davis J, Vaughan C, Nankinga J, Davidson L, Kigodi H, Alalo E, et al. Expectant fathers’ participation in antenatal care services in Papua New Guinea: a qualitative inquiry. BMC Pregnancy Childbirth. 2018;18(1):138. https://doi.org/10.1186/s12884-018-1759-4.CrossRefPubMedPubMedCentral

26.

Shapiro K, Ray S. Sexual health for people living with HIV. Reprod Health Matters. 2007;15(29 Suppl):67–92. https://doi.org/10.1016/S0968-8080(07)29034-2.CrossRefPubMed

27.

Chimbiri AM. The condom is an ‘intruder’ in marriage: evidence from rural Malawi. Soc Sci Med. 2007;64(5):1102–15. https://doi.org/10.1016/j.socscimed.2006.10.012.CrossRefPubMed

28.

Falnes EF, et al. “It is her responsibility”: partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania. J Int AIDS Soc. 2011;14(1):21. https://doi.org/10.1186/1758-2652-14-21.CrossRefPubMedPubMedCentral

29.

Leichliter JS, Paz-Bailey G, Friedman AL, Habel MA, Vezi A, Sello M, et al. ‘Clinics aren’t meant for men’: sexual health care access and seeking behaviours among men in Gauteng province, South Africa. Sahara J. 2011;8(2):82–8. https://doi.org/10.1080/17290376.2011.9724989.CrossRefPubMed

30.

Fleming PJ, Colvin C, Peacock D, Dworkin SL. What role can gender-transformative programming for men play in increasing men’s HIV testing and engagement in HIV care and treatment in South Africa? Cult Health Sex. 2016;18(11):1251–64. https://doi.org/10.1080/13691058.2016.1183045.CrossRefPubMedPubMedCentral

31.

Makoni A, Chemhuru M, Chimbetete C, Gombe N, Mungati M, Bangure D, et al. Factors associated with male involvement in the prevention of mother to child transmission of HIV, Midlands Province, Zimbabwe, 2015 - a case control study. BMC Public Health. 2016;16(1):331. https://doi.org/10.1186/s12889-016-2939-7.CrossRefPubMedPubMedCentral

32.

Ditekemena J, Koole O, Engmann C, Matendo R, Tshefu A, Ryder R, et al. Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review. Reprod Health. 2012;9(1):32. https://doi.org/10.1186/1742-4755-9-32.CrossRefPubMedPubMedCentral

33.

Byamugisha R, Tumwine JK, Semiyaga N, Tylleskär T. Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in eastern Uganda: a cross-sectional survey. Reprod Health. 2010;7(1):12. https://doi.org/10.1186/1742-4755-7-12.CrossRefPubMedPubMedCentral

34.

Gibore NS, Bali TAL, Kibusi SM. Factors influencing men’s involvement in antenatal care services: a cross-sectional study in a low resource setting, Central Tanzania. Reprod Health. 2019;16(1):52. https://doi.org/10.1186/s12978-019-0721-x.CrossRefPubMedPubMedCentral

35.

Blackstone SR, Nwaozuru U, Iwelunmor J. Antenatal HIV testing in sub-Saharan Africa during the implementation of the millennium development goals: a systematic review using the PEN-3 cultural model. Int Q Community Health Educ. 2018;38(2):115–28. https://doi.org/10.1177/0272684X17749576.CrossRefPubMed

36.

Vermeulen E, Solnes Miltenburg A, Barras J, Maselle N, van Elteren M, van Roosmalen J. Opportunities for male involvement during pregnancy in Magu district, rural Tanzania. BMC Pregnancy Childbirth. 2016;16(1):66. https://doi.org/10.1186/s12884-016-0853-8.CrossRefPubMedPubMedCentral

37.

Ganle JK, Dery I. ‘What men don’t know can hurt women’s health’: a qualitative study of the barriers to and opportunities for men’s involvement in maternal healthcare in Ghana. Reprod Health. 2015;12(1):93.CrossRef

38.

Aborigo RA, Reidpath DD, Oduro AR, Allotey P. Male involvement in maternal health: perspectives of opinion leaders. BMC Pregnancy Childbirth. 2018;18(1):3. https://doi.org/10.1186/s12884-017-1641-9.CrossRefPubMedPubMedCentral

39.

Barker G, et al. Engaging men and boys in changing gender-based inequity in health : evidence from programme interventions / Gary Barker, Christine Ricardo and Marcos Nascimento. Geneva: World Health Organization; 2007.

40.

Sharma S, Kc B, Khatri A. Factors influencing male participation in reproductive health: a qualitative study. J Multidiscip Healthc. 2018;11:601–8. https://doi.org/10.2147/JMDH.S176267.CrossRefPubMedPubMedCentral

41.

Law C. Men on the margins? Reflections on recruiting and engaging men in reproduction research. Methodol Innov. 2019;12(1):2059799119829425.

42.

UNAIDS, 90–90-90 an ambitious treatment target to help end the AIDS epidemic. 2014.

Title: Men’s perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis
Authors: Tulani Francis L. Matenga
Joseph Mumba Zulu
Sharon Nkwemu
Perfect Shankalala
Karen Hampanda
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Care
Human Immunodeficiency Virus
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11430-3

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Springer Medicine

Men’s perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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