MALE INVOLVEMENT AND PARTICIPATION IN

PREVENTION OF MOTHER TO CHILD

TRANSMISSION (PMTCT) OF HIV/AIDS – THE
CASE OF CHIPATA DISTRICT

By

BENKELE RODGERS GIFT

UNZA © 2007

1
 ACKNOWLEDGEMENTS

THE UNIVERSITY OF ZAMBIA

SCHOOL OF MEDICINE
DEPARTMENT OF NURSING

MALE INVOLVEMENT AND PARTICIPATION IN PREVENTION OF MOTHER TO

CHILD TRANSMISSION (PMTCT) OF HIV/AIDS – THE CASE OF CHIPATA DISTRICT

By

BENKELE RODGERS GIFT

BSc. Nrs. (2007), RN (2000), EN (1995)

A research submitted to the Department of Post Basic Nursing, School of

Medicine, University of Zambia in partial fulfilment of the requirements for the
Bachelor of Science Degree in Nursing.

Suggested citation:
Benkele, R. G., (2007), Male Involvement and Participation in the Prevention of Mother to Child Transmission
(PMTCT) of HIV/AIDS in Chipata District, UNZA, School of Medicine, Department of Nursing , Lusaka, Unpublished.

2
First and foremost, I would like to give Honour and Glory to the Almighty God for
the knowledge, skill and understanding He blessed me with and for taking care of
my family while I was away for studies. I do thank my wife Emma P. Benkele; my
sons Chipego Robert Benkele and Mazuba Chisomo Benkele for allowing me
pursue Bachelor of Science in Nursing program at the University of Zambia
(UNZA), Ridgeway Campus in the Department of Nursing, many kilometres away
from home.

I am greatly indebted to my beloved father and mother; Mr. Robert Siabeka

Benkele and Esnart Mutinta Benkele for the interest of taking me to school in the
first place. I do not forget to thank my bothers and sisters for their unceasing
prayers for my success in life.

My heartfelt gratitude goes to my supervising lecturer, Ms. C. N. Kwaleyela, for

patiently guiding and correcting me in the study. I greatly appreciate her
professional advice and critical analysis. I thank Mrs. C. Ngoma the course
coordinator for imparting in me knowledge in research. I am indebted to Dr. R. N.
Likwa for her encouragement and hard work in ensuring that the Research
Methodology course was well understood. I would also like to thank Mr. Y. Banda
for his expert assistance with statistical presentation in my study.

I remain indebted to my friends Ndhlovu David, Chisupa Erik, Munganga Juliet

and Bwanali Lilian for their constructive criticisms and to my other friends who
assisted in one way or another in making this study a success. I thank the
Seventh-Day Adventist Campus Ministries members for the fellowship we had
together and their encouragements.

For financial assistance I thank the Ministry of Health through the Expanded
Basket Fund Scholarship to study at UNZA. The acknowledgements would be

3
incomplete without recognising the permission from the Chipata District Health
Management Team for allowing me conduct the study in the selected centres in
the district.

Finally, my heart felt appreciation go to the men and women who participated in
the focus group discussions during data collection stage of the study whose
names I cannot mention for the reasons of confidentiality. Their revelations have
made the study a success and interesting.

TABLE OF CONTENTS

4
Content Page No.
Acknowledgments…………………...……………………………………………i
Table of Contents…………………………...………………………………….... iii
List of Appendices……………………………………………………………….. vi
List of Tables ……………………………………………...……………………… vii
List of Figures……………………………………...……………………………...xi
List of Abbreviations…………………………………………………...………… xii
Declaration………………………………………...……………………………... xiv
Statement………..………………………………...……………………………... xv
Dedication……………………………………………………………………...…. xvi
Abstract…………..………………………………...……………………………...xvii

CHAPTER ONE
1.0 INTRODUCTION
1.1 Background……………….………..........……………….……………….1
1.2 Statement of the problem……………………………………….. ……... 5
1.3 Research question……………………………………………….. ……... 9
1.4 Factors influencing male participation in PMTCT ……………..……...9
1.5 Problem analysis.……………….………………………………...……... 11
1.6 Justification ………………………….…………………………… …….. 12
1.7 Research objectives…………………………..……………….… ……... 12
1.8 Hypotheses…………………………………………….……….… ……... 13
1.9 Operational definitions of terms………………………………… ……... 13
1.10 Variables and cut off points……………………………………... ……... 14

CHAPTER TWO
2.0 LITERATURE REVIEW

5
2.1 Introduction…………………….…………………………………. ……... 15
2.2 Global perspective ………………………………………………..……...15
2.3 Regional perspective ……………………………….……………………16
2.4 National perspective………………...…………………………………… 16
2.5 Conclusion……………………………………………………….............. 17

CHAPTER THREE
3.0 RESEARCH METHODOLOGY
3.1 Introduction……………….………………………………………. ……... 18
3.2 Research design…………………...…………………………….. ……... 18
3.3 Research setting…………………………….…………………… ……... 18
3.4 Study population…………………………………….…………… ……... 21
3.5 Sampling procedure..……………………………………….…… ……... 21
3.6 Sample size………………………………………………………. ……... 21
3.7 Data collection tools…..……………………………….………… ……... 22
3.8 Data collection techniques……………………………………… ……... 22
3.9 Pilot study…………………………………………………………. ……... 22
3.10 Validity and Reliability…………………………………………… ……... 23
3.11 Ethical and cultural considerations……………........................ ……... 23

CHAPTER FOUR
4.0 DATA ANALYSIS AND PRESENTATION OF FINDINGS
4.1 Introduction……………………………………………………….. ……... 25
4.2 Data Analysis……………………………………………………………... 25
4.3 Presentation of Findings………………………………………….……... 26
4.3.1 Males aged between 20 and 45 years………………………….26
4.3.2 Females in either 2nd and 3rd trimester………………………… 41
4.3.3 Cross Tabulations………………………………………………... 50

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CHAPTER FIVE
5.0 DISCUSSION OF THE FINDINGS AND IMPLICATIONS FOR
THE HEALTH CARE SYSTEM
5.1 Introduction……………………………………………………………...... 64
5.2 Characteristics of the Sample…………………………………………... 64
5.3 Discussion of variable………..………………………………………….. 66
5.3.1 Knowledge…………………………………………………………66
5.3.2 Communication……………………………………………………69
5.3.3 Attitude……………………………………………………………..72
5.3.4 Practice……………………………………………………………. 73
5.4 Implications to the Health Care System……………………………….. 75
5.5 Conclusion………………………………………………………………... 76
5.6 Recommendations……………………………………………….. ……... 77
5.6.1 To the health care providers……………………………………. 77
5.6.2 To the DHM……………………………………………………….. 77
5.6.3 To policy makers.....……………………………………………… 78
5.7 Limitations of the study………………………………………………….. 78
5.8 Dissemination of study findings………………………………………… 78

References………………………………..……………………………............... 80

LIST OF APPENDICES

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1. Focus Group Discussion Guide for men………………..……………... 86
2. Focus Group Discussion Guide for women…………………………… 89
3. Application Letter for authority………………………………………….. 92
4. Ethical approval letter from the Department of Nursing……………… 94
5. Authority letter from the Ministry of Health…………………………….. 95
6. Authority Letter from the District..………………………………………. 97
7. Map of Eastern Province………………………………………………... 98
8. Map of Chipata District…………………………………………………... 99
9. Work Schedule…………………….……………………………………..
100
10. Gantt Chart……………………………………..…………………………
101
11. Budget……………………………………………………………………..
102
12. Justification for the budget……………………………………………….
103

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 LIST OF TABLES

Table No. Page No.

Table 1. Population Projections of Different Categories
from 2002 to 2006……………………………………………... 3
Table 2. Male : Female participation in VCT at Chipata
VCT Centre; 2004 4th quarter to 2005 4th quarter………… 6
Table 3. Utilisation of PMTCT services by mothers in Chipata
District: 2004 4th Quarter to 2006 1st Quarter……………... 7
Table 4. Variables and cut-off points…………………………………... 14
Table 5. Participants’ age distribution…………………………………. 26
Table 6. Participants’ number of wives………………………………... 27
Table 7. Participants’ number of Children…………………………….. 27
Table 8. Participants’ Tribe……………………………………………… 28
Table 9. Participants’ residential area…………………………………. 28
Table 10. Participants’ education Level………………………………… 29
Table 11. Participants’ occupation………………………………………. 29
Table 12. Participants’ denomination…………...……………………….. 30
Table 13. Participants’ response on definition of HIV…………………. 31
Table 14. Participants’ response on definition of AIDS……………….. 31
Table 15. Participants’ response on knowledge regarding
the modes of HIV transmission………………………………. 32
Table 16. Participants’ response regarding where HIV is
found in the body………………………………………………. 33
Table 17. Participants’ response on knowledge regarding
MTCT of HIV…………………………………………………… 33
Table 18. Participants’ response on knowledge on HIV prevention…. 34

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Table 19. Participants’ response on source of information…………… 35

Table 20. Participants’ response on knowledge about

PMTCT programme…………………………………………… 36
Table 21. Participants’ view towards males attending ANC
sessions with their wives……………………………………… 37
Table 22. Participants’ view on males’ role in PMTCT………………… 38
Table 23. Participants’ view on male involvement and
participation in PMTCT……………………………………….. 38
Table 24. Traditional practices that may promote HIV
transmission from the parents to the baby…………………. 39
Table 25. Participants’ view on alternative safe traditional practices
instead of use of semen smearing and use of tattoos…….. 40
Table 26. Participants’ age distribution…………………………………. 41
Table 27. Participants’ Residential area………………………………… 41
Table 28. Participants’ Educational level……………………………….. 42
Table 29. Participants’ occupation………………………………………. 42
Table 30. Participants’ marital status…………………………………… 43
Table 31. Participants’ parity…………………………………………….. 43
Table 32. Participants’ gestation age…………………………………… 43
Table 33. Participants’ tribe……………………………………………… 44
Table 34. Participants’ denomination…………………………………... 44
Table 35. Participants’ response on problems women face
with spouses regarding the PMTCT programme…………. 47
Table 36. Traditional practices that may promote HIV
transmission from the parents to the baby………………… 47
Table 37. Participants’ view on alternative safe traditional practices
instead of use of semen smearing and use of tattoos……. 48
Table 38. The relation between knowledge of male participants on

10
 where HIV can be found in the body and education level… 50
Table 39. The relation between knowledge of female participants
on were HIV is found in the body and education level…….. 51
Table 40. The relation between knowledge of male participants
regarding MTCT of HIV and education level……………….. 52
Table 41. The relation between knowledge of male
participants regarding Knowledge on HIV prevention and
residential area………………………………………………… 53
Table 42. The relationship between males who never heard of the
term PMTCT and residential area …………………………… 54
Table 43. The relationship between males who did not know the
activities in PMTCT programme and residential area ………. 54
Table 44. The relation between views towards males attending
antenatal care sessions with their wives and
residential area………………………………………………… 56
Table 45. The relation between views towards males attending
antenatal care sessions with their wives and
educational level………………………………………………. 57
Table 46. The relation between men’s views towards male
involvement and participation in PMTCT and
residential area………………………………………………… 58
Table 47. The relation between women’s views on how men can
be involved and participate in PMTCT programme
and gestation age……………………………………………… 59
Table 48. The relation between traditional practices that may
promote HIV transmission to the baby from the parents
and age of male participants…………………………………. 60
Table 49. The relation between traditional practices that may promote
HIV transmission to the baby from the parents and Tribe of

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 male participants………………………………………………. 61
Table 50. The relation between traditional practices that may
promote HIV transmission to the baby from the parents and
educational level of male participants………………………. 62

Table 51. Traditional practices in relation to gender and

educational level of male participants ………………...…… 63

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 LIST OF FIGURES

Figure 1 Problem Analysis Diagram………………………………….. 11

Figure 2 Participants’ response on knowledge regarding
where HIV is found in the body……………………………… 45
Figure 3 Participants’ response on communication
of PMTCT programmes to spouse………………………….. 46
Figure 4 Women’s views on how men can be involved in
PMTCT programme…………………………………………… 49

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 LIST OF ABBREVIATIONS

AIDS - Acquired Immune Deficiency Syndrome

ANC - Antenatal Clinic
CIDRZ - Centre for Infectious Diseases Research in Zambia
CSO - Central Statistics Office
DMO - District Medical Officer
FGD - Focus Group Discussion
HC - Health Centre
HIV - Human Immunodeficiency Virus
HMIS - Hospital Management Information System
IEC - Information Education and Communication
MCH - Maternal and Child Health
MDGs - Millennium Development Goals
MoH - Ministry of Health
MTCT - Mother to Child Transmission
NGOs - Non-Governmental Organizations
NMCHC - National Maternal and Child Health Centre
PGNC - Pentecostal Good News Church
PMO - Provincial Medical Officer
PMTCT - Prevention of Mother to Child Transmission
PPL - Pentecostal Prince of Life
PS - Permanent Secretary
RCC - Roman Catholic Church
RCCG - Reformed Christian Church of God
RCZ - Reformed Church in Zambia

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RTA - Road Traffic Accident
SafAIDS - Southern African AIDS Information Dissemination Service
SDA - Seventh-Day Adventist Church
STIs - Sexually Transmitted Infections
UNAIDS - United Nations Programmes on HIV/AIDS
UNICEF - United Nations International Children Emergency Fund
VCT - Voluntary Counselling and Testing
ZDHS - Zambia Demographic Health Survey
ZDV - Zidovudine

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 DECLARATION

I, hereby declare that the work presented in this study for a Bachelor of Science
Degree in Nursing has not been presented either wholly or in part, for any other
degree and is not being currently submitted to any other degree.

Signed: ………………………………… Date: …………………….

(Candidate)

Approved: ……………………………… Date: ……………………….

(Supervising Lecturer)

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 STATEMENT

I, Rodgers Gift Benkele, do hereby certify that this study is entirely the result of
my own independent investigations. The various sources to which I am indebted
are clearly indicated in the text and reference.

