Couple-oriented prenatal HIV counseling for HIV primary prevention

Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study.

A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, the authors assessed the acceptability of couple-oriented post-test HIV counselling and men's involvement within prenatal care services, among pregnant women, male partners, and health care workers in Cameroon, Dominican Republic, Georgia, and India. Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men, and health care workers; monitoring of the couple-oriented post-test HIV counselling intervention; and exit interviews with couple-oriented post-test HIV counselling participants. In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve antenatal care and HIV prevention services. Couple-oriented post-test HIV counselling was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counselling and testing and overall in reproductive health services. One of the keys to men's involvement within prenatal HIV counselling and testing is the better understanding of couple relationships, attitudes, and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counselling, which aims at integrated prevention of mother-to-child transmission and primary prevention of HIV.

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Editors’ note: The Prenahtest trial assessing the impact of couple-oriented post-test counselling, underway in 4 low-to-medium HIV prevalence countries, will be completed in 2011. This preparatory study revealed support for the idea of increasing men’s involvement but identified a number of barriers that first must be overcome. These include making antenatal care services more physically and interpersonally receptive to male participation and challenging gender norms to address the social barriers to male involvement. This process can help change the paternalistic, unidirectional nature of relationships between most health care providers and patients which can reveal itself as lectures without opportunities for personalised prevention messages. Testing options for men are limited to sexually transmitted disease clinics, voluntary counselling and testing services, and male circumcision programmes. Couple counselling and testing in the context of pregnancy is an opportunity to increase the testing options for men while decreasing the likelihood of transmission to infants. It is an opportunity that should not to be missed – most men and women living in a serodiscordant couple do not know their status nor that of their partner.