How can more men be encouraged to share their HIV status with pregnant partners?

A South African study has found more than a quarter of pregnant women do not know if their partner has HIV or not, and are less likely to know if they live separately or the pregnancy is unplanned. 

What is the research about? 

The research looked at the proportion of pregnant women that know their male partner’s HIV status, and the factors that might make it less likely for male partners to share their status. Researchers surveyed around 2,000 women who were using antennal services in six South African districts. They also held focus groups with women and male partners. 

Why is this research important? 

The evidence suggests that male partners are one of the biggest influences on women’s decisions, including whether to use HIV services when pregnant. This is essential for preventing parent-to-child HIV transmission, and for the health of the pregnant woman and her partner.  

What did they find out? 

More than a quarter (29%) of women were unaware of their partner’s HIV status. In comparison, only 12% of women had not shared their HIV status with their partner.  

Just under half (46%) of the women knew their partner was HIV negative. While 25% knew their partner had HIV.  

Being unmarried and having an unplanned pregnancy increased the odds of a woman not knowing a partner’s HIV status. A woman sharing her HIV status to her male partner reduced the odds.  

The focus groups revealed three key themes about partner disclosure. 

1. Men’s reluctance to test for HIV  

Both women and men said male partners are often reluctant to test for HIV. Many men are also unsupportive of couples testing. In some cases, women asking their partner to test for HIV led to violence. 

Some women suspected their partner tested in secret and kept the results to themselves. Other women said their partners used the woman’s result to assume their own. As a pregnant woman from KwaZulu Natal explained: “He has never tested, he just assumes that if I am okay then he is also okay.” 

2. Men are less likely to share their status when they do not live with their partner 

This supports the survey finding that unmarried women were less likely to know their partner’s HIV status than married women. Women in non-cohabiting relationships also expressed concerns that their partner had sex with other women yet refused to wear condoms, putting them at risk.  

3. What happens when a woman tells her partner she has HIV  

Some women with HIV said that telling their partner influenced him to test and share his results. Many women with HIV who shared their status said their partner supported them and agreed to use condoms. 

But others said women were sometimes blamed by partners for bringing HIV into the relationship, whether or not this was true. This could lead to a withdrawal of partner support and/or violence. A man from KwaZulu Natal described this as “when the mother of the baby is the first one to know about her HIV-positive status, then get[s] blamed by her partner for transmitting the disease, disrespecting the woman in the process…”  

What does this mean for HIV services? 

There is a need for initiatives that support the male partners of pregnant women to test for HIV and disclose their status, particularly among non-cohabiting couples and unplanned pregnancies. 

In the focus groups it was suggested that it might be effective if healthcare workers directly invite male partners to attend antenatal services, or if women invite them stating they have been told to do so. Clinics could shorten waiting times for couples and offer appointments outside working hours to encourage men to come. 

Other strategies to try include: 

• door-to-door HIV testing and disclosure campaigns for couples  

• providing self-testing kits for men, plus information or counselling that shows the benefits of disclosure for their health, their partner’s health and their infants 

• providing PrEP to women who are unaware of their partner’s status  

• working with men and women to challenge unequal power dynamics in relationships.