Signed: ………………………………………. Date: ………………………..

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 DEDICATION

To
My wife Emma Benkele whose patience and consideration sustained me through the
years of my studies

To
My sons Chipego Benkele and Mazuba Benkele for their understanding

To

My parents Robert Siabeka Benkele and Esnart Mutinta Benkele whose love and
affection inspired this endeavour

And

To
The child who has innocently become the victim of HIV/AIDS and the mother and father
devoted to prevention of transmission of HIV from the parents to the child. .

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 ABSTRACT

The HIV/AIDS epidemic is the most far reaching and damaging epidemic the
world has seen. The epidemic has not only resulted in high morbidity and
mortality among Zambians, but it continues to pose a great challenge on the
Zambian economy. The costs spent on HIV/AIDS programmes are high. One
such programme is PMTCT. The Ministry of Health (MoH) in 1998 formed the
MTCT working group to spearhead and coordinate activities related to prevention
of MTCT (MoH, 1999). The group was later referred to as Prevention of Mother to
Child Transmission (PMTCT) working group. Since then PMTCT programmes
have been supported by MoH and strategic plans have been developed to scale
up the implementation of theses programmes. In Zambia PMTCT is a concept
which is nearly 8 years old.

The purpose of this study was to determine the factors influencing male
involvement and participation in PMTCT programmes in Chipata District. Since
men are powerful decision makers; their involvement and participation in PMTCT
programmes can positively or negatively influence the utilisation of PMTCT
services and also curb the spread of HIV. Literature review for this study is from
various scholars globally, regionally and nationally.

A non experimental qualitative research approach using the exploratory study

design was used for this study. This study design enabled the researcher gain
insight and understanding of the factors that influence male involvement and
participation in PMTCT programmes.

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The research participants were selected using purposive sampling method
through the use of participation criteria. Thirty nine (39) males and eleven (11)
females participated in the study and data was collected through four (4) FGDs.
Data was analysed using content analysis. The codes that were drawn from the
analysis were entered into the computer software SPSS 9.0 for windows. A
SHARP scientific and statistical calculator was further used to draw and present
data using frequency tables, pie charts and cross tabulations.

The study has revealed that males in Chipata district are not adequately
participating in PMTCT programmes. This is mainly due to lack of information on
PMTCT, as there is no direct communication between PMTCT staff and the
males. The PMTCT programme has been integrated in ANC, which traditionally
mainly offered care to pregnant women. Therefore, men naturally felt left out
despite having positive views regarding roles they can play in PMTCT
programmes.

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 CHAPTER ONE

6.0 INTRODUCTION
6.1 BACKGROUND
Zambia is a landlocked country in the Sub-Saharan Africa with a population of
approximately 10 million people and an estimated Human Immunodeficiency
Virus (HIV) prevalence of 16 % overall (Central Statistical Office, 2003). The
Zambia Sentinel Surveillance conducted in 2002 by Central Statistics Office
(CSO) reported that the rate among antenatal clinic (ANC) attendances was
19%. The rate is higher in urban areas. At the end of 2001, it was estimated that
1.2 million Zambians were living with HIV/AIDS, with over half of these infections
in women and approximately 150, 000 infections in children (Ministry of Health,
2004).

The 2004 United Nations Programmes on HIV/AIDS (UNAIDS) reports that, as at

the end of 2003, 16.5% adults aged between 15–49 years were infected with
HIV, out of which the higher percentage were women. This data indicates that the
larger population infected are the women. Factors contributing to the high
prevalence of HIV among women could be their biological vulnerability, their low
economic status and their lack of assertiveness.

The socioeconomic impact of HIV /AIDS in Zambia is enormous. HIV /AIDS has
left an estimated 620,000 orphans, 6% of these are on the street and 1% in
orphanages (National AIDS Council, 2004). It is estimated that approximately
30,000 children become infected with HIV each year in Zambia (Ministry of

21
Health, 2004). The National AIDS Council (2004), further reports that 40% of
babies born to HIV infected mothers are infected with the virus. This situation has
caused the paediatric wards to become increasingly populated with chronically ill
and dying children leading to low bed turn over because these patients stay
longer in the wards.

In recent years, the evidence in support of feasible interventions to reduce

Mother to Child transmission (MTCT) of HIV has been growing. In 1994, research
showed that three months treatment with the drug Zidovudine (ZDV) for the
mother at the end of pregnancy, with an intravenous loading dose during
pregnancy and at the time of labour as well as 6 weeks treatment for the infant,
while not breastfeeding would reduce Mother to Child transmission by two thirds
(World Health Organisation, 1998).

In view of this evidence, the Ministry of Health (MoH) in 1998 formed the MTCT
working group to spearhead and coordinate activities related to prevention of
MTCT (MoH, 1999). The group was later referred to as Prevention of Mother to
Child Transmission (PMTCT) working group. Since then PMTCT programmes
have been supported by MoH and strategic plans have been developed to scale
up the implementation of these programmes.

In 2002, Zambia had 83 PMTCT sites (National AIDS Council, 2004). Chipata
district has six (6) PMTCT sites. Five (5) of these sites are in health centres while
one (1) is at a health post. The health centres with PMTCT sites are Kapata,
Namuseche and Chipata in the urban area, while Mwami, Chiparamba and
Makwe health post are in the peri-urban area. Among the PMTCT sites the
furthest is Chiparamba approximately 26km from the district office and the
nearest is Chipata about 2km from the district office.

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Chipata district is located in the Eastern province of Zambia. The district
boarders with Lundazi district in the north, Katete district in the west, Chadiza
district in the South and Mambwe in the northwest. It also shares an international
boundary with the Republic of Malawi in the east. The district covers a wide area,
with a total surface of about 6,112 sq km (Chipata District Health Office, 2006).
The largest area of the district is a plateau while the rest of the area is
surrounded by a range of hills.

The district is surrounded by a good network of electricity and telephone facilities.

This makes it possible for the district to communicate within and outside the
district. The main forms of communication within the district are radios and
telephones. There is also a good network of both tarmac and gravel roads. The
population of Chipata district is 444,262 of which 70% live in the rural areas and
30% live in the urban areas (Chipata District Health Office, 2006).

Table 1 indicates population projections of different categories as from January

2002 to December 2006.

Table 2 Population Projections of Different Categories from 2002 to 2006

CATEGORY % 2002 2003 2004 2005 2006
Children 0-11 months 4 16,156 16,681 17,770 18,348 -
Children less than 5 years 20 80,779 83,403 88,852 91,740 94,736
Children 5-14 years 31.2 126,015 130,108 138,610 143,114 147,789
Women 15-45 Years 22 88,856 91,743 97,738 100,914 104,209
All adults 15 years + 51.2 206,793 213,511 227,462 234,854 242,525
Total males(all ages) 49 197,906 204,337 217,688 224,763 232,104
Total females 51 205,987 212,677 226,574 233,937 241,578
Total population 100 403,893 417,014 444,262 458,700 473,682
Expected pregnancies 5.4 21,810 22,519 23,990 24,770 25,279
Expected deliveries 5.2 21,002 21,685 23,102 23,852 24,631
SOURCE: Chipata District Health Office (2006-2008)

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The District Health Office in partnership with Centre for Infectious Diseases
Research in Zambia (CIDRZ) coordinates PMTCT services. CIDRZ provides the
necessary logistics for smooth running of the PMTCT programmes in the district.
In providing PMTCT services the four (4) key strategies (Prongs) are used; which
are: Prevention of primary infection, Prevention of unintended pregnancy in HIV
infected women, Interventions aimed at the prevention of mother to child
transmission and Care and Support of infected and families, (MoH, 2004).

The major tribes in Chipata district are Ngoni and Chewa. These tribes have
some cultural beliefs and norms, which may impede development and delivery of
health services in the district. For instance the Ngoni people practice polygamy,
which may have a negative bearing on PMTCT programmes. Furthermore, the
cultural beliefs in the district most often affect women participation in decision
making as well as male involvement and participation in PMTCT programmes.

Men play key roles in reproductive health issues as individuals, family members
and community decision makers. Therefore reaching them is ‘key’ to making
PMTCT more widely accepted and used. In the PMTCT activities and strategies
outlined, men’s involvement and participation is critical and therefore there is
need for them to be motivated in all PMTCT programmes. Men can prevent
primary HIV infection to women by practicing safe sex through condom use and
also by being faithful to one uninfected faithful sexual partner. It is also important
for men to know their HIV status.

Rouw (2002), reports that traditionally, in many low and middle income countries,
men do not participate in Reproductive or Maternal and Child Health Care
services with their partners. Zambia is no exception. The inadequate male
involvement and participation has been cited as one of the reasons for poor
programme uptake. Traditionally, ANC and postnatal care have been viewed as

24
tasks for a woman. From 27 June to 22 July 2002, the Global PMTCT E-list
discussed the issue of Male Involvement - concerns and ways to overcome the
obstacles, (Rouw, 2002).

6.2 STATEMENT OF THE PROBLEM

Men’s involvement and participation in PMTCT should be the new focus for the
programme as well as other reproductive health programmes because men are
strong decision makers on reproductive health issues. Robey et al (1998),
reports that men are accustomed to making reproductive health decisions even
without the permission from their wives; for example, they will decide when to
have sex, how to have it, how many children to have and how many wives to
marry. At the community level men have an influence on cultural norms that
guide individual and community behaviour, such as sexual cleansing and how
information about HIV/AIDS is interpreted.

Nevertheless, despite the key roles males have, they have not participated fully
in PMTCT in Zambia and Chipata district is no exception. Data available shows
that there is only 5% male involvement in Voluntary Counselling and Testing
(VCT) programmes in the district.

25
Table 2 shows the ratios of male: female participation in VCT at Chipata VCT
Centre from 2004 to 2005. The average male participation at the centre is also
5%.

Table 2: Male : Female participation in VCT at Chipata VCT Centre; 2004 4th
quarter to 2005 4th quarter.
Year 2004 2005
Quarters 4th 1st 2nd 3rd 4th
Women 88 100 78 94 66
Males 5 5 3 7 4
Total 93 105 81 101 70
Males 5.4% 4.8% 3.7% 6.9% 5.7%
Women 94.6% 95.2% 96.3% 93.1% 94.3%
Source: (Chipata Health Centre PMTCT site, 2005)

Table 3 shows the overall utilisation of PMTCT services by mothers in Chipata

district from 2004 4th quarter to 2006 1st Quarter.

26
Table 3: Utilisation of PMTCT services by mothers in Chipata District: 2004
4th Quarter to 2006 1st Quarter

2004 2005 2006

4th 1st 2nd 3rd 4th 1st
Category
Qtr. Qtr. Qtr. Qtr. Qtr Qtr.
New antenatal attendances 1,008 944 1,192 1,118 1,275 1,266
Antenatal re-attendances 3,365 2,470 3,788 3,803 3,589 2,383
Pre-Test counselling 1,248 1,452 1,615 1,502 1,590 1,780
HIV Test 765 840 1,209 1,074 1,131 1,261
HIV +Ve 175 168 217 198 211 242
Mothers on Nevirapine 158 115 208 153 167 180
Infants on Nevirapine 29 72 73 95 101 42
Reporting Sites 3 3 5 5 5 5

Percentage of Pre-test 37% 59% 43% 39% 44% 75%

Percentage HIV+ 23% 20% 18% 18% 19% 19%
Percentage mothers on
Nevirapine 90% 68% 96% 77% 79% 74%
Source: Chipata District Health Office (2006)

On average the percentage of mothers who are tested is low compared to the
total number of antenatal re-attendances. At Makwe PMTCT site, the ratio of
males accompanying their spouses for ANC is 1:50 (Makwe HMIS, 2006). This
represents 2% of male participation in PMTCT programmes.
The low male participation could be due to the fact that PMTCT is provided at the
ANC under the banner of Maternal and Child Health (MCH) as opposed to the all
inclusive Family Health. Men are therefore excluded by definition. If the Zambian
programme is to have significant impact on childhood HIV infection and the

27
increasing mortality trends, PMTCT services need to be scaled-up to all Maternal
Child Health (MCH) services in the country, (MoH, 2004).

When the women have received counselling on HIV/AIDS, too often still they
prefer not to involve their male partners because of fear of their reactions. An
informal study conducted in six (6) PMTCT sites in Chipata district revealed that
there are women who do not inform their husbands about the HIV test results
which are positive for fear of divorce, going on separation or worse still being
beaten.

Furthermore in Kenya, the United Nations International Children Emergency

Fund (UNICEF) Project conducted in 2002 (Osborne, 2002) reported that women
explained that they were afraid of being tested for HIV because they would be
sent away by their husbands or accuse them of immorality if their spouses got to
know their status. Therefore, unless the problem of low male involvement and
participation in PMTCT activities are systematically researched and factors
established, the vision and goals of PMTCT will not be met.

6.3 RESEARCH QUESTION

Zambia’s strives to meet the Millennium Development Goal (MDGs) Number 4;
To Reduce Child Mortality and Number 5; To Improve Maternal Health by 2015
(Ministry of Finance and National Planning, 2006), its efforts will be in vain if

28
males are not involved and do not participate in the PMTCT programme. There is
need therefore, to explore the involvement and participation of men in PMTCT.
With this background, the researcher wanted to answer this question:- To what
extent are males involved and participating in PMTCT programmes in Chipata
District?

6.4 FACTORS INFLUENCING MALE PARTICIPATION IN PMTCT

Several factors may influence male involvement and participation in Prevention
of Mother to Child Transmission (PMTCT) of HIV/AIDS in Chipata District. These
factors include:

1.1.1 Socio-cultural values and norms

(a) Strong misconceptions about men’s involvement and participation in
reproductive health needs. The reproductive health role is seen as a
woman’s business in society.
(b) Traditional beliefs
(c) Poor communication between couples
(d) Religious beliefs that conflict with men’s involvement and participation in
PMTCT such as, condom use in some churches.
(e) Lack of motivation among health service providers to encourage males to
be involved and participate in PMTCT.
(f) Traditional masculine stereotypes which reinforce male superiority –
“Macho concept”.
(g) Polygamy

1.1.2 Individual Related Factors

(a) Poor understanding of PMTCT services offered in the community as this is
seen as a service for women only.

