Using a Social Support Framework to Understand How HIV Positive Kenyan Men Engage in PMTCT/EID Care: Qualitative Insights From Male Partners

  • Natabhona M. MabachiEmail author
  • Melinda Brown
  • Matthew Sandbulte
  • Catherine Wexler
  • Kathy Goggin
  • May Maloba
  • Sarah Finocchario-Kessler
Original Paper


Greater male partner involvement in Prevention of Mother to Child Transmission (PMTCT) and Early Infant Diagnosis (EID) is associated with improved outcomes. Perceived low social support for the mother can negatively impact the uptake of PMTCT/EID services. Most research relies on women’s reports of the types and quality of male partner support received versus what is desired. This qualitative study examines Kenyan male partners' reported social support provision pre- and post-partum from their own perspective. The study was embedded within intervention development studies in Kenya designed to develop and pilot a PMTCT module of a web based system to improve EID. Focus groups were conducted with male partners of pregnant women with HIV and elicited feedback on male partner involvement in maternal and child care and factors affecting participation. Interviews were analyzed within a theoretical social support framework. Participants described providing tangible support (financial resources), informational support (appointment reminders) and emotional support (stress alleviation in the face of HIV-related adversity). African conceptualizations of masculinity and gender norms influenced the types of support provided. Challenges included economic hardship; insufficient social support from providers, peers and bosses; and HIV stigma. Collaboration among providers, mothers and partners; a community-based social support system; and recasting notions of traditional masculinity were identified as ways to foster male partner support.


PMTCT EID Social support Male engagement Masculinity Kenya 



This work is supported by National Institutes of Health grants R34MH107337, funded by the National Institute of Mental Health, and R01HD076673 and R01HD076673-04S1, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflicts of interest

