Raymond Aborigo, MPH, PhD
Nominated From: University of Michigan
Research Site: Uganda
Research Area: Maternal Health and HIV
Primary Mentor: Cheryl Moyer
HIV Testing during ANC and partner disclosure in a patriarchal setting in rural Ghana
Despite the importance of counselling and testing for HIV during antenatal care (ANC), voluntary testing is generally low. In response to the low rates of HIV testing during ANC, the World Health Organization (WHO) encouraged countries to adopt an opt-out, provider initiated testing and counselling (PITC) approach to increase utilization and promote early intervention. This approach is a shift from the opt-in, client initiated approach. The recommendation is for HIV testing to be included in the standard group of prenatal tests unless the woman refuses to provide consent (CDC, n.d.). The policy was adapted by the ministry of Ghana and implemented nationwide in 2010. Although, disclosure of HIV status to male partners after antenatal HIV testing plays a critical role in reducing the burden of HIV among women and mother-to-child transmission, the process is faced with challenges especially in patriarchal societies where unequal gender power dynamics are a strong predictor of intimate partner violence after HIV disclosure (Shamu et al., 2014). Currently, little is known about men’s perceptions of the opt-out policy for HIV testing during ANC in Ghana. It is however crucial to understand their perceptions and views about disclosure and testing to reduce the risk of transmission to the foetus and potential intimate partner violence. An understanding of the views of men would increase the likelihood of successful implementation of the policy through a better integration of male partners in the policy and in strategies to engage them.
Many studies have explored health worker’s and pregnant women’s understanding of the opt-out policy but very few have explored the views of their partners regarding the policy. Very few men spontaneously accompany their partners for ANC where information about the opt-out policy is shared. Consequently, most men do not have information on the policy. What is more challenging are the consequence of a positive test of their pregnant partners which demands that there is disclosure to the man and an invitation to test for HIV in order to reduce the risk of mother-to-child transmission. The absence of clear and culturally acceptable strategies for such disclosures and invitations has sparked intimate partner violence in some settings (Shamu et al., 2014). Individual counselling for pregnant women emphasizes the importance of disclosure to partners. However, the counselling lacks strategies to address specific partner characteristics that may serve as a barrier to women’s disclosure (Roxby et al., 2013). Women have described the disclosure and invitation to test for HIV to their partners as ‘difficult’ or ‘heavy’ due to fear of abandonment, violence and accusation for bringing HIV into the family (Rujumba et al., 2012). Hence, understanding men’s perspectives of HIV testing during antenatal care will be useful in protecting pregnant women and infants from HIV and violence.
Advice for Potential Candidates
The program provides an opportunity to work in an interdisciplinary environment and work with other Fogarty fellows and mentors from around the world. It’s longterm importance is the opportunity to build a network of colleagues and mentors that you can collaborate with for years to come. So begin the process early, identify your mentors and work with them to identify the research topic and finalise the proposal to brighten your chances of success.