29
(b) Negative attitudes towards PMTCT and reproductive health services by
some men
(c) Most men seek health services only when they are ill.
(d) Lack of enthusiasm to share knowledge on the progress of pregnancy and
the necessary care provided at the ANC among spouses.

1.1.3 Health Related Factors

(a) Long waiting time at the health facilities
(b) Negative attitudes and behaviour of staff at the health facilities towards
men
(c) Inadequate trained personnel in PMTCT and male reproductive health
needs.
(d) Lack of knowledge by health staff about men’s expectations
(e) Ineffective programme management and lack of team work
(f) Inadequate follow up plans for health service providers
(g) Poor location of health facilities

1.1.4 Policy Related factors

(a) Low priority in financing communication programmes for men
(b) Restrictive policies and standards of reproductive health services
(c) The word “Father” is not included in the PMTCT programme’s name.

1.1.5 Disease Related Factors

(a) Stigma associated with HIV/AIDS
(b) Fear of the outcome of HIV test

30
6.5 PROBLEM ANALYSIS
Figure 1
Poor location of Negative
Stigma the PMTCT attitudes of
associated with rooms health workers
HIV/AIDS towards men

Lack of Long waiting

enthusiasm to Fear of outcome time at the health
share knowledge facility
on progress of
pregnancy
Restrictive
Male participation in policies and
Negative prevention of mother to standards
attitudes towards child transmission of HIV in
PMTCT by men Chipata District

Low priority in
financing male
programmes
Religious beliefs Poor
conflicting male communication Traditional
participation among couples beliefs

31
6.6 JUSTIFICATION
The purpose of this study was to determine factors that influence male
involvement and participation in PMTCT programmes in Chipata district. Since
men are powerful decision makers; their involvement and participation in PMTCT
programmes will positively or negatively influence the utilisation of PMTCT
services and also curb the spread of HIV.

As there was no operational research or any systematic study carried out on the
implementation of PMTCT programme with regards to male involvement and
participation in Zambia and in the district in particular, the study aimed providing
information on how they can be involved effectively. Operations research is a
process or a way of identifying and solving programme problems (Fisher and
Foreit, 2002). The study will also provide a foundation for further studies
regarding PMTCT and male participation in reproductive health programmes in
Zambia.

Finally, the information gathered could be used by MoH and Non-Governmental

Organizations (NGOs) involved in provision of PMTCT services in Chipata
district, Zambia and the region at large to formulate policies that will open an
avenue for males to be involved and participate in PMTCT programmes.

6.7 RESEARCH OBJECTIVES

1.1.6 General Objective
To determine factors which influence male involvement and participation in
PMTCT programmes in Chipata district.

1.1.7 Specific Objectives

(a) To identify the ratio of male involvement and participation in PMTCT in
Chipata District in comparison to their female counterparts.

32
(b) To assess the attitude and knowledge on PMTCT among men in Chipata
District.
(c) To assess current PMTCT practices and guidelines in relation to male
involvement and participation in Chipata District.
(d) To identify the socio-cultural factors that may influence male involvement
and participation in PMTCT in Chipata District.

6.8 HYPOTHESES
(a) Inadequate knowledge on PMTCT leads to low male involvement and
participation in PMTCT programmes.
(b) Certain Socio-cultural norms have a direct influence on male involvement
and participation in PMTCT programmes.
(c) Provision of PMTCT services from the ANC leads to low male involvement
and participation in PMTCT programmes.

6.9 OPERATIONAL DEFINITIONS OF TERMS

(a) AIDS: A chronic syndrome of opportunistic diseases which are a result of
acquired immunodeficiency following infection with HIV.
(b) Attitude: The respondent’s way of perceiving PMTCT.
(c) Beliefs: Specific statements that people define to be true.
(d) Counselling: A form of intervention under the direction of someone with
appropriate training which enables an individual, family or community to
take responsibility for prevention of HIV/AIDS.
(e) Cultural Norms: Rules and expectations by which a traditional society
guides the behaviour of its members.
(f) HIV: The virus that causes AIDS by destroying the biological ability of the
human body to fight opportunistic infections such as tuberculosis.
(g) Knowledge: Level of understanding or awareness of PMTCT.
(h) Male involvement: To include men in PMTCT programmes.
(i) Male participation: Men taking part in PMTCT programmes.

33
(j) Partner: A person of the opposite sex with whom one has sexual
relationships.
(k) PMTCT: A programme designed to prevent mother to child transmission of
HIV/AIDS.
(l) Prevention: Taking precautionary measures to avoid infection.

6.10 VARIABLES AND CUT OFF POINTS

Table 4 Variables and cut-off points

No. Variable Indicator Cut off points

1 Knowledge High • Men know all key issues about
HIV/AIDS and PMTCT
Moderate • Men know most of key issues about
HIV/AIDS and PMTCT
Low • Men know little of key issues about
HIV/AIDS and PMTCT
2 Communicatio Good • Information always available
n Fair • Information not always given
3 Attitude Positive • Men interested to get involved
participate in PMTCT programmes.
Negative • Men view PMTCT as a woman’s
programme.
4 Practice Good • Use safe practices to prevent HIV
transmission
Poor • Use risky traditional practices

CHAPTER TWO

34
7.0 LITERATURE REVIEW
7.1 INTRODUCTION
Literature review is a critical summary of research on a topic of interest, often
prepared to put a research problem in context or as the basis for an
implementation project (Polit and Hungler, 1997). This review focuses on
previous studies conducted to determine the magnitude of the problem of low
male involvement and participation in PMTCT programmes.

7.2 GLOBAL PERSPECTIVE

The HIV/AIDS epidemic has become a global problem. The 2004 UNAIDS
reports that, at the end of 2003, 16.5% adults aged between 15–49 years were
infected with HIV, out of which the higher percentage were women.

Formal and informal surveys around the world on reproductive health are
increasingly focusing on male involvement in reproductive health programmes.
Focus group discussions have also concentrated at looking at the male
participation and involvement in reproductive health programmes. They look at
males’ attitudes towards reproductive health and sexual behaviours. This
increase in the surveys reflects the widening recognition of men’s importance in
sexual and reproductive health. During the 14th International conference on AIDS
held in Barcelona, on 9th of July 2002 attended by about 300 participants
(Osborne 2002), it was discovered that although “male” involvement was still very
low, more males were getting involved in PMTCT related reproductive health
issues than ever before and, were making a difference to program uptake.

In a research which was conducted in Cambodia in June 2005 (Walston, 2005), it

was revealed that only a few indicators for male involvement in PMTCT
programmes were developed. The Cambodian’s Ministry of Health’s National
Maternal and Child Health Centre (NMCHC) therefore established A Safe

35
Motherhood Initiative that promoted the involvement of men as participants in
antenatal and postnatal care. The NMCHC’s program for PMTCT found much
higher female continuation when husbands are involved than when they were not
(Walston, 2005).

7.3 REGIONAL PERSPECTIVE

The HIV/AIDS epidemic has its greatest impact in Sub-Saharan Africa, where a
disproportionate number of all HIV/AIDS infections occur. HIV prevalence is now
as high as 40% among antenatal care attendees in some parts of Africa and
AIDS-related maternal deaths have increased dramatically and have recently
begun to outpace the already alarming number of deaths from obstetric causes,
(Moore 2003). The high prevalence of maternal mortality related to HIV among
women in African indicates the need for programs that involve their spouses.

A study conducted in Soweto – South Africa in 2004 by Philippa Garson (Garson,

2005), revealed that women were failing to disclose there HIV status to partners
and families fearing rejection and isolation. This can negatively affect the breast
feeding alternative as the woman will be living in secrecy.

7.4 NATIONAL PERSPECTIVE

HIV /AIDS has left an estimated 620,000 orphans, 6% of these are on the street
and 1% in orphanages (National AIDS Council, 2004). A PMTCT pilot program
covering six sites was launched in Zambia in 1998, and by the end of 2002
extended to 64 sites. Currently PMTCT is offered as an integral part of Maternal
and Child Health services in 83 sites across the country (National AIDS Council,
2004). The health centre personnel at each of the PMTCT designated sites have
been involved in community sensitization.

36
A study conducted in Chililabombwe on reproductive health in 1998 revealed that
reproductive health issues were traditionally a woman’s business hence men
were left out, (Chela, 1998).

The Medical Women’s Association of Zambia hosted a regional congress of the

Near East and Africa region from the 29th June to 3rd July 2006 in Lusaka, under
the theme “The Impact of HIV/AIDS on the Attainment of the Millennium
Development Goals”. The Congress among other issues discussed the social
and cultural impact of HIV/AIDS with reference to male involvement and PMTCT
strategies (Medical Women Association of Zambia, 2006). This is a clear
indication that there is need to provide more information on this essential
programme for the smooth implementation of the PMTCT programmes.

7.5 CONCLUSION
Literature available and the studies that have been done are on male
participation in reproductive health in general and family planning in particular.
This study will concentrate at male involvement and participation in PMTCT. Male
involvement in PMTCT is the key to effective implementation of the programme in
order to meet the MDGs; To Reduce Child Mortality and To Improve Maternal
Health by 2015.

37
 CHAPTER THREE

8.0 RESEARCH METHODOLOGY

8.1 INTRODUCTION
The chapter presents the research methodology that was used in this study. It
focuses on research design, study setting, study population, sample selection,
sample size, data collection tools, data collection technique, pilot study, validity
and reliability, ethical and cultural considerations, plan for data analysis, plan for
dissemination of findings and limitations of the study.

8.2 RESEARCH DESIGN

A research design is a plan or strategy for conducting a study. Uys and Basson
(2000), define research design as the total strategy for the study, from
identification of the problem to the final plans for collecting data, or as the
structural framework within which the study is to be implemented.

A non experimental qualitative research approach (Treece & Treece, 1986) using
the exploratory study design (Uys and Basson, 2000) was used for this study.
Qualitative data are narrative descriptions obtained by interviewing subjects by
making detailed notes of how subjects behave in naturalistic settings (Polit and
Hungler, 1997). This study design enabled the researcher gain insight and
understanding of the factors influencing male involvement and participation in
PMTCT.

8.3 RESEARCH SETTING

Research setting is “the physical location and conditions in which data collection
takes place in a study” (Polit and Hungler, 1997). The study was conducted in
Chipata district at three PMTCT sites namely Chiparamba RHC, Kapata urban
health centre and Chipata urban health centre.

38
The three (3) health centres were selected using random sampling. Initially all the
six PMTCT sites in the district were put in two clusters; that is sites in the rural
and sites in the urban area. A cluster sample was obtained thereafter. A cluster
sample is a type of sample that uses multiple stages and is often used to cover
wide geographical areas in which aggregated units are randomly selected and
then samples are drawn from the sample aggregated units, or clusters (Neuman,
2006). The rural cluster comprised Mwami Adventist hospital, Chiparamba rural
health centre and Makwe rural health post and the urban cluster comprised of
Chipata health centre, Kapata urban health centre and Namuseche health
centre.

Using simple random sampling method, one site was selected from the rural
cluster while two sites were selected from the urban cluster. Random sampling
method is a method sample in which the researcher uses a random number table
or similar mathematical random process so that each sampling element in the
population will have an equal probability of being selected, (Neuman, 2006). The
sample sites were therefore obtained by choosing elementary units through a
raffle draw. The sample sites selected were Chiparamba health centre, Chipata
health centre and Kapata urban health centre.

• Chiparamba Health Centre

Chiparamba rural health centre was opened in 1952 and it is 26km from the main
post office. It is located in the rural area, west of Chipata district, (Chiparamba
Health centre, 2006). The centre has seven (7) Neighbourhood Health
Committees It offers curative, supportive, preventive, laboratory and referral
services. According to the Action Plan (2006) for the health centre, the centre has
a catchment population of 12, 199 and the expected number of pregnancies is
659. It serves fifty-five (55) villages for two (2) chiefs; Chief Chikuwe for the
Chewa people and Chief Mishoro for the Ngoni people.

39
The majority of the people in the catchment area are peasant farmers while a few
are subsistence farmers. Being in the rural area several traditional practices are
being practiced such as Chokolo sexual cleansing (Chiparamba Health Centre,
2006). The main tribes in the area are Chewa and Ngoni.

• Chipata Health Centre

Chipata urban health centre is situated within the premises of Chipata General
Hospital. It is in a low residential area. It is about 1.5 km from the main post office
(Chipata Health Centre, 2005). The clinic was established in 1999 and offers
services to approximately 25, 740 population (Chipata Health Centre, 2005) from
both low and high residential areas. The expected number of pregnancies is 1,
390, (Chipata Health Centre, 2005).

The health centre offers curative, supportive, preventive and referral services.
The clinic offers services to the following catchment areas; Kalongwezi, Kanjala,
Mchini, St Monica’s, Maferendum and Chipata Motel. Majority of the clients are
small businessmen with “Tuntemba” and others are civil servants in government
offices. Some of the clients are farmers. The catchment is composed of various
tribes though the main tribes are Ngoni, Chewa, Nsenga and Tumbuka

• Kapata Health Centre

Kapata health centre is located in a high density area about 2.3km from the main
post office. It offers services to Kapata, New Jim, Old Jim, New Houses,
Mtilansembe, David Kaunda Plots, Nabvutika and St Anne’s. It has a catchment
population of approximately 35, 255 (Kapata Health Centre, 2006). It offers
curative, supportive, preventive, laboratory and referral services and the
expected number of pregnancies is 1, 904, (Kapata Health Centre, 2006).

40
The main tribes in the area are Chewa, Ngoni, Tumbuka and Nsenga. The
majority of the people are engaged in small business such as “Salaula”,
“Tuntemba” and vegetable selling.