No potential conflicts exist for all authors.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wachira J, Middlestadt SE, Vreeman R, Braitstein P. Factors underlying taking a child to HIV care: implications for reducing loss to follow-up among HIV-infected and-exposed children. SAHARA-J. 2012;9(1):20–9.PubMedGoogle Scholar
  2. 2.
    Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are aith decreased infant HIV infection and increased HIV free survival. J Acquir Immune Defic Syndr. 2011;56(1):76.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Aluisio AR, Bosire R, Bourke B, Gatuguta A, Kiarie JN, Nduati R, et al. Male partner participation in antenatal clinic services is associated with improved HIV-free survival among infants in Nairobi, Kenya: a prospective cohort study. J Acquir Immune Defic Syndr. 2016;73(2):169–76.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Ambia J, Mandala J. A systematic review of interventions to improve prevention of mother to child HIV transmission service delivery and promote retention. J Int AIDS Soc. 2016;19(1):20309.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Maman S, Moodley D, Groves AK. Defining male support during and after pregnancy from the perspective of HIV-positive and HIV-negative women in Durban, South Africa. J Midwifery Women Health. 2011;56(4):325–31.Google Scholar
  6. 6.
    Turan JM, Miller S, Bukusi E, Sande J, Cohen C. HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services. AIDS Care. 2008;20(8):938–45.PubMedGoogle Scholar
  7. 7.
    Matovu S, Kirunda B, Rugamba-Kabagambe G, Tumwesigye N, Nuwaha F. Factors influencing adherence to exclusive breast feeding among HIV positive mothers in Kabarole district, Uganda. East Afr Med J. 2008;85(4):162–70.PubMedGoogle Scholar
  8. 8.
    Sibeko L, Coutsoudis A, Nzuza SP, Gray-Donald K. Mothers’ infant feeding experiences: constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa. Public Health Nutr. 2009;12(11):1983–90.PubMedGoogle Scholar
  9. 9.
    Audet CM, Blevins M, Chire YM, Aliyu MH, Vaz LM, Antonio E, et al. Engagement of men in antenatal care services: increased HIV testing and treatment uptake in a community participatory action program in Mozambique. AIDS Behav. 2016;20(9):2090–100.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Murithi LK, Masho SW, Vanderbilt AA. Factors enhancing utilization of and adherence to prevention of mother-to-child transmission (PMTCT) service in an urban setting in Kenya. AIDS Behav. 2015;19(4):645–54.PubMedGoogle Scholar
  11. 11.
    Osoti A, Han H, Kinuthia J, Farquhar C. Role of male partners in the prevention of mother-to-child HIV transmission. Res Rep Neonatol. 2014;4:131–8.Google Scholar
  12. 12.
    Msuya SE, Mbizvo E, Hussain A, Uriyo J, Sam N, Stray-Pedersen B. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care. 2008;20(6):700–9.PubMedGoogle Scholar
  13. 13.
    Haile F, Brhan Y. Male partner involvements in PMTCT: a cross sectional study, Mekelle, Northern Ethiopia. BMC Pregnancy Childbirth. 2014;14:65.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Manjate Cuco RM, Munguambe K, Bique Osman N, Degomme O, Temmerman M, Sidat MM. Male partners’ involvement in prevention of mother-to-child HIV transmission in sub-Saharan Africa: a systematic review. Sahara J. 2015;12:87–105.PubMedGoogle Scholar
  15. 15.
    Frizelle K, Solomon V. Strengthening PMTCT through communication. Johannesburg: Center for AIDS Development and Evaluation, CADRE; 2009.Google Scholar
  16. 16.
    Morfaw F, Mbuagbaw L, Thabane L, Rodrigues C, Wunderlich AP, Nana P, et al. Male involvement in prevention programs of mother to child transmission of HIV: a systematic review to identify barriers and facilitators. Syst Rev. 2013;2:5.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Nanjala M, Wamalwa D. Determinants of male partner involvement in promoting deliveries by skilled attendants in Busia, Kenya. Glob J Health Sci. 2012;4(2):60.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Koo K, Makin JD, Forsyth BW. Barriers to male-partner participation in programs to prevent mother-to-child HIV transmission in South Africa. AIDS Educ Prev. 2013;25(1):14–24.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Fleming PJ, DiClemente RJ, Barrington C. Masculinity and HIV: dimensions of masculine norms that contribute to men’s HIV-related sexual behaviors. AIDS Behav. 2016;20(4):788–98.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Siu GE, Wight D, Seeley J. ‘Dented’ and ‘resuscitated’ masculinities: the impact of HIV diagnosis and/or enrolment on antiretroviral treatment on masculine identities in rural eastern Uganda. Sahara J. 2014;11(1):211–21.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Falnes E, Moland K, Tylleskär T, de Paoli M, Msuya SE, Engebretsen IM. “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.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Ditekemena J, Matendo R, Koole O, Colebunders R, Kashamuka M, Tshefu A, et al. Male partner voluntary counselling and testing associated with the antenatal services in Kinshasa, Democratic Republic of Congo: a randomized controlled trial. Int J STD AIDS. 2011;22(3):165–70.PubMedGoogle Scholar
  23. 23.
