Gender Factors Influencing Participation in the Prevention of Mother-to-Child Transmission of HIV Program in Malawi under Option B+

In Malawi and other sub-Saharan African countries, womens traditional gender roles center on marriage and motherhood, caring for family members and the sick, and household duties. Women are expected to consult with their husbands and obey their husbands decisions. Mens traditional roles are to be the head of the family; bring in income to pay for shelter, food, and school fees; and represent the family. In contrast to women, who are expected to be faithful and monogamous, men are expected to have more than one wife or girlfriend, as a sign of their masculinity. These traditional gender roles have been noted as challenges to HIV prevention efforts. They may also constrain womens access to health services, including their participation in the prevention of mother-to-child transmission (PMTCT) program.

Globally, all countries are working toward achieving the goal of having 90 percent of people who are diagnosed with HIV on sustained antiretroviral therapy (ART). This has been difficult to achieve in PMTCT programs in sub-Saharan African countries, owing to weak health care systems and a variety of individual, interpersonal, and cultural factors. A number of studies have examined barriers to PMTCT participation. Common constraints are fear of HIV stigma, fear of divorce or abandonment upon HIV disclosure, ART side effects, lack of funds for transport to the clinic, negative interactions with health workers, and lack of male involvement. Most studies of barriers were conducted prior to the implementation of Option B+, which initiates lifelong ART for HIV-positive pregnant or breastfeeding women. This study fills an important gap in knowledge about Option B+ programs, by examining how gender interplays with individual, interpersonal, health system, and community factors that contribute to the discontinuation of PMTCT participation.