KC James Kityo's experience as a man at an antenatal clinic.
After receiving a text message from an organization that calls itself Vision J. AIDS Free Uganda, which read Research shows that AIDS is getting resistant to ARVs. Take a test, live responsibly and care for those who are infected, love wisely, I decided to do something I have never done.
I decided that as a man I would accompany my spouse to her first antenatal care service (ANC), which she decided to attend when she was four months pregnant.
I thought that, we men sometimes talk a lot about the need for women to attend ANC services without knowing what takes place there.
Since we live in Kampala, the range of health services available are not representative of the healthcare delivery services in the rural areas of Uganda. I must also confess that our lifestyle is slightly above the average of the poor Ugandan, so our experience may appear superficial considering the difficulties faced by women delivering in institutional facilities in rural and other parts of Uganda.
A 30 minute drive, despite the traffic jam, was enough for us to reach a service of our choice at Nsambya, in the south eastern part of Kampala. My spouse and I discussed the choice of a health facility first. My choice was Nsambya. She was initially reluctant to go to Nsambya, but being where she delivered our first born Joshua, she accepted it. My Choice for Nsambya was because I considered the institution to be old, with experienced medical workers and founded on strong Roman Catholic principles. Being a Roman Catholic myself, though a bit liberal and non- practicing, I still have influences and strong groundings of the Catholic Church. I believe different people make choices to health facilities based on different reasons, including proximity, costs and friendliness.
When we entered the hospital, I gave my spouse 50,000 Uganda shillings (20 US dollars) and told her to go and register as I waited outside. In five minutes she returned and told me that the price had doubled since she last delivered. The first time she was here, she had paid 25,000 Uganda shillings (10 US Dollars).
Feeling lonely outside, I decided to go and sit inside with the rest of the women waiting to be attended to. It felt a bit awkward being a man sitting among more than 100 women waiting for ANC services but then I realised this was the price I was paying.
Fortunately I saw another man. It soon became clear that, being uncertain of the fidelity of her husband, the wife – who was expecting her first baby – had told her husband to accompany her to the hospital, and the pair had just taken an HIV test together. The man appeared to want to flee but the doctors were insisting that they both see a counsellor and have their results released to them as a married couple.
“Doctor, for me I know my results. I came here to accompany my wife but not to take an HIV test. You have got my blood, so you can do anything you want with it. It is up to you, for me I do not need my results, you go ahead and give my wife her results,” said the man.
When the doctor called the man’s wife to have a word with her, the same man again made quite a scene and shouted, making noise all-over the place, telling the doctor: “You have no right to speak to my wife without my presence. She is my wife and I have to be there when you are talking to her”.
It was at this point that the same doctor and a nurse spotted me. If I had not in the past been involved in voluntary counselling and testing (VCT) services and if I had never taken an HIV test, this is the time I should have fled from the hospital, never to return. Taking an HIV test, is not for the faint hearted.
“Have you also come in with your wife?”
“Yes sir,” I answered well knowing my fate.
The nurse then addressed me: “When it is time for you wife to go in, please enter the laboratory with her because you two have to be attended to as a couple.”
Of course I expected that they would counsel us together and then offer to us to take an HIV test, but I had not foreseen it initially when coming to the hospital. We entered the lab, my spouse and I, and they took our blood specimen. We were then cautioned to go and see a counsellor together, who gave us our results.
This experience was very good to me. Only two men were present at this particular health centre (myself and the rowdy guy). But the experience helped me understand us, the men. We are an important factor in addressing new infections from HIV among women in Sub Saharan Africa. Because men do not attend regular health services, the vast majority of us go on living in the make-believe world that HIV is brought in homes by women.
Men in African communities also have immense authority and exhibit a lot of macho power, which guides them into thinking they can marry as many women as they want. And they alone can make a decision of when and how to have sex. Many men engage in risky behaviour such as excessive use of alcohol and drugs. Many that travel long distance travels acquire as many partners as they can come across. This leaves women at the receiving end of HIV from men. And in many cases women are powerless to deny men that much needed sex or keep themselves safe while engaging in sex with their man. Many cases of domestic violence in African communities are as a result of men complaining that they are denied sex.
The efforts towards VCT have not overwhelmingly captured the men. What’s more preventing mother to child transmission services are normally aimed at the mother, who is cautioned to take the necessary precautions after knowing that she is HIV positive. This is usually done to save the yet unborn baby.
A greater integration of the men in the antenatal services is crucial. This should involve testing the men in the presence of their wives and giving mothers the reassurance from their husbands that they are in it (maternity and HIV prevention) together.
Women may be cautioned to attend ANC visits with their husbands but some men will definitely oppose this! They will send their friends, first born sons or male relatives to accompany their wives. If it becomes an institutional prerequisite it may also initially make pregnant women shy away from the services. But in the long run, if HIV is to be prevented the men must be brought on board at all stages of the maternity and reproductive health cycles.