An initiative that encourages men to visit exclusively male clinics is gaining popularity in western Kenya and increasing male participation in prevention of mother-to-child HIV transmission (PMTCT) programmes.
Most clinics are dominated by female staff and patients, which can be off-putting for men. At the male health centres HIV-positive men form support groups and both positive and negative men are counselled on the importance of accompanying their partners for antenatal visits. The men also receive education on issues that are usually taboo for men such as the importance of exclusive breastfeeding for HIV-positive mothers.
The aim of the initiative, part of Zingatia Maisha - Swahili for “carefully consider life” - a programme of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), is to get men more involved in PMTCT.
A 2008 study by the University of North Carolina at Chapel Hill and South Africa's University of KwaZulu Natal, found that male involvement in PMTCT was linked to greater uptake of HIV testing, antiretroviral treatment, condom use, and support for infant feeding choices.
|There are men out there who will still tell you, 'A female nurse cannot attend to me.' Others fear they will be stigmatized and some are in denial|
As well as referring men to the male clinics, the Zingatia Maisha programme has attempted to make clinics more male-friendly by giving priority to women who attend with their male partners and to men who bring their children.
"When you are working in a patriarchal society such as this, it is important to take the route of least resistance, and that is to make antenatal and post-natal clinics male friendly and thus increase the demand for the services," said Faith Oriwo, a field officer with EGPAF.
Since its 2006 launch, the programme has enrolled 15,000 men in western and eastern Kenya.
One of them is Wilson Odinga, 33, who refused to believe it when his wife, Christine, came home from the antenatal clinic and told him she had tested positive for HIV. Appeals by his wife to accompany her to the clinic for HIV testing and counselling at first fell on deaf ears, but following counselling by his pastor, Odinga finally agreed.
At the clinic they received PMTCT services and their baby, now 10 months old, was born HIV-free. The antenatal clinic also referred Odinga to the male clinic in Vihiga (near Kakamega in western Kenya) which he now regularly attends to get tips on how to ensure his baby stays healthy.
"I am taught about breastfeeding and nutrition for me, my wife and our child," he told IRIN/PlusNews. "When my wife isn't well, I just take the child to the clinic… I never thought I would go to the clinic like a woman."
The clinics are valuable to both HIV-positive and HIV-negative men. "Some of them are negative, but they are in discordant relationships and they get the necessary information to stay negative and also to support their positive spouses," said Martha Opisa, nursing officer in charge of the Vihiga clinic.
She added that the support groups had improved drug adherence both for the children and their parents and reduced the stigma surrounding HIV.
"When you combine all these, you have greater success and better outcomes both for paediatric HIV prevention and for adults too."
But not all men are keen to make use of the clinics. "There are men out there who will still tell you, 'A female nurse cannot attend to me.' Others fear they will be stigmatized and some are in denial," Opisa noted.
In an effort to broaden acceptance of the clinics, the programme uses local men to spread the word about them.
"We not only escort [treatment] defaulters to the clinic, but we also try to reach out to the others who are missing out and we tell them: 'We are men as you are and we are in this and our spouses and children are benefiting.' We explain to them the benefits and we have seen converts," said Pastor Joseph Muhemberi, the leader of one support group.