8.4 STUDY POPULATION

A study population is “the total group of individuals or things meeting the
designated criteria of interest to the researcher” (Dempsey and Dempsey, 2000).
In this study, the study population included all married men aged between 20 to
49 years as well as pregnant women in either their second or third (2nd or 3rd)
trimester living in Chipata district.

8.5 SAMPLING PROCEDURE

Sample selection is “a process of selecting a portion of the population to
represent the entire population” (Treece and Treece, 1986). The researcher
selected the research participants using purposive sampling methods (Treece &
Treece, 1986). Men and women who satisfied the participation criteria, and
agreed to participate were recruited on a first come first served basis until the
required number of participants was reached. The selection criteria were; married
males aged 20-45 years living in Chipata district and pregnant mothers in either
their 2nd or 3rd trimester.

8.6 SAMPLE SIZE

Uys and Basson, (2000) defines sample size as the total number of
subjects/objects to represent the population under study. More technical
considerations suggest that the required sample size is a function of the
precision of the estimates one wishes to achieve, the variability or variance, one
expects to find in the population and the statistical level of confidence one wishes
to use (Mugo, 2004). Due to limited time and financial constraints, a total of 39
married men and 11 pregnant women comprised the sample size.

41
8.7 DATA COLLECTION TOOLS
A data collection tool is a device that is used to collect data, (Polit and Hungler,
1997). Data collection was done between September and October 2006 in
Chipata district. Data was collected through four (4) FGDs; that is one (1) with 11
pregnant women and three (3) with thirty nine (39) married men; thirteen (13)
participants in each FGD.

The researcher was the moderator. A FGD guide was used to direct the
discussions. Radio cassette recorder and note pad were used to record and take
note of all the points raised during the FGDs. Each FGD lasted about 60
minutes.

8.8 DATA COLLECTION TECHNIQUES

Polit and Hungler (1997) define data collection technique as “a procedure of
collection of data needed to address a research problem”. At the beginning of
each FGD, the moderator introduced himself, and then the participants also
introduced themselves.

An explanation of the purpose of the study in simple terms was made; this
enabled the respondents participate with ease during the discussions. The
participants were oriented to the data collection tools and assured them that
confidentiality was going to be maintained. During the discussions tape recording
and note taking were done.

8.9 PILOT STUDY

A pilot study which is a small study or trial run, done in preparation for the major
study (Polit and Hungler, 1997), was done in the 4th week of August 2006 at
Lunkwakwa health centre in Chipata. Seven participants participated in the pilot
study. The pilot study findings were used to make changes to the methodology.

42
8.10 VALIDITY AND RELIABILITY
Uys and Basson, (2000) define validity as “the degree to which an instrument
measures what it is supposed to measure. It constitutes both internal and
external validity”. External validity is the extent to which the findings of the
research can be generalized to a larger population or to a different social,
economical and political setting (Uys and Basson, 2000). To ensure external
validity the sample size comprised people from different social, economic,
political and religious backgrounds.

Internal validity refers to interpretation of the findings within the study or data
collected, (Uys and Basson, 2000). It seeks to find out if the effect on the
dependent variable observed was actually due to the action of the independent
variable. This was ensured through the use of a scientific and statistics
calculator and HPSS for analysis.

Reliability refers to “the degree of consistency or accuracy with which an

instrument measures the attribute it is designed to measure” (Uys and Basson,
2000). This was ensured by use of the FDG guide whose questions were verified
by two independent people.

8.11 ETHICAL AND CULTURAL CONSIDERATIONS

The development and implementation of research should be ethically and
culturally acceptable. Ethics is defined as “a system of moral values that is
concerned with the degree to which research procedure adhere to professional,
legal and social obligations to the study participants” (Polit and Hungler, 1997).
Uys and Basson, (2000) further states that the ethical acceptability of the
research should apply first to the people directly involved in it, and then to the
people involved in carrying out the research.

43
It is important to consider ethics in research to ensure the protection of human
rights. The researcher got permission to carry out the study from; Head of
Department of Nursing – School of Medicine; Permanent Secretary (P.S.) at the
MoH; Provincial Medical Officer (P.M.O.) Eastern Province; District Medical
Officer (D.M.O.) from Chipata District Health Office; Health Centre In-charges
and Research participants. The nature and purpose of the study was explained
to the respondents before discussions. The participants were assured of privacy
that the information would only be used for the research and the names would
not be communicated to any one.

44
 CHAPTER FOUR

9.0 DATA ANALYSIS AND PRESENTATION OF FINDINGS

9.1 INTRODUCTION
The purpose of this chapter is to present information on how the research data
were analysed and what information was obtained.

9.2 DATA ANALYSIS

Data analysis is the systematic organisation and synthesis of research data, and
the testing of research hypotheses using those data (Polit and Hungler, 1997).
Content analysis (Polit and Hungler, 1997), which is a technique for gathering
and analysing the content of text, was used to analyse the data.

The researcher began the analysis by reading the entire script while playing back
the tape. The tape recording on average for each FDG was 60 minutes. Listening
to the recordings several times enabled the researcher to organize the raw data
into conceptual categories and create themes or concepts (Neuman, 2006). The
concepts were broken down and arranged into a machine readable form of data
for statistical analysis. The core categories and sub themes were then entered on
the data master sheet manually.

Coding of data into a machine readable format was through open coding
(Neuman, 2006), to condense the mass of data into categories. The codes were
used to enter data in computer software SPSS to draw frequency tables, pie
charts and bar charts. Data were also analysed using a SHARP scientific and
statistical calculator. The researcher found these as appropriate to present the
findings because they are easy to interpret. They are also useful to make cross
tabulations and inferences.

45
The analysis of the data from the two categories (men & women) was done
separately. The core categories for the men were; demographic data, knowledge,
attitude, communication and participation, while for the women were;
demographic data, knowledge, communication and practice.

9.3 PRESENTATION OF FINDINGS

Presentation of data is done in two folds; data from FGD with males aged
between 20 to 45 years and data from FGD with pregnant mothers. Data is
presented in frequency tables, graphs and pie charts. Cross tabulations of the
variables used has also been done to identify relationships among them.

9.3.1 MALES AGED BETWEEN 20 AND 45 YEARS

A. DEMOGRAPHIC DATA
Table 5, Participants’ age distribution
(n=39)
Age Frequency Percentage
20-24 years 4 10.3
25-29 years 5 12.8
30-34 years 12 30.8
35-39 years 7 17.9
40-44 years 9 23.1
45 years+ 2 5.1
Total 39 100.0

Twelve (30.8%) of the participants were in the age group of 30-34 years, 9
(23.1%) were between 40-44 years, 5 (12.8%) were between 25-29 years, 4
(10.3%) were between 20-24 years while 2 (5.1%) were above 45 years old.
Seven (17.9%) were aged between 35-39 years.

Table 6, Participants’ number of wives

(n=39)
No. of Wives Frequency Percent

46
1 35 89.7
2 4 10.3
Total 39 100.0

The majority of the participants, 35 (89.7%) had one wife while 4 (10.3%) had
two wives each.

Table 7, Participants’ number of Children

(n=39)
No. of Children Frequency Percent
0-2 16 41.0
3-5 15 38.5
6-8 8 20.5
Total 39 100.0

Sixteen (41%) of the participants had number of children ranging between 0-2,
while 15 (38.5%) had number of children ranging between 3-5 and 8 (20.5%) had
number of children ranging 6-8.

Table 8, Participants’ Tribe

(n=39)
Tribe Frequency Percent
Tumbuka 8 20.5
Ngoni 13 33.3
Chewa 16 41.0
Bisa 1 2.6

47
Bemba 1 2.6
Total 39 100.0

Sixteen (41%) of the participants belonged to the Chewa tribe, Ngoni tribe had 13
(33.3%), Tumbuka tribe had 8 (20.5%) participants while Bisa and Bemba tribes
had 1 (2.6%) participant each.

Table 9, Participants’ residential area

(n=39)
Residential Area Frequency Percent
High Density 19 48.7
Low Density 4 10.3
Village 16 41.0
Total 39 100.0

Nineteen (48.7%) of the participants were from high density areas, 16 (41%)
participants were residing in villages while 4 (10.3%) were from low density
areas.

Table 10, Participants’ education Level

(n=39)
Educational Level Frequency Percent
None 1 2.6
Primary 19 48.7
Junior Secondary 6 15.4
Senior Secondary 11 28.2
College 1 2.6
University 1 2.6
Total 39 100.0

48
Nineteen (48.7%) of the participants attained primary school education, 11
(28.2%) had senior secondary education level and 6 (15.4%) had junior
secondary education level while 1 (2.6%) attained college and university
education each. Another 1 (2.6%) had no education at all.

Table 11, Participants’ occupation

(n=39)
Occupation Frequency Percent
Farmer 19 48.7
Accountant 1 2.6
Clerk 6 15.4
Security Guard 2 5.1
Machine Attendant 1 2.6
Classified daily Employee 2 5.1
Traditional Healer 2 5.1
Businessman 6 15.4
Total 39 100.0

Nineteen (48.7%) of the participants were farmers, 6 (15.4%) were clerks and the
other 6 (15.4%) were businessmen, 2 (5.1%) were security guards, 2 (5.1%)
were classified daily employees and the other 2 (5.1%) were traditional healers
while 1 (2.6%) was an accountant and 1 (2.6%) was a machine attendant.

Table 12, Participants’ denomination

(n=39)
Denomination Frequency Percent
Reformed Church in Zambia 10 25.6
Roman Catholic Church 18 46.2
Reformed Christian Church of God 1 2.6
Pentecostal Good News Church 1 2.6
Baptist 2 5.1
Pentecostal Prince of Life 1 2.6
Anglican Church 1 2.6
Zionist 2 5.1
Seventh-Day Adventist 3 7.7
Total 39 100.0

49
Eighteen (46.2%) of the participants belonged to the Roman Catholic Church
(RCC), 10 (25.6%) belonged to the Reformed Church in Zambia (RCZ), 3 (7.7%)
belonged to the Seventh-day Adventist Church (SDA) and 2 (5.1%) belonged to
the Baptist and Zionist Churches each. The least number of the participants’
denominations were Reformed Christian Church of God (RCCG), Pentecostal
Good News Church (PGNC), Pentecostal Prince of Life (PPL) and Anglican
Churches at 1 (2.6%) each.

B. KNOWLEDGE
Table 13, Participants’ response on definition of HIV
(n=39)
Definition of HIV Frequency Percent
Virus 21 53.8
Disease 18 46.2
Total 39 100.0

Eighteen (46%) of the participants defined HIV as a disease while 21 (53.8%)

defined HIV as a virus.

Table 14, Participants’ response on definition of AIDS

(n=39)
Definition of AIDS Frequency Percent
Disease 39 100.0

All the 39 (100%) participants defined AIDS as a disease.

50
Table 15, Participants’ response on knowledge regarding the modes of HIV
transmission
(n=39)
Modes of HIV Transmission Frequency Percent
MTCT, blood transfusion, unprotected sex & use of 1 2.6
contaminated sharps
MTCT, blood transfusion, unprotected 2 5.1
Unprotected sex & use of contaminated sharps 19 48.7
Unprotected sex 15 38.5
Unprotected sex, use of contaminated sharps & sharing 1 2.6
toothbrush
Unprotected sex, use of contaminated sharps & 1 2.6
contamination in an RTA
Total 39 100.0

Nineteen (48.7%) of the participants indicated that the modes of HIV

transmission were unprotected sex & use of contaminated sharps. One (2.6%) of
the participants indicated that it was through MTCT, blood transfusion,
unprotected sex & use of contaminated sharps, another 1 (2.6%) indicated
unprotected sex, use of contaminated sharps & sharing toothbrushes while a
further 1 (2.6%) indicated unprotected sex, use of contaminated sharps &
contamination in an RTA as modes of transmission. Fifteen (38.5%) indicated
unprotected sex.

51
Table 16, Participants’ response regarding where HIV is found in the body
(n=39)
Components where HIV is found in the body Frequency Percent
Blood, semen, milk & vaginal fluids 3 7.7
Blood, semen & milk 1 2.6
Blood, semen & vaginal fluids 1 2.6
Blood & vaginal fluids 1 2.6
Blood & semen 1 2.6
Blood & milk 13 33.3
Blood 19 48.7
Total 39 100.0

Nineteen (48.7%) of the participants indicated that HIV is found in Blood, 13

(33.3%) indicated blood & milk and 3 (7.7%0 indicated blood, semen, milk &
vaginal fluids. One (2.6%) indicated blood, milk and semen, 1 (2.6%) indicated
blood, semen and vaginal fluids, 1 (2.6%) l fluids indicated blood and vaginal
fluids another 1 (2.6%) indicated blood and milk.

Table 17, Participants’ response on knowledge regarding MTCT of HIV

(n=39)
MTCT of HIV Frequency Percent
During pregnancy, delivery & breastfeeding 2 5.1
During delivery & breastfeeding 7 17.9
During Pregnancy and breast feeding 6 15.4
During pregnancy 13 33.3
During delivery 2 5.1
During breast feeding 8 20.5
Not sure 1 2.6
Total 39 100.0

52
Thirteen (33.3%) of the participants indicated that MTCT of HIV is during
pregnancy, 8 (20.5%) indicated during breast feeding, 7 (17.9%) indicated during
delivery & breastfeeding, 6 (15.34% indicated during pregnancy and breast
feeding, 2 (5.1%) indicated during pregnancy, delivery & breastfeeding, another 2
(5.1%) indicated during delivery while 1 (2.6%) was not sure.

