'They went for the test together but came back separately': a constructivist grounded theory perspective on male engagement in antenatal HIV testing in Bamenda, Cameroon.

introductionMale engagement in HIV testing during pregnancy significantly contributes towards the prevention of maternal seroconversion and paediatric HIV acquisition. Despite this, men especially the male partners of pregnant women have been consistently missing in the HIV prevention cascade. The factors accounting for sub-optimal levels in male engagement intersect but reasons for this are poorly understood. Using the combined perspectives of pregnant women and their partners, this study aims to expand the evidence on the forces that influence prenatal HIV testing behaviours among couples in Bamenda, Cameroon.

methodsThis qualitative study purposively selected pregnant women receiving prenatal care for semi-structured interviews (n = 38); focus group discussion (n = 6) and their male partners (n = 30 for semi-structured interviews and n = 6 for focus group discussion) in Nkwen Baptist Hospital-an urban hospital in Bamenda, Cameroon. Nvivo was used for data management and subsequently we performed a grounded theory analysis through memoing and constant comparisons.

resultsMaternal HIV risk perception was the prominent theme intersecting with couple communication, perceptions on HIV testing outcome, and engagement of male partners by facility staff to influence couple prenatal HIV testing behaviours. Although participants recognised the need for couple HIV testing, individual, interspousal, structural and socio-cultural factors determined uptake of male partner testing. Perceptions on HIV risk were largely inaccurate and strongly gendered. For example, normative expectations on female fidelity were perceived as a buffer against HIV acquisition but this was not the norm regarding male partner behaviour. Also, couple communication was rare or subtle-mostly initiated by women who suspected spousal infidelity. For some men, HIV testing was a conscious decision to confirm fidelity, for others this was challenged by the fear of sero-discordant results and assumptions that maternal test results were a representation of their sero-status.

conclusionMale partner involvement in prenatal HIV testing is largely influenced by gendered perceptions on HIV risk and couple testing outcomes. Given that these perceptions are moderated by spousal communication and the engagement of male partners by health facility staff, we call for gender-transformative interventions and policies that offer education on prenatal HIV risk, support couple communication and spousal disclosure.