A qualitative study of partner engagement in HIV testing in Malawi and Kenya

In low-income settings, partner engagement in HIV testing during pregnancy is well recognised, but uptake remains low. To understand why men fail to engage, seventy-three interviews were conducted with women (n=23), men (n=37), and community stakeholders (n=17) in Malawi and Kenya. Data were collected through individual, in-depth interviews. Transcribed data were analysed thematically. Male engagement was verbally supported. However, definitions of ‘engagement’ varied; women wanted a shared experience, whereas men wanted to offer practical and financial support. Women and stakeholders supported couples-testing, but some men thought separate testing was preferable. Barriers to couples testing were strongly linked to barriers to antenatal engagement, with some direct fear of HIV-testing itself. The major themes identified included diverse definitions of male engagement, cultural norms, poor communication and environmental discomfort – all of which were underpinned by hegemonic masculinity. Couples-testing will only increase when strategies to improve reproductive healthcare are implemented and men’s health is given proper consideration within the process. As social norms constitute a barrier, community-based interventions are likely to be most effective. A multi-pronged approach could include advocacy through social media and community forums, the provision of tailored information, the presence of positive role models and a welcoming environment.