Table 18, Participants’ response on knowledge of HIV prevention

(n=39)
HIV prevention Frequency Percent
Abstinence & being faithful to one faithful sexual partner 3 7.7
Abstinence & condom use 10 25.6
Being faithful to one faithful sexual partner & condom 1 2.6
use
Abstinence, condom use, no sharing of sharps 2 5.1
Abstinence, condom use & screening of blood 2 5.1
Abstinence & no sharing of sharps 7 17.9
Being faithful to one faithful sexual partner & no sharing 1 2.6
of sharps
Condom use & screening of blood 1 2.6
No sharing of sharps 1 2.6
Abstinence 7 17.9
Being faithful to one faithful sexual partner 1 2.6
Abstinence & screening of blood 1 2.6
Condom use 2 5.1
Total 39 100.0

Ten (25.6%) of the participants indicated that HIV prevention is through

abstinence and condom use, 7 (17.9%) indicated abstinence & no sharing of
sharps, another 7 (17.9%) indicated abstinence, 3 (7.7%) indicated abstinence &
being faithful to one faithful sexual partner, 2 (5.1%) indicated abstinence,
condom use, no sharing of sharps, another 2 (5.1%) indicated abstinence,
condom use & screening of blood, while a further 2 (5.1%) indicated condom
use. Others; 1 (2.6%) indicated being faithful to one faithful sexual partner &
condom use, 1 (2.6%) indicated being faithful to one faithful sexual partner & no
sharing of sharps, 1 (2.6%) indicated condom use & screening of blood, 1 (2.6%)

53
indicated no sharing of sharps, 1 (2.6%) indicated being faithful to one faithful
sexual partner and 1 (2.6%) indicated abstinence & screening of blood.

C. COMMUNICATION
Table 19, Participants’ response on source of information
(n=39)
Source of Information about PMTCT Frequency Percent
Wife 12 30.8
Media 12 30.8
Health Centre 1 2.6
None 14 35.9
Total 39 100.0

Fourteen (35.9%) of the participants indicated that they have never heard of
PMTCT, 12 (30.8%) heard about the programme from their wives, while another
12 (30.8%) heard from the media and 1 (2.6%) heard about PMTCT from the
health centre.

Table 20, Participants’ response on knowledge about PMTCT programme

(n=39)
Information on PMTCT programme Frequency Percent
IEC, counselling & ARVs 4 10.3
IEC & ARVs 1 2.6
IEC & counselling 6 15.4
ARVs & counselling 1 2.6
IEC 3 7.7

54
Do not know 24 61.5
Total 39 100.0

Twenty four (61.5%) of the participants indicated that they did not know what
PMTCT programme was all about, 6 (15.4%) indicated that it was about IEC &
counselling, 4 (10.3%) indicated that it was about IEC, counselling & ARVs, 3
(7.7%) indicated it was about IEC only, while 1 (2.6%) indicated that it was about
IEC & ARVs and another 1(2.6%) indicated it was about ARVs & counselling.

D. ATTITUDE

Table 21, Participants’ view towards males attending antenatal care

sessions with their wives
(n=39)
Views towards males attending antenatal Frequency Percent
care sessions with their wives
It is for women & men are busy 2 5.1
Men busy, but can attend 10 25.6
Never thought of it 5 12.8

55
It is for women, men can not attend 17 43.6
Only escorted, but not attended sessions 5 12.8
Total 39 100.0

Seventeen (43.6%) of the participants indicated that ANC was a programme for
women and men can not attend, 10 (25.6%) indicated that men are busy, but can
attend, 5 (12.8%) indicated that they only escorted, but not attended sessions
and while 2 (5.1%) added that men are too busy to attend ANC. Five (25.6%)
indicated that they never thought of it that men could attend.

Table 22, Participants’ view on males’ role in PMTCT

(n=39)
Views on roles of men in PMTCT Frequency Percent
Encouraging 5 12.8
Supporting & HIV testing 4 10.3
Supporting 6 15.4
HIV testing 11 28.2
Behaviour change 11 28.2
Do not know 2 5.1
Total 39 100.0

Eleven (28.2%) of the participants indicated HIV testing as a role for males in
PMTCT and the other 11 (28.2%) indicated behaviour change as a role for males
in PMTCT. Six (15.4%) indicated that men can take the supportive role, 5

56
(12.8%) indicated that men can take the role of encouraging women, 4 (10.3%)
indicated that men can take a supportive role and HIV testing. Only 2 (5.1%) they
indicated that they did not know the roles men could take in PMTCT
programmes.

Table 23, Participants’ view on male involvement and participation in

PMTCT
(n=39)
Male involvement and participation Frequency Percent
Men are left out in the programme 16 41.0
Programme is focused on women 7 17.9
Men should be invited invitation letters 16 41.0
Total 39 100.0

Sixteen (41%) participants indicated that men are left out in PMTCT programmes
and another 16 (41%) indicated that males should be invited using invitation
letters while 7 (17.9%) indicated that the programme is focused on women.

E. PRACTICE

Table 24, Traditional practices that may promote HIV transmission from the
parents to the baby
(n=39)
Traditional practices Frequency Percent
Smearing semen (Kukonza Mwana) 29 74.4
Smearing semen & tattooing 1 2.6
Tattooing 2 5.1
None 7 17.9
Total 39 100.0

Twenty nine (74.4%) of the participants indicated smearing of semen on the baby
(Kukonza mwana) as a traditional practice that may promote HIV transmission
from the parents to the baby, 7 (17.9%) were not certain of any risky traditional

57
practice, 2 (5.1%) indicated tattooing of babies as risky practice while 1 (2.6%)
indicated smearing semen & tattooing as risky practices.

Table 25, Participants’ view on alternative safe traditional practices instead

of use of semen smearing and use of tattoos
(n=39)
Safe traditional practices instead of semen Frequency Percent
smearing and use of tattoos
Using herbs or chickens or young cousins 3 7.7
Using herbs or chickens 3 7.7
Using chickens or young cousins 4 10.3
Using herbs 10 25.6
Using herbs or young cousins 10 25.6
Not aware 9 23.1
Total 39 100.0

Ten (25.6%) participants indicated the use of herbs as a safe traditional practice
in place of semen smearing and use of tattoos and another 10 (25.6%)
participants indicated use of herbs or young cousins as safe traditional practices
in place of semen smearing and use of tattoos, while 9 (23.1%) said they were
not aware of alternative safe traditional practices in place of semen smearing and
use of tattoos. Four (36.4%) indicated use of chickens or young cousins as safe
traditional practices in place of semen smearing and use of tattoos, 3 (7.7%)
indicated use of herbs or chickens or young cousins as safe traditional practices
in place of semen smearing and use of tattoos and other 3 (7.7%) indicated the

58
use of herbs or chickens as safe traditional practices in place of semen smearing
and use of tattoos.

9.3.2 FEMALES IN EITHER 2ND AND 3RD TRIMESTER

A. DEMOGRAPHIC DATA
Table 26, Participants’ age distribution
(n=11)
Age Frequency Percent
<20 years 1 9.1
20-24 years 4 36.4
25-29 years 3 27.3
30-34 years 1 9.1
35-39 years 2 18.2
Total 11 100.0

Four (36.9%) of the participants were in the age range of 20-24 years, 3 (27.3%)
were between 25-29 years, 2 (18.2%) were between 35-39years, 1 (9.1%) was
between 30-34 years while another 1 (9.1%) was below 20 years.

Table 27, Participants’ Residential area

(n=11)
Residential Area Frequency Percent
High Density 8 72.7
Low density 3. 27.3
Total 11 100.0

The majority of the participants 8 (72.7%), were from high density residential
areas while 3 (27.3%) were from low density areas.

59
Table 28, Participants’ Educational level
(n=11)
Education level Frequency Percent
Primary 4 36.4
Junior Secondary 6 54.5
College 1 9.1
Total 11 100.0

Six (54.5%) of the participants had junior secondary school education and 1
(9.1%) had college education while 4 (36.4%) had primary education

Table 29, Participants’ occupation

(n=11)
Occupation Frequency Percent
Scholar 1 9.1
Marketer 4 36.4
Teacher 1 9.1
None 5 45.5
Total 11 100.0

Five (45.5%) of the participants had no occupation, 4 (36.4%) were marketers, 1

(9.1%) was a teacher and another 1 (9.1%) was a scholar.

60
Table 30, Participants’ marital status
(n=11)
Marital Status Frequency Percent
Married 10 90.9
Single 1 9.1
Total 11 100.0

One (9.1%) participant was single while the rest 10 (90.9%) were married.

Table 31, Participants’ parity

(n=11)
Parity Frequency Percent
0-2 7 63.6
3-5 2 18.2
6-8 2 18.2
Total 11 100.0

Seven (63.6%) of the participants had 0-2 children, 2 (18.2%) had 3-5 children
while another 2 (18.2%) had 6-8 children.

Table 32, Participants’ gestation age

(n=11)
Gestation Age Frequency Percent
nd
2 Trimester 5 45.5
3rd Trimester 6 54.5
Total 11 100.0

Six (54.5%) of the participants were in their 3rd trimester while 5 (45.5%) were in
their second trimester.
Table 33, Participants’ tribe
(n=11)
Tribe Frequency Percent
Chewa 5 45.5
Ngoni 2 18.2
Tumbuka 2 18.2

61
Nsenga 2 18.2
Total 11 100.0

Five (45.5%) of the participants belonged to the Chewa tribe, 2 (18.2%) were
Ngoni, another 2 (18.2%) were Tumbuka while a further 2 (18.2%) were Nsenga.

Table 34, Participants’ denomination

(n=11)
Denomination Frequency Percent
Roman Catholic Church (RCC) 5 45.5
Jehovah’s’ Witness 1 9.1
Reformed Church in Zambia (RCZ) 2 18.2
Pentecostal Assemblies of God (PAOG) 3 27.3
Total 11 100.0

Five (45.5%) of the participants belonged to the RCC, 3 (27.3%) belonged to

PAOG, 2 (18.2%) belonged to RCZ and 1 (9.1%) was a Jehovah’s Witness.

B. KNOWLEDGE
80 72.7
70
Figure 2, Participants’ response on knowledge regarding
Blood, where HIV is
breast milk,
60
found in the body vaginal fluids and
50 semen
Percentage 40 Blood and breast
milk, (n=11)
30
18.2
20 Blood, breast milk
9.1
10 and vaginal fluids
0
Responses
62
 (2) (8) (1)

Eight (72.7%) of the participants indicated that HIV is found in blood and breast
milk, while 2 (18.2%) indicated that it is found in blood, breast milk, vaginal fluids
and semen and 1 (9.1%) indicated that it is found in blood, breast milk and
vaginal fluids.

Informed
Did not inform
Tried to inform, spouse not interested

27.3%
C. COMMUNICATION

Figure 3, Participants’ response on communication of PMTCT programmes

to spouse
(n=11)

9.1% 63.6%

63
 (3)
(7)
(1)

Seven (63.6%) of the participants indicated that they informed their spouses
about the PMTCT programme, 3 (27.3%) indicated that they tried to inform their
spouses but the spouse were not interested, while 1 (9.1%) said they did not
inform their spouses.

D. PRACTICE

Table 35, Participants’ response on problems women face with spouses

regarding the PMTCT programme
(n=11)
Problems Frequency Percent
Women responsible for “disease” (HIV/AIDS) 1 9.1
Men not helpful 6 54.5
No problems 2 18.2
None 2 18.2

64
 Total 11 100.0

Six (54.5%) of the participants indicated that men are not helpful in issues of
PMTCT, while 1 (9.1%) indicated that women are said to be responsible for the
“disease”. 2 (18.2%) did not face any problems while another 2 (18.2%) did not
know.

Table 36, Traditional practices that may promote HIV transmission from the
parents to the baby
(n=11)
Traditional practices Frequency Percent
Smearing semen on the baby 6 54.5
Tattooing the baby 5 45.5
Total 11 100.0

The majority of the participants 6 (54.5%) indicated that the traditional practice
that may promote HIV transmission from the parents to the baby is smearing of
semen on the baby. 5 (45.5%) indicated tattooing of the baby.

Table 37, Participants’ view on alternative safe traditional practices instead

of use of semen smearing and use of tattoos
(n=11)
Safe traditional practices instead of semen smearing Frequency Percent
and use of tattoos
Using herbs or chickens 2 18.1
Using herbs or young cousins 1 9.1
Using herbs 4 36.4
Not aware 4 36.4
Total 11 100.0

Four (36.4%) of the participants indicated use of herbs as a safe traditional

practice, while another 4 (36.4%) indicated that they were not aware of any safe

65
traditional practice. 2 (18.1%) indicated the use of herbs or chickens while 1 (9.1)
indicated use of young cousins.

Figure 4, Women’s views on how men can be involved in PMTCT

programme
(n=11)
Couple Sensitisation
Conducive environment for men at PMTCT centres
Invite men using Letters

40.0% 36.4% 36.4%

35.0%
27.2%
30.0%
Percentage

25.0%
20.0%
(4) (3) (4)
15.0%
10.0%
5.0%
0.0% 66
Views of women
Four (36.4%) of the participants indicated that males could be involved in PMTCT
through couple sensitisation and inviting men to attend PMTCT sessions, while
another 4 (36.4%) indicated invitation of males using letters. 3 (27.2%) indicated
provision of a conducive environment for males at the PMTCT centres.

67
9.3.3 CROSS TABULATIONS
A. KNOWLEDGE
Table 38, The relationship between knowledge of male participants on where HIV can be found in the body (table
16) and education level (table 10)
(n=39)
Educational Level
None Primary J. Sec S. Sec College University
HIV in the body Total
Blood, semen, milk & vaginal fluids 0 (0%) 0 (0%) 0 (0%) 2 (5.1%) 1 (2.6%) 0 (0%) 3 (7.7%)
Blood, semen & milk 0 (0%) 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Blood, semen & vaginal fluids 0 (0%) 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Blood & vaginal fluids 0 (0%) 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Blood & semen 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 0 (0%) 1 (2.6%)
Blood & milk 1 (2.6%) 6 (15.4%) 1 (2.6%) 4 (10.3%) 0 (0%) 1 (2.6%) 13 (33.3%)
Blood 0 (0%) 13 (33.3%) 4 (10.3%) 2 (5.1%) 0 (0%) 0 (0%) 19 (48.7%)
Total 1 (2.6%) 19 (48.7%) 6 (15.4%) 11 (28.2%) 1 (2.6%) 1 (2.6%) 39 (100%)

Among the participants with primary education 13 (33.3%) indicated that HIV is found in blood and only 6 (15.4%)
indicated that it is found in blood and milk. For those with senior secondary education, 2 (5.1%) indicated that it is found in
blood, 4 (10.3%) indicated that it is found in blood and milk and only 2 (5.1%) indicated that it is found in blood,

68
semen, milk & vaginal fluids, while 1 (2.60%) of the participant with college
education indicated that it is found in blood, semen, milk & vaginal fluids.

