CCIH 2013 Concurrent Sessions 1 Preventing HIV/AIDS and Promoting Gender Equity Sara Melillo CMMB
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This presentation describes Catholic Medical Mission Board's Men Taking Action program, providing specific best practices and tips for incorporating male partner involvement into programming to prevent HIV/AIDS.
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CCIH 2013 Concurrent Sessions 1 Preventing HIV/AIDS and Promoting Gender Equity Sara Melillo CMMB
- 1. Men Taking Action™ (MTA): Male Involvement in HIV Prevention CCIH Annual Conference June 2013
- 2. Presentation Agenda • The MTA Model • Engaging Men • MTA in Action: HIV Prevention • Results • Next Steps
- 3. The MTA™ Model • Innovative behavior change model that engages positive champions for family health • Works with traditional leaders to gain buy-in • Men serve as champions for uptake of health services
- 4. The MTA™ Model: Geography • Zambia: Launched in 2007 to boost uptake of PMTCT, VCT and gender issues. •South Africa: Launched in 2009 to promote home-based CT for men and their families
- 5. Why Involve Men in HIV Prevention •Role of the male in the home • Access to resources and healthcare • Men as Partners
- 6. How We Involve Men in HIV Prevention • Listen! •KAP Survey: Before & After • Role Play • Q&A Community/ANC Sessions • ANC Outreach & Promotion
- 7. Sell the Benefits • Engage traditional leaders as your salesmen • Use the (not-so-bully) pulpit at church • Emphasize man’s involvement at ANC • Sell PMTCT, HTC, ARV in pregnancy • Meet men where they are…positive peer pressure
- 8. Make it ‘Man-Friendly’ • Special outreach sessions just for men • Hold after-hours ANC and community sessions • Mini-speed sessions for men • Male-Friendly SBCC techniques
- 9. MTA for HIV Prevention: PMTCT • Great need and applicability • Promotes three prongs of PMTCT through community and individual outreach: •Primary Prevention: ABC •Testing and uptake of HIV care services for pregnant women and their partners/family •Comprehensive HIV care, including ART for HIV positive pregnant women and their partners/family
- 10. MTA for HIV Prevention: MC • Being rolled out in Zambia – Central, Western and North- Western Provinces • CMMB is currently refining curriculum to directly address MC
- 11. Results: More Pregnant Women Attending ANC Tested for HIV
- 12. Results: Almost All HIV+ Pregnant Women Have their Babies Accept ARVs
- 13. Results: Couples ANC HIV Testing Skyrocketed
- 15. The Kambwela Family: Building Trust for Couples HIV Counseling and Testing BEFORE CMMB ZAMBIA’S COMPACTS PROGRAM: “Testing for HIV can bring divisions in the family because of determining who could have brought the infection between the two of them if either of them or both, tested positive.” Mary Kambwela, 24, mother of 3 children Luampa, Zambia Couples HIV prevention education for the Kambwelas in their home
- 16. AFTER CMMB’s PROGRAM: “…it means that if my wife tests positive during pregnancy, we have a chance to have a healthy baby who is not infected with HIV if she takes ARVs.” Munthu Kambwela, 23, father of 3 children Luampa, Zambia The couple leaving HIV testing center
- 17. Male Involvement: Next Steps • Document best practices • Expansion to HIV, malaria and other CMMB health programs • Adaptation to other health issues, including Chronic Diseases
- 18. Contact Information Sara Melillo Director of Strategic Information US Tel: + 1 703-525-0277 Email: smelillo@cmmb.org Skype: sara.melillo
Editor's Notes
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- Our most prominent and concerted examples of MTA our in our Zambia and South African programs. In Zambia, with support from USAID initially, we launched MTA in 2007, working in concert with 31 local Church Health Institutions from the Churches Health Association of Zambia. This program has now blossomed and carried on in several of CMMB’s currently funded programs with CDC and USAID and takes several forms. In South Africa, we adapted MTA for a five-year CDC funded program focused on engaging men in home-based counseling and testing, a new area that was a little tricky. Getting men to let you into their homes and test them and their families has been a challenge – but one that the model has borne well. We’ve been implementing the program in impoverished pockets of Eastern Cape Province with high HIV prevalence, and have seen acceptability and uptake steadily grow with each passing year. The program also includes urban and peri-urban areas.