    Osoti AO, John-Stewart G, Kiarie J, Richardson B, Kinuthia J, Krakowiak D, et al. Home Visits during pregnancy enhance male partner HIV counseling and testing in Kenya: a randomized clinical trial. AIDS. 2014;28(1):95–103.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Katz DA, Kiarie JN, John-Stewart GC, Richardson BA, John FN, Farquhar C. Male perspectives on incorporating men into antenatal HIV counseling and testing. PLoS ONE. 2009;4(11):e7602.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Reece M, Hollub A, Nangami M, Lane K. Assessing male spousal engagement with prevention of mother-to-child transmission (pMTCT) programs in western Kenya. AIDS Care. 2010;22(6):743–50.PubMedGoogle Scholar
  26. 26.
    Orne-Gliemann J, Tchendjou PT, Miric M, Gadgil M, Butsashvili M, Eboko F, et al. Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study. BMC Public Health. 2010;10(1):197.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Rodriguez M, Cohen S. Social support. Encyclopedia of mental health. New York: Academic Press; 1998.Google Scholar
  28. 28.
    Bekele T, Rourke SB, Tucker R, Greene S, Sobota M, Koornstra J, et al. Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/AIDS. AIDS Care. 2013;25(3):337–46.PubMedGoogle Scholar
  29. 29.
    Galvan FH, Davis EM, Banks D, Bing EG. HIV stigma and social support among African Americans. AIDS Patient Care STDs. 2008;22(5):423–36.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Takada S, Weiser SD, Kumbakumba E, Muzoora C, Martin JN, Hunt PW, et al. The dynamic relationship between social support and HIV-related stigma in rural Uganda. Ann Behav Med. 2014;48(1):26–37.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Brittain K, Giddy J, Myer L, Cooper D, Harries J, Stinson K. Pregnant women’s experiences of male partner involvement in the context of prevention of mother-to-child transmission in Khayelitsha, South Africa. AIDS Care. 2015;27(8):1020–4.PubMedGoogle Scholar
  33. 33.
    Nyondo-Mipando AL, Chimwaza AF, Muula AS. “He does not have to wait under a tree”: perceptions of men, women and health care workers on male partner involvement in prevention of mother to child transmission of human immunodeficiency virus services in Malawi. BMC Health Serv Res. 2018;18(1):187.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Asefa F, Geleto A, Dessie Y. Male partners involvement in maternal ANC care: the view of women attending ANC in Hararipublic health institutions, eastern Ethiopia. Sci J Public Health. 2014;2(3):182–8.Google Scholar
  35. 35.
    Theuring S, Nchimbi P, Jordan-Harder B, Harms G. Partner involvement in perinatal care and PMTCT services in Mbeya Region, Tanzania: the providers’ perspective. AIDS Care. 2010;22(12):1562–8.PubMedGoogle Scholar
  36. 36.
    Medley AM, Mugerwa GW, Kennedy C, Sweat M. Ugandan men’s attitudes toward their partner’s participation in antenatal HIV testing. Health Care Women Int. 2012;33(4):359–74.PubMedGoogle Scholar
  37. 37.
    Mburu G, Ram M, Siu G, Bitira D, Skovdal M, Holland P. Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes. BMC Public Health. 2014;14(1):1061.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Mankayi N, Vernon Naidoo A. Masculinity and sexual practices in the military: a South African study. Afr J AIDS Res. 2011;10(1):43–50.PubMedGoogle Scholar
  39. 39.
    Siu GE, Wight D, Seeley JA. Masculinity, social context and HIV testing: an ethnographic study of men in Busia district, rural eastern Uganda. BMC Public Health. 2014;14:33.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Siu GE, Seeley J, Wight D. Dividuality, masculine respectability and reputation: how masculinity affects men’s uptake of HIV treatment in rural eastern Uganda. Soc Sci Med. 2013;89:45–52.PubMedGoogle Scholar
  41. 41.
    Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. What role do masculine norms play in men’s HIV testing in sub-Saharan Africa?: a scoping review. AIDS Behav. 2018;22(8):2468–79.PubMedGoogle Scholar
  42. 42.
    Lindegger G, Quayle M. Masculinity and HIV/AIDS. HIV/AIDS in South Africa 25 years on. New York: Springer; 2009. p. 41–54.Google Scholar
  43. 43.
    Jewkes R, Morrell R. Sexuality and the limits of agency among South African teenage women: theorising femininities and their connections to HIV risk practises. Soc Sci Med. 2012;74:1729–37.PubMedGoogle Scholar
  44. 44.
    Johnson LF. Access to antiretroviral treatment in South Africa, 2004-2011. South Afr J HIV Med. 2012. Scholar
  45. 45.
    Ratele K. Analysing males in Africa: certain useful elements in considering ruling masculinities. Afr Asian Stud. 2008;7:515–36.Google Scholar
  46. 46.
    Seeley J, Mbonye M, Ogunde N, Kalanzi I, Wolff B, Coutinho A. HIV and identity: the experience of AIDS support group members who unexpectedly tested HIV negative in Uganda. Sociol Health Illn. 2012;34(3):330–44.PubMedGoogle Scholar
  47. 47.
    Ramirez-Ferrero E. Male involvement in the prevention of mother-to-child transmission of HIV. Geneva: World Health Organization; 2012.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Family MedicineUniversity of Kansas Medical CenterKansas CityUSA
  2. 2.Children’s Mercy Kansas City, Health Services and Outcomes ResearchKansas CityUSA
  3. 3.Global Health InnovationsNairobiKenya

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