Table 39, The relationship between knowledge of female participants on

were HIV is found in the body (figure 4) and education level (table 28%)
(n=11)
Educational level
Primary J. Sec College
HIV in the body Total
Blood, semen, milk & vaginal fluids 0 (0%) 1 (9.1%) 1 (9.1%) 2 (18.2%)
Blood & milk 3 (27.3%) 5 (45.5%) 0 (0%) 8 (72.7%)
Blood, milk & vaginal fluids 1 (9.1%) 0 (0%) 0 (0%) 1 (9.1%)
Total 4 (36.4%) 6 (54.5%) 1(9.1%) 11 (100%)

Among the female participants with junior secondary education, 5 (45.5%)

indicated that HIV in the body is found in blood and milk, 1 (9.1%) indicated that it
is found in blood, semen, milk & vaginal fluids and none indicated Blood, milk
and vaginal fluids only. The only participant with college education 1 (9.1%)
indicated that HIV is found in blood, semen, milk and vaginal fluids. Those with
primary education 3 (27.3%) indicated blood and milk while 1 (9.1%) indicated
blood, milk and vaginal fluids.

69
Table 40, The relationship between knowledge of male participants regarding MTCT of HIV (table 17) and
education level (table 10)
(n=39)
Educational Level
MTCT of HIV None Primary J. Sec S. Sec College University
Total
During pregnancy, delivery & breastfeeding 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2.6%) 1 (2.6%) 2 (5.1%)
During delivery & breastfeeding 0 (0%) 1 (2.6%) 1 (2.6%) 5 (12.8%) 0 (0%) 0 (0%) 7 (17.9%)
During pregnancy & breast feeding 0 (0%) 3 (7.7%) 3 (7.7%) 0 (0%) 0 (0%) 0 (0%) 6 (15.4%)
During pregnancy 0 (0%) 10 (25.6%) 2 (5.1%) 1 (2.6%) 0 (0%) 0 (0%) 13 (33.3%)
During delivery 0 (0%) 2 (5.1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (5.1%)
During breast feeding 1 (2.6%) 3 (7.7%) 0 (0%) 4 (10.3%) 0 (0%) 0 (0%) 8 (20.5%)
Not sure 0 (0%) 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Total 1 (2.6%) 19 (48.7%) 6 (15.4%) 11 (28.2%) 1 (2.6%) 1 (2.6%) 39 (100%)

Among the participants with primary education, 10 (25.6%) indicated that MTCT of HIV is during pregnancy, 3 (7.7%)
indicated during breast feeding, another 3 (7.7%) indicated during pregnancy and breast feeding, 2 (5.1%) indicated
during delivery, 1 (2.6%) indicated during delivery and breastfeeding while none 0 (0%) indicated during pregnancy,
delivery & breastfeeding and none 0 (0%) was not sure. Among the participants with senior secondary education 5
(12.8%) indicated during delivery & breastfeeding, 4 (10.3%) indicated during breast feeding, 1 (2.6%) indicated during
pregnancy and 1 (2.6%) was not sure.
Table 41, The relationship between knowledge of male participants regarding knowledge on HIV prevention (table
18) and residential area (table 9)
(n=39)

70
 Residential Area
H. density L. density Village
HIV Prevention Total
Abstinence, Being faithful to one sexual partner 1 (2.6%) 0 (0%) 2 (5.1%) 3 (7.7%)
Abstinence, Condom use 4 (10.3%) 1 (2.6%) 5 (12.8%) 10 (25.6%)
Being faithful to one sexual partner, Condom use 0 (0%) 0 (0%) 1 (2.6%) 1 (2.6%)
Abstinence, Condom use, No sharing of sharps 1 (2.6%) 1 (2.6%) 0 (0%) 2 (5.1%)
Abstinence, Condom use, Blood screening 1 (2.6%) 1 (2.6%) 0 (0%) 2 (5.1%)
Abstinence, No sharing of sharps 6 (15.4%) 0 (0%) 1 (2.6%) 7 (17.9%)
Being faithful to one sexual partner, No sharing of sharps 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Condom use, Blood screening 0 (0%) 0 (0%) 1 (2.6%) 1 (2.6%)
No sharing of sharps 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Abstinence 3 (7.7%) 1 (2.6%) 3 (7.7%) 7 (17.9%)
Being faithful to one sexual partner 0 (0%) 0 (0%) 1 (2.6%) 1 (2.6%)
Abstinence, Blood screening 0 (0%) 0 (0%) 1 (2.6%) 1 (2.6%)
Condom use 1 (2.6%) 0 (0%) 1 (2.6%) 2 (5.1%)
Total 19 (48.7%) 4 (10.3%) 16 (41%) 39 (100%)

71
Among the participants from high-density areas, 6 (15.4%) indicated that HIV
prevention is through abstinence and not sharing sharps, 4 (10.3%) indicated
abstinence and condom use, 3 (7.7%) indicated abstinence, 1 (2.6%) indicated
condom use, 1 (2.6%) indicated no sharing of sharps, 1 (2.6%) indicated being
faithful to one faithful sexual partner and no sharing of sharps, 1 (2.6%) indicated
abstinence, condom use and screening of blood and 1 (2.6%) indicated
abstinence and being faithful to one faithful sexual partner.

10.0 COMMUNICATION
Table 42, The relationship between males who never heard of the term
PMTCT and residential area
(n=14)
Residential Area
High Density Low Density Village
Source of information Total

Never heard of PMTCT 6 (42.9%) 3 (21.4%) 5 (35.7%) 14 (100%)

Total 6 (42.9%) 3 (21.4%) 5 (35.7%) 14 (100.0%)

The male participants who indicated that they never heard of the term PMTCT, 6
(42.9%) were from high density residential area, 3 (21.4%) were from low density
areas and 5 (35.7%) were from the villages.

Table 43, The relationship between males who did not know the activities in
PMTCT programme and residential area
(n=24)
Information on activities Residential Area
High Density Low Density Village
in PMTCT Programme Total
Do not know 8 (33.3%) 3 (12.5%) 13 (54.2%) 24 (100%)
Total 8 (33.3%) 3 (12.5%) 13 (54.2%) 24 (100.0%)

The male participants who indicated that they never heard of the term PMTCT, 8
(33.3%) were from high density residential area, 3 (12.5%) were from low density
areas, while the majority, 13 (54.2%) were from the villages.

72
73
C ATTITUDE
Table 44, The relation between views towards males attending antenatal care sessions with their wives (table 21)
and residential area (table 9)
(n=39)
Residential Area
High Density Low Density Village
Views on males attending ANC Total
It is for women & men are busy to attend 2 (5.1%) 0 (0%) 0 (0%) 2 (5.1%)
Men busy, but can attend 8 (20.5%) 0 (0%) 2 (5.1%) 10 (25.6%)
Never thought of it 3 (7.7%) 1 (2.6%) 1 (2.6%) 5 (12.8%)
It is for women, men can not attend 5 (12.8%) 3 (7.7%) 9 (23.1%) 17 (43.6%)
Only escorted, but not attended sessions 1 (2.6%) 0 (0%) 4 (10.3%) 5 (12.8%)
Total 19 (48.7%) 4 (10.3%) 16 (41%) 39 (100%)

Among the participants from high density residential area, 8 (20.5%) indicated that men were busy, but can attend the
sessions, 5 (12.8%) indicated that it was for women men can not attend, 3 (7.7%) said they never thought of it, 2 (5.1%)
indicated that it is for women and that men were busy to attend while 1 (2.6%) said he only escorted, but did not attended
the sessions. Among the participants from the village, 9 (23.1%) indicated that it was for women and men can not attend,
2 (5.1%) indicated that men were busy, but can attend the sessions and 1 (2.6%) indicated that he never thought of it.
Four (10.3%) indicated that men can only escort but not attend the sessions.

Table 45, The relation between views towards males attending antenatal care sessions with their wives (table 21)
and educational level (table 10)
(n=39)

74
 Views towards males attending ANC Educational Level Total
None Primary Junior Sec Senior Sec College University
sessions
It is for women & men are busy to attend 0 (0%) 1 (2.6%) 1 (2.6%) 0 (0%) 0 (0%) 0 (0%) 2 (5.1%)
Men busy, but can attend 0 (0%) 4 (10.3%) 3 (7.7%) 3 (7.7%) 0 (0%) 0 (0%) 10 (25.6%)
Never thought of it 0 (0%) 1 (2.6%) 0 (0%) 3 (7.7%) 1 (2.6%) 0 (0%) 5 (12.8%)
It is for women, men can not attend 1 (2.6%) 9 (23.1%) 2 (5.1%) 4 (10.3%) 0 (0%) 1 (2.6%) 17 (43.6%)
Only escorted, but not attended sessions 0 (0%) 4 (10.3%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 5 (12.8%)
Total Count 1 (2.6%) 19 (48.7%) 6 (15.4%) 11 (28.2%) 1 (2.6%) 1 (2.6%) 39 (100%)

Among the participants with primary education, 9 (23.1%) indicated that it was for women and men can not attend, 4
(10.3%) indicated that men were busy but can attend, another 4 (10.3%) indicated that they can only escort, but not
attend the sessions, 1 (2.6%) indicated that it is for women and that men were busy to attend while another 1 (2.6%)
indicated that he never thought of it. While among the participants with senior secondary education, 4 (10.3%) indicated
that it was for women and men can not attend, 3 (7.7%) indicated that men were busy but can attend, another 3 (7.7%)
indicated that they never thought of it, while 1 (2.6%) indicated that they can only escort, but not attend the sessions.

Table 46, The relation between men’s views towards male involvement and participation in PMTCT (table 23) and
residential area (table 9)
(n=39)
Views on male involvement and participation in PMTCT Residential Area
High Density Low Density Village
Total
Men are left out in the programme 8 (20.5%) 2 (5.1%) 6 (15.4%) 16 (41%)

75
Programme is focused on women 6 (15.4%) 0 (0%) 1 (2.6%) 7 (17.9%)
Inviting men using invitation letters 5 (12.8%) 2 (5.1%) 9 (23.1%) 16 (41%)
Total 19 (48.7%) 4 (10.3%) 16 (41%) 39 (100%)

Among the participants from the villages, 9 (23.1%) indicated that men can be involved and participate in PMTCT by
inviting them using invitation letters, 6 (15.4%) indicated that men were left out in the programme while 1 (2.6%) indicated
that the programme is more focused on women. For the participants from the high density areas, 8 (20.5%) indicated that
men were left out in the programme, 6 (15.4%) indicated that the programme is more focused on women while 5 (12.8%)
indicated that men can be involved and participate by inviting them using invitation letters.

76
Table 47, The relation between women’s views on how men can be involved
and participate in PMTCT programme (figure 6) and gestation age (table 32)
(n=11)
Women's views on how men can Gestational age
2nd Trimester 3rd Trimester
be involved in PMTCT Total
Couple sensitisation 2 (18.2%) 2 (18.2%) 4 (36.4%)
Conducive environment 1 (9.1%) 2 (18.2%) 3 (27.3%)
Inviting men using invitation letters 2 (18.2%) 2 (18.2%) 4 (36.4%)
Table 5 (45.5%) 6 (54.5%) 11 (100%)

Among the participants in the 2nd trimester, 2 (18.2%) indicated that couple
sensitisation on PMTCT would make men get involved and participate in PMTCT,
another 2 (18.2%) indicated invitation of men using invitation letters while 1
(9.1%) indicated provision of a conducive environment for males at the PMTCT
centres. Among women in the 3rd trimester, 2 (18.2%) indicated couple
sensitisation, another 2 (18.2%) indicated invitation of men using invitation letters
while the other 2 (18.2%) indicated provision of a conducive environment for
males at the PMTCT centres.

77
D PRACTICE
Table 48, The relation between traditional practices that may promote HIV transmission to the baby from the
parents (table 24) and age of male participants (table 5)
(n=39)
Age in Years
20-24 25-29 30-34 35-39 40-44 > 45
Traditional practices Total

Smearing semen (Kukonza Mwana) 4 (10.3%) 3 (7.7%) 7 (17.9%) 5 (12.8%) 8 (20.5%) 2 (5.1%) 29 (74.4%)
Smearing semen & Tattooing 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2.6%)
Tattooing 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 1 (2.6%) 0 (0%) 2 (5.1%)
Not certain 0 (0%) 1 (2.6%) 4 (10.3%) 2 (5.1%) 0 (0%) 0 (0%) 7 (17.9%)
Total 4 (10.3%) 5 (12.8%) 12 (30.8%) 7 (17.9%) 9 (23.1%) 2 (5.1%) 39 (100%)

Among the participants who indicated smearing of semen as a traditional practice that may promote HIV transmission to
the baby from the parents, 4 (10.3%) were aged between 20-24 years, 3 (7.7%) were aged between 25-29 years, 7
(17.9%) were aged between 30-34 years, 5 (12.8%) were aged between 35-39 years, 8 (20.5%) were aged between 40-
44 years and 2 (5.1%) were above 45 years.