- In Zambia, where MTA includes a strong PMTCT uptake component, there are a variety of barriers to men participating in PMTCT. According to both documented research and team observations, men rarely attend antenatal services (where most PMTCT services are offered) and gender norms ensure that women defer to their male partner on reproductive health and resource allocation decisions. Further complicating matters is the issue of HIV testing and disclosure that create challenges. Stigma for HIV is high, particularly in rural areas and around pregnancy (we have great sources of qualitative data on pregnancy transmission myths). In addition, the linkages between the community and health facilities are weak, something MTA specifically addresses. Embedded in the overall positive health promotion messages Includes promotion of 3 PMTCT prongs: Primary Prevention: ABC Testing and uptake of HIV care services for pregnant women and their partners/family who are HIV positive Comprehensive HIV care, including ART for HIV positive pregnant women and their partners/family
- CMMB is currently or recently conducted voluntary medical male circumcision programs for HIV prevention in Kenya, Uganda, Zambia and South Africa. Obviously, you can’t have male circumcision occur without male involvement. (Pause for laughter). However, we think the MTA model of community ownership and promotion of positive health family decisions can be a useful tool for boosting uptake. All of our programs take that approach to mobilization – however, we are specifically using MTA for MC promotion in Zambia – in Chongwe province through a private
- According to an independent program evaluation at end-line over the course of the program that monitored records for more than 52,000 people, the proportion of pregnant women who tested for HIV at ANC rose from 60% to 92%. In the focus group component - Participants expressed adequate knowledge with regard to PMTCT and strongly emphasized the need for both husband and wife to be tested as a couple. “The man and woman need to go to the hospital to be tested and if they are positive tey can be helped so that their baby does not contract HIV….by taking drugs such as Nevirapine and best ways of breastfeeding the baby.”1
- 100% (n=4,460) vs. 70% at baseline of women who tested HIV positive accepted ARVs for PMTCT and HIV care.
- Couples TC among pregnant women and their spouses was 19,177 (70% of first ANC attendees vs. a baseline of 3%). In addition – we had some other ‘bonus benefits’ - Approximately 98% of women reported some reduction in beatings by their spouses and 65% said they now jointly plan together how funds earned by male partner should be spent.
- So now that we’ve share all the hard stats – I want to share with you an actual success story, so you can see how male involvement impacts real lives. Here in the picture is one of our participants Phinias Matoto, 34, who is married to two wives and a father of eight children. He lives in Choongo village under the leadership of chief Chamuuka in Chibombo district, Central Province in Zambia. In this area, as it is in many other parts of rural Zambia, the cultural norms regarding the relationship between a wife and a husband is that the role of a wife is to bear and look after children, a man’s wealth and status is measured by the number of children one has with different women, and that discussing issues of sex is a taboo. Therefore when Phinias was invited by the headman to accompany his pregnant wife to Antenatal Care (ANC) at the local clinic (Chipembi Mission Health Centre) to join other men and their spouses and participate in the discussion of Men Taking Action (MTA) program regarding the prevention of Mother to Child Transmission of HIV (PMTCT), he was very surprised but curious. He was curious because the invitation was made by the head man “who was better placed to protect the traditional and cultural norms that ANC is solely for pregnant women and that real men cannot even go near a place where ANC services are offered”. Therefore he agreed to accompany his wife to the local clinic to meet other men. After attending a social and behavioral change session at the clinic where HIV/AIDS issues were discussed, including role of a man in ANC and PMTCT services, couples testing and counseling and risky sexual behaviors that can make a man and a woman vulnerable to contract HIV, Phinias realized that ANC services are not just for pregnant women alone. He said “it was amazing that my friends could speak so freely and passionately on the critical role that a man can play in protecting his wife and children from getting infected with HIV.” After the sessions Phinias and his spouse joined other couples in couple counseling, tested for HIV and received results. Although their HIV status was negative, Phinias narrates that “what I learned and experienced in participating to know the HIV status for myself and my wife has brought me close to my family”. Later Phinias also brought his other wife for testing. “I decided that my second wife should also be tested and she agreed, and it was comforting that she also tested negative” said Phinias. Phinias now talks about HIV and AIDS prevention to his family. He emphasizes the importance of faithfulness to his wives and helps in household chores such as fetching water from a distant mono-pump, gathering firewood and escorts his wives and children to the clinic whenever need arises. He was thankful to USAID for supporting the Catholic Medical Mission Board (CMMB) to bring the MTA program in his village and involving traditional leaders as champions of the program. “This program is wonderful as it encourages men to be more responsible for their families and to lead the fight against HIV” concluded Phinias.
- Given the initial successes we’re having with this model, CMMB is working on documenting this work in greater detail for dissemination and sharing publicly. That should occur in the next year. We are also looking at how we may adapt MTA to our other HIV and malaria programs in our other African countries – we’ve already done this a bit with our Malaria Communities program in rural Zambia where we engaged men at ANC for pregnant women to protect themselves against malaria. You can see an example here of a picture of a community event in our malaria program. We’re also looking to see how we can tweak the format for some of CMMB’s other interest areas, particularly around Chronic Diseases (high blood pressure, cancer, some NTDs) and in our cervical cancer prevention and vaccination programs.
- Thanks for your time and attention – here’s my contact information if you have anymore questions.