Examining male partner support for women on HIV treatment

A Malawi study suggests that what previous studies have described as male partner support to help women with HIV adhere to treatment can sometimes hide partner control when it comes to permitting (or withholding) access to resources to attend health facilities.

What is the research about?

The role men play in supporting their female partners to adhere to HIV treatment.

Interviews and focus groups discussions were held in four healthcare facilities in Southern Malawi, involving 73 people (40 men and 33 women). Participants were people with HIV who attended the clinics, patient peer representatives, couples and healthcare workers.

Why is this research important?

Evidence suggests that not having the support of their partner stops women with HIV from staying in HIV care programmes.

As a result, programmes have been designed to increase male partner support for women with HIV to ensure women can access antiretroviral treatment and adhere to it. But understanding what drives this support is important. If it is driven by male control of women, such programmes could produce unintended and harmful consequences that reinforce gender inequalities.

What did they find out?

Underlying ‘gender norms’ about how men and women ‘should’ behave limits women’s ability to engage with HIV care.

This is because, unless they have male support (or permission) to access the resources to attend a clinic, they may not be able to do so. This also applies to accessing contraception and family planning services.

Participants described how men are typically the main income source in a household. This means men are the main decision-makers in the family. Gender-based violence also undermines women’s limited decision-making power.

Male partner support is expressed by two main activities.

Activity 1: Providing access to transport to clinic appointments

Living far away from a health facility can stop some women with HIV from staying in care. Male partners provide practical support by providing transport or money to travel to clinics.

But lower levels of acceptance from men about their partner’s HIV status led to situations where they would not provide money for transport. Sometimes, extreme and violent responses to a women’s HIV status could result in the women being ‘chased back’ to their home village and left with no money at all.

Activity 2: Going with partners to appointments

Some men went with their partners to appointments, but most did not. Most women wanted their partner to go with them. They saw this as a demonstration of love.

The things that stopped men going to partner appointments were having a negative reaction to their partner’s HIV status, HIV-related stigma, clinics not offering privacy, being unable to take time off from work, and not having a secure space to park their bike.

What does this mean for HIV services?

When it comes to adhering to treatment, the issue of male partner support is a complicated one for women with HIV.

Women with HIV have expressed a desire for support from their partners. But due to unequal power relations between men and women, men often act as gatekeepers to women’s access to healthcare. For some women, this is a form of control.

Interventions to encourage male partner support for women with HIV should consider whether they reinforce male power over women. This can be done by conducting a gender analysis.

Engaging men to be community health workers and patient peer supporters, and providing gender-specific training, could help raise awareness about the importance of identifying unequal gender norms. Doing these things could help change harmful masculine norms and promote more equal relationships.