78
Table 49, The relation between traditional practices that may promote HIV transmission to the baby from the
parents (table 24) and tribe of male participants (table 8)
(n=39)
Tribe
Tumbuka Ngoni Chewa Bisa Bemba
Traditional practices Total

Smearing semen (Kukonza Mwana) 6 (15.4%) 7 (17.9%) 15 (38.5%) 1 (2.6%) 0 (0%) 29 (74.4%)
Smearing semen (Kukonza Mwana) & Tattooing 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 0 (0%) 1 (2.6%)
Tattooing 0 (0%) 2 (5.1%) 0 (0%) 0 (0%) 0 (0%) 2 (5.1%)
Not certain 2 (5.1%) 3 (7.7%) 1 (2.6%) 0 (0%) 1 (2.6%) 7 (17.9%)
Total 8 (20.5%) 13 (33.3%) 16 (41%) 1 (2.6%) 1 (2.6%) 39 (100%)

Smearing semen was mentioned by 6 (15.4%) Tumbuka, 7 (17.9%) Ngoni, 15 (38.5%) Chewa and 1 (2.6%) Bisa. No
Bemba mentioned this practice. Tattooing was mentioned by Ngoni only, 2 (5.1%). Both semen smearing and tattooing
were mentioned by 1 (2.6%) Ngonis. None of the other tribes mentioned the two practices together. Two (5.1%)
Tumbukas, 3 (7.7%) Ngonis, 1 (2.6%) Chewas and 1 (2.6%) Bemba did not mention any traditional practice.

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Table 50, The relation between traditional practices that may promote HIV transmission to the baby from the
parents (Table 24) and educational level of male participants (Table 10)
(n=39)
Educational Level
None Primary Junior Sec Senior Sec College University
Traditional practices Total

Smearing semen (Kukonza Mwana) 1 (2.6%) 14 (35.9%) 5 (12.8%) 8 (20.5%) 0 (0%) 1 (2.6%) 29 (74.4%)
Smearing semen & Tattooing 0 (0%) 0 (0%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 1 (2.6%)
Tattooing 0 (0%) 1 (2.6%) 0 (0%) 1 (2.6%) 0 (0%) 0 (0%) 2 (5.1%)
Not certain 0 (0%) 4 (10.3%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 0 (0%) 7 (17.9%)
Total 1 (2.6%) 19 (48.7%) 6 (15.4%) 11 (28.2) 1 (2.6%) 1 (2.6%) 39 (100%)

Among the participants who indicated smearing of semen as a traditional practice that may promote HIV transmission to
the baby from the parents, 1 (2.6%) had no formal education, 14 (35.9%) had primary education, 5 (12.8%) had junior
secondary education, 1 (2.6%) had university education and none 0 (0%) had college education.

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Table 51, Traditional practices in relation to gender
(n=50)
Frequency
Males Females
Traditional practices Total
Smearing semen (Kukonza Mwana) 29 (58%) 6 (12%) 35 (70%)
Tattooing 2 (4%) 5 (10%) 7 (14%)
Smearing semen & Tattooing 1 (2%) 0 (0.0%) 1 (2%)
Not certain 7 (14%) 0 (0.0%) 7 (14%)
Total 39 (78%) 11 (22%) 50 (100.0%)

Among the participants who indicated smearing of semen as a traditional practice

that may promote HIV transmission to the baby from the parents, 6 (12%) were
females and 29 (58%) were males. 1 (2%) male practiced both smearing of
semen and tattooing and no female practiced both. Five (10%) females practiced
tattooing, while 6 (12%) practiced smearing of semen. Seven (14%) males did
not practice any of the.

CHAPTER FIVE

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5.0 DISCUSSION OF THE FINDINGS AND IMPLICATIONS FOR
THE HEALTH CARE SYSTEM
10.1 INTRODUCTION
The discussion of findings of this study are based on an analysis of responses
from the research participants; thirty nine (39) married men and eleven (11)
pregnant women living in the urban and rural areas of Chipata district at the time
of data collection.

10.2 CHARACTERISTICS OF THE SAMPLE

The age range for male participants was from 20 years to 45 years. The mean
age range and modal age range was 30-34 years. The age range for female
participants was 20 years to 39 years and the modal age range was 25-29 years.
According to the ZDHS 2001-2002 (CSO 2003), 16% of the Zambian population
for both males and females are aged between 30-34 years.

The participants were from villages, high density and low density areas. This
implies that all socioeconomic groups were represented. All the male participants
(table 5), 39 (100%) were married and among female participants (table 26) 1
(9.1%) was not married. The majority of the male participants (table 6), 35
(89.7%) had one wife and 4 (10.3%) had two wives. All participants (both male
and female) had children (table 7 and table 31). The median number of children
among men ranged from 3-5 and for female participants it ranged from 0-2. More
of the female participants (table 32), 6 (54.5%) were in their 3rd trimester and 5
(45.5%) were in their 2nd trimester.

The dominant tribe among the research participants was Chewa and Ngoni.
Among the male participants (table 8), 16 (41%) were Chewa and 13 (33.3%)
were Ngoni. Others were; Tumbuka 8 (20.5%), Bisa 1 (2.6%) and Bemba 1
(2.6%). Among the female participants (table 33), 5 (45.5%) were Chewa and 2
(18.2%) were Ngoni. The other tribes were Tumbuka 2 (18.2%) and Nsenga also

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2 (18.2%). This can imply that the study setting had cultural pluralism (Thomas,
1995), which is the simultaneous existence of many cultures within the larger
society. This situation brings together different cultural beliefs and practices that
may be similar or different, influence the interaction within society and influence
the health of society.

The other characteristic worthy noting is the education level. The participants had
different education levels. These included; university, college, senior secondary
education, junior secondary education and primary education. However among
the participants some had no formal education. Most of the male participants
(table 10), 19 (48.7%) had primary education, 11 (28.2%) had senior secondary
school education, 6 (15.4%) had junior secondary education and the rest 1
(2.6%) each had college, university or no formal education at all. For the female
participants (table 28), 6 (54.5%) had junior secondary education, followed by
primary education 4 (36.4%) and college education 1 (9.1%). There was no one
among the female participants with senior secondary education, university
education or who never attained formal education.

All the male participants (table 11) had occupations and among the female
participants, 5 (45.5%) had no occupations. This implies that economically they
are dependant on their male partners. The male participants had the following
occupations; farming, accounting, clerk, security guard, machine attendant,
classified daily employee, traditional healers and business. The female
participants had the following occupations; marketer, and teaching. One was still
a scholar.

The male participants (table 12) belonged to the following denominations; 18

(46.2%) RCC, 10 (25.6%) RCZ, 3 (7.7%) SDA and 2 (5.1%) Baptist and Zionist
Churches each. The least number of the participants’ denominations were
RCCG, PGNC, PPL and Anglican Churches at 1 (2.6%) each. Further more the

83
female participants (table 34) belonged to the following denominations; 5
(45.5%) RCC, 3 (27.3%) PAOG, 2 (18.2%) RCZ and 1 (9.1%) Jehovah’s
Witness. This implies that all the participants belong to the Christian religion.
Religion serves an important role in society. According to Thomas (1995) religion
serves as a powerful agent of social control, encouraging conformity to the norms
and values surrounding important societal issues.

10.3 DISCUSSION OF VARIABLES

10.3.1 KNOWLEDGE
Having knowledge about PMTCT is an important step in promoting male
participation and involvement in PMTCT. The male participants were asked to
discuss the following in order to assess their knowledge on; definition of HIV and
AIDS, where HIV can be found in the body, MTCT of HIV, HIV prevention and
PMTCT programme. The female participants were asked to only discuss where
HIV can be found in the body. This was with an assumption that since they were
still pregnant and attending ANC, they still had fresh knowledge on the basics of
HIV.

The results showed that, 18 (46.2%) males defined HIV as a disease while 21
(53.8%) defined HIV as a virus (table 13). Interestingly however, table14 showed
that all the 39 (100%) male participants knew that AIDS was a chronic disease
caused by HIV. On the question of HIV transmission, the commonly known
modes of transmission of HIV (table 15) among the participants were; through
unprotected sex & use of contaminated sharps, 19 (48.7%). Furthermore the
research findings have revealed that only 1 (2.6%) of the participants knew that
HIV could be transmitted through vertical route; MTCT. Most of the participants,
19 (48.7%) knew that the fluid in the body where HIV can be found is in blood
(table 16). Very few, 3 (7.7%) had knowledge that HIV is found in four main
fluids; blood, semen, vaginal fluids and breast milk. Most surprising is that even
among the pregnant women the knowledge on where HIV is found in the body

84
was not to the expectation. Only 2 (18.2 %) mentioned the four main fluids
(figure 2). However, the majority 8 (72.7%) of the female participants knew that
HIV is found in blood and breast milk.

The other finding of the research revealed that the male participants generally
knew that MTCT was during pregnancy (table 17). Only very few, 2 (5.1%) of the
participants knew that MTCT was during pregnancy, delivery & breastfeeding.
Furthermore, on the question of prevention of HIV the well known prevention was
through abstinence and condom use, 10 (25.6%). Surprisingly there was none
who exhibited knowledge on the common known acronym ABC (Abstinence, Be
faithful and Condom use) as regards to the prevention of HIV.

Therefore these research findings are revealing that knowledge regarding

HIV/AIDS issues and PMTCT is inadequate among both males and females. The
revelations of the study show that only 2 (5.1%) out of 11 (100%) male
participants with secondary education and 1 (2.6%) with college education were
able to mention the four infectious fluids where HIV is found in the body (table
38). According to Centre for Control of Diseases and Prevention (2006), the
infectious fluids where HIV can be found in the body are; blood, semen (including
seminal fluids), vaginal fluid and breast milk. The majority of the participants, 19
(48.7%) knew that in an HIV infected person, the virus is found in blood. This
could be attributed to the concepts used when delivering the necessary
information. For example, the PMTCT Reference Manual for Health Workers of
the MoH/CBoH (2004) Module 3; page 3-3, does not have a component outlining
the infectious fluids were HIV can be found in the body. Therefore an elite person
will only have better understanding through reading on his/her own from other
literature on HIV/AIDS or go to the World Wide Web (www) to browse for HIV
material where it is available.

85
Similarly among women, the findings revealed that 1 (9.1%) with junior
secondary education and 1 (9.1%) with college education knew the four
infectious fluids where the virus can be found in an HIV infected person, (table
39). Interestingly, some of the participants, 3 (27.3%) with lower level of
education (primary education) were able to mention at least three infectious
fluids. This can be attributed to the fact that some women do acquire information
during PMTCT sensitisations.

All the male participants, 1 (2.6) with college and 1 (2.6) with university
education, mentioned the three modes of MTCT (table 40). According to the
PMTCT Reference Manual for Health Workers of the MoH/CBoH Module 3
(2004), these modes are during pregnancy, during delivery and during breast
feeding. None of those with no education, primary, junior secondary education,
and senior secondary education mentioned all the three modes of MTCT. They
either mentioned one or two modes.

The research has also revealed that the commonly preventive measures in
practice in the area are abstinence and condom use (table 41). Ten (25.6%) of
the male participants indicated so. Five (12.8%) were from villages, 4 (10.3%)
were from high residential areas and only 1 (2.6%) was from low residential
areas. This can be attributed to HIV prevention campaign of “Abstinence iliche, if
you can’t abstain, use a condom”. The low percentage for low residential area
could be attributed to low coverage on sensitisation campaign as residents are
considered to be elite.

Therefore, although knowledge on PMTCT was generally inadequate in both

male and female participants, those with secondary education and above were
more knowledgeable irrespective of their residential area.

10.3.2 COMMUNICATION

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Communication is essential in dissemination of information on HIV/AIDS and
PMTCT. It is a vehicle that can be used in the delivery of information.
Communication is used to share pieces of information. The study revealed that
14 (35.9%) male participants had no source of information on PMTCT (table 19).
However it is worth noting that majority, 25 (64.1%) of the participants had some
source of information. Encouraging revelations were that their sources of
information were; 12 (48%) from their wives and another 12 (48%) from media,
while only 1 (4%) from the health centre. The data from female participants
(figure 3) revealed that 7 (63.6%) informed their spouses about the PMTCT
programme.

These findings are indicating that the two main sources of information on PMTCT
among men are their wives and media, while very few get information directly
from the health centre staff. This indicates that although there is communication
between spouses and that there are also avenues for information on PMTCT
through the media, there is very little direct communication between health
workers and the men.

Therefore, it was not surprising that despite 25 (64.1%) of male participants

having sources of information about PMTCT (table 19), only 4 (10.3%) correctly
knew that it involved the activities of giving IEC to pregnant mothers; counselling
and administration of ARVs to HIV positive mothers before delivery (table 20).
The rest of the participants they either mentioned two or only one of the activities
at PMTCT. These findings therefore could mean that the information women
communicate to their spouses is not adequate.
The research has further revealed that among the 14 (100%) participants who
had never heard of the term PMTCT; 6 (42.9%) were from high density
residential area followed by 5 (35.7%) from villages and 3 (21.4%) from low
density areas (table 42). Furthermore, among the 24 (100%) participants who
said that they did not know the activities in the PMTCT programme; 13 (54.2%)

87
were from villages, 8 (33.3%) were from high density residential areas and 3
(12.5%) were from low density area (table 43).

It can be concluded therefore that, villagers and residents of high density areas
are accessing information on PMTCT while residents of low residential areas are
not accessing information on PMTCT. This is contrary to the findings of ZDHS
2001-2002 (CSO, 2003) where it was found that men in rural areas have
substantially lower access to all forms of media than their urban counterparts.
The high percentage of males from the villages not knowing what PMTCT
programme was all about was attributed to inconsistence of information from
their spouses who are the major sources. The ZDHS 2001-2002 (CSO, 2003),
found that more rural women cited getting money for transport, distance to the
health facility and availability of transport as big problems than urban women
making them not access health care services regularly.

Although the research has revealed that communication between spouses is

present, it is not effective as the majority, 24 (61.5%) of the male participants did
not know what was involved in PMTCT. The controversy between having
adequate sources of information and males not having adequate information on
what PMTCT programme is all about the type of information shared.

Many scholars have outlined various barriers to effective communication.

According to Cole (2004), some of the barriers are individual bias, status
difference, fear, verbal difficulties, and information overload. On individual bias,
Cole says ‘’people are selective as they only want to hear what they want to
hear’’. In this case it means that males could have not paid much attention to
what their spouses wanted to communicate to them. The research has revealed
that actually 3 (27.3%) of the female participants tried to inform their spouses but
these spouses were not interested. Therefore individual bias can be a barrier to
flow of PMTCT information to males (figure 3).

88
In the case of status difference, Cole says ‘’superiors may listen less carefully to
information passed by their subordinates’’. In this case since males generally are
considered to be superior to females, they could have not paid much attention to
the messages from their spouses. Furthermore on the barrier of fear Cole says
‘’if a person has news of information which is almost certain to upset the
recipient, they will tend to avoid the whole truth and pass on part of the
message’’. In this case then, women could have withheld certain information that
could have upset their spouses. This could have been the reason why 1 (9.1%)
of the female participants did not inform the husband about the PMTCT
programme (figure 3).

On verbal difficulties Cole says ‘’failure to get to the point quickly and concisely
and use of jargon and lack of fluency will cause confusion and misunderstanding
in communication’’. In this case the women could have not captured the right
information. The majority, 7 (63.6%) of the females participants who said they
informed their husbands might not have delivered right messages to their
husbands. In Chewa they say “Kandinverere ananvera zamumaruwa”. This means
that sending someone to get information will actually bring you wrong
information.

Finally, according to Cole, a person given a lot of information at once will not
offload exactly. In this case it could be that females/males are given so much
information at once which they may not handle effectively.

10.3.3 ATTITUDE
Men’s attitude towards PMTCT and ANC was also assessed. Male participants
were asked to discuss their views on males attending ANC sessions, what their
roles could be in PMTCT and how males could be involved in PMTCT.

89
Seventeen (43.6%) of the participants viewed ANC as a programme for women
and therefore men can not go there to get information, 5 (12.8%) said men can
only escort their wives but could not attend the sessions, while another 5 (12.8%)
did not take time to think about ANC as part of men’s business as well and 10
(25.6%) said they were too busy at work to attend ANC with their wives (table
21).

From these findings therefore, the attitude of males towards ANC are portrayed
as negative. PMTCT services are integrated into ANC activities; therefore men
could have seen it as a programme for women.

The findings on men’s views on their role in PMTCT (table 22) revealed that 11
(28.2%) expected to take up the role of going for HIV testing, not only letting it be
a role of females, while another 11 (28.2%) expected to take up the role of
fostering behaviour change among males. The other roles the men viewed as
theirs included; 6 (15.4%) said support the women during pregnancy, 5 (12.8%)
said encourage women to attend ANC, 4 (10.3%) said supportive role. Two
(5.1%) did not know what roles men could take. These findings therefore reveal
that despite the portraying negative attitudes towards PMTCT, their views
towards the roles they could take are positive.

Interestingly the study also revealed that 16 (41%) of the males realised that men
are left out in PMTCT programmes and a further 7 (17.9%) said the programme
was focused on women, while 16 (41%) of the participants showed an interest to
get involved and participate in PMTCT by suggesting that males should be
invited using invitation letters(table 23). This was also echoed by 4 (36.4%)
female participants who said men should be invited using invitation letters, other
4 (36.4%) participants is said males can be involved through couple sensitisation
and 3 (27.2) saw the need of creating conducive environment at ANC premises
for males to feel at ease (figure 3).

90
Therefore these findings show that the attitude of males towards PMTCT is
influenced by the current health care delivery systems. It can be said that men
are not involved and participating in PMTCT because the service is provided in
the ANC making the environment not conducive for the males. Traditionally the
ANC services were tailored for women. Therefore the males were automatically
delineated from PMTCT programmes. In a study conducted in Malawi on ANC,
health workers did not involve males in ANC because the services were tailored
for pregnant women and not men. Furthermore, midwives had never thought or
discussed about involving men (Misiri, Tadesse, and Muula, 2004)

10.3.4 PRACTICE
The practices of men in PMTCT were investigated. The findings revealed that the
majority of the female participants, 6 (54.5%) said men were not helpful in
matters of HIV/AIDS and PMTCT (table 35). Furthermore, 1 (9.1%) woman said
that women were accused of being responsible for the “disease” if the woman is
tested positive.

The study revealed that both male and female participants were involved in HIV
risky traditional practices which comprised of smearing semen on baby’s body
(Kukonza mwana) at three to four months old and tattooing of the baby (table
51). Of the two traditional practices, the common one is the smearing of semen
on the baby (locally known as Kukonza mwana). The majority, 35 (70%) of both
male and female participants practiced it [29 (74.4%) male participants and 6
(54.5%) female participants].
The traditional practices are performed in order for the baby to grow healthy with
a lot of stamina. It is believed that the child as he or she grows will be physically
fit. These traditional practices were not influenced by age, major tribes in the
area and educational level (table 48, table 49 and table 50).

91
Traditionally, men are the major decision makers concerning health issues in the
households. These findings are indicating that the decisions being made by men
influence the well being of their children. Therefore if they are less informed
about the details concerning transmission of HIV and PMTCT, there will be a
perpetuation of risky traditional practices.

The study has revealed that the risky traditional practices are done across all
ages (table 48). All 4 (10.3%) of male participants aged between 20-24 years
were involved in the practices; majority, 5 (12.8%) of male participants aged
between 35-39 years were also involved in the practice, while all the two (5.1%)
of male participants aged above 45 years were also involved in the practice.

Furthermore, the findings revealed that the practice is deep rooted in the three
major tribes namely Chewa, Ngoni and Tumbuka although other tribes also did
indicate involvement in such practices. The study revealed 1 (2.6%) of the
participant of Bemba tribe was not involved in such practices. The study revealed
that risky traditional practices cut across level of education (table 50). The
revelations are that; the 1 (2.1%) participant with university education practiced
smearing of semen on the baby (table 49).

In a study that was done in Nigeria, it was found out that certain traditional
practices in rural parts of Africa were creating routes of HIV transmission that are
unique to the continent, (Kaiser family foundation, 2005). From these findings
therefore, HIV risky traditional practices have been allowed to be practiced
without caution and control because men who are the decision makers are not
involved and participating in PMTCT programmes. The traditional practices might
lead to a ‘wildfire spread’ of HIV” among infants whose HIV positive parents have
opted formula feeding.

10.4 IMPLICATIONS TO THE HEALTH CARE SYSTEM

92
Taking all the above findings of the study, it shows that there are cultural, socio-
economic and health related factors influencing male involvement and
participation in PMTCT programme in Chipata District. These factors need to be
addressed if PMTCT programme is to be effective in the district.

The traditional practice of smearing semen on the baby shoots down the efforts
being made to prevent MTCT of HIV. According to CDC (2006) transmission of
HIV is very high when HIV comes in contact with the more porous mucous
membranes. The skin of the baby at the age when the practice is performed may
be more porous. Furthermore babies at this age usually have heat-rash which
may become the entry point for HIV. Therefore, the PMTCT programme’s efforts
can be frustrated by such traditional practices. An HIV infected who chooses not
to breast feed but practices such traditions will risky the baby contract HIV.

Utilisation of knowledge among men on PMTCT remains a challenge for the

health system. These findings have implications on the IEC system, with special
reference to HIV/AIDS and PMTCT. The silence needs to be broken. Unless
continuous IEC and sensitization is carried out men will not get involved and
effectively participate in PMTCT. Continuing practicing risky traditional practices
will frustrate the national efforts to meet the MDGs number four and number five
(Medical Women Association of Zambia, 2006).

10.5 CONCLUSION
The study sought to determine male involvement and participation in PMTCT
programmes in Chipata district. The study has revealed that males have
adequately not been involved in PMTCT programmes in Chipata district,
consequently affecting their participation. The lack of involvement and

93
participation is related to socio-economic factors, cultural factors and health
systems delivery factors.

The research findings have shown that although knowledge regarding HIV/AIDS
issues and PMTCT is influenced by educational level it is not affected by the
residential area. Most of the participants who had senior secondary education
were able to at least mention three infectious fluids where HIV is found in the
body irrespective of where they resided. Knowledge of MTCT is essential to
prevent infants from becoming infected with HIV through vertical transmission
from mother to child.

The integration of the PMTCT programme to ANC is an obstacle for males to

access the service because the environment is tailored to favour females more
than males. Therefore, if men are to be involved in PMTCT, the ANC activities
should be redesigned in such a way that men are involved. Low male
participation has been found to be attributed to inadequate information for males
on PMTCT as they depend on second hand information from their wives which
tends to be inadequate most of the time. Health workers have not created
avenues for males to get first hand information straight from the health centres.
The encouraging fact is that males are willing to get involved and participate in
PMTCT programmes.

The efforts of PMTCT programmes in the district will not contribute effectively
towards meeting the MDGs by 2015 due to the high level practice of HIV risky
traditional practices in the district. Since men are the major decision makers in
many cultures, concerning health issues in the households, their limited
involvement in activities related to the care of their wives and newborns imparts
negatively to the success of such programmes, PMTCT inclusive.

10.6 RECOMMENDATIONS

94
10.6.1 TO THE HEALTH CARE PROVIDERS
Health care providers should make deliberate efforts to educate men about
PMTCT so that they will be able to make informed choices. This can be done
wherever there is opportunity to meet men for example on the wards through
their wives as they come for PMTCT services or even calling short sensitization
meetings in places where men are found including churches. Community based
agents should also be educated on PMTCT so that they can teach men in the
communities. Health care providers should read more about PMTCT so that they
get all the facts and be able to pass on the information to men.

10.6.2 TO THE DHMT

The DHMT should ensure that health care delivery centres have adequate
staffing so that the staff will be able to deliver quality services to the clients,
health education inclusive. The DHMT should also ensure that health care
delivery centres are giving IEC to the men by carrying out periodic monitoring
and evaluation surveys to find out if men have been given the information.

DHMT should provide the IEC materials needed for health workers to teach
about PMTCT. Men should be encouraged to come to the ANC clinics with their
wives so that they can get the information together. The DHMT should also plan
to carry out the study on a larger scale; including the rural areas in order to be
able to generalize the findings better and improve the quality of the service.

10.6.3 TO POLICY MAKERS

MoH should plan carrying out national sensitization campaigns on PMTCT so
that men are given information about it. MoH should also include indicators to
measure male involvement and participation in PMTCT. The current indicators

95
only capture females. This makes it difficult assess male involvement and
participation.

MoH should ensure that information about PMTCT reaches the men by including
it in the family planning services/clinics. It should be incorporated and activated in
the MCH services.

10.7 LIMITATIONS OF THE STUDY

The limitation of the study was that the sample size was too small because of
financial and time constraints to be representative of the population in Chipata
District.

10.8 DISSEMINATION OF STUDY FINDINGS

The researcher intends to disseminate the study findings by making copies of the
report and giving a copy to each of the following; Department of Post Basic
Nursing, UNZA, The Medical Library, UNZA, Ministry of Health Headquarters –
Library, CIDRZ-Chipata and D.M.O

The researcher also intends to disseminate the findings in seminars and

conferences such as ECSACON (East, Central and Southern Africa College for
Nurses) meetings that take place, as opportunity arises. Information will also be
disseminated to traditional leaders in the district through NGOs as well local radio
stations.

Finally the researcher intends to write a proposal to UNZA research ethics

committee so that the research is done on a wider and more scientific way and
be published in one of the medical journals.

96
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12. Ghosh, B.N, (2003), Scientific Method and Social Research, Revised Ed,
Sterling Publishers Private Limited, New Delhi.

13. HMIS, (2006), First Quarter Antenatal Clinic utilisation Report, Chipata
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Contributing to Spread of HIV, Researchers Say, Medical News, On Line,
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15. Kapata Health Centre (2006), Action Plan 2007-2009, Chipata DHMT,
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17. Medical Women Association of Zambia, (2006), An invitation to the

Regional Congress of the Near East and Africa Region on medical
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18. Ministry of Finance and National Planning, (2006), Zambia Millennium
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Clinics in Blantyre, Malawi, Ready to Offer Services for the Prevention
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16:25Hrs], http://www.bioline.org.br/

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Presentation Graphics for Trainers, On Line, [Accessed on 26.04.2006:
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23. MOH, (2005), Zambia Antenatal Clinic sentinel Surveillance Report, 1994
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25. Morse, J. M, and Field, P. A, (1996), Nursing Research – The Application
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103
 APPENDICES

13. FOCUS GROUP DISCUSSION GUIDE FOR MEN

THE UNIVERSITY OF ZAMBIA

SCHOOL OF MEDICINE
DEPARTMENT OF NURSING
FOCUS GROUP DISCUSSION GUIDE ON MALE INVOLVEMENT AND PARTICIPATION IN PREVENTION OF
MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV/AIDS IN CHIPATA DISTRICT

Name of the institution :…………………………………………………………………………………………..……………….

Date :………………………………………………………..………………………………………………….

Name of the Moderator :…………………………………………………………………………………………………..………..

Names of recorders :…………………………………………………………………………………………………..…

104
Participants List

Education No. of No. of

Age Tribe Residence Level Occupation wives Child. Denomination

105
1. Welcome / introduction and purpose of the discussion.
2. In your own words what is HIV?
3. In your own words what is AIDS?
4. How can HIV be transmitted from person to person?
5. Where can HIV found in the human body?
6. How can a child contract HIV from the mother?
7. How can HIV/AIDS be prevented?
8. What do you understand by PMTCT programmes?
9. What are your views on males attending Antenatal Clinics with wives?
10. What would you do if you were invited for PMTCT services? (Substantiate
your answer)
11. Explain some of the traditional practices that are performed by men and
women following birth that promote transmission of HIV from parents to the
child?
12. How best can this practice be done?
13. What are the roles of men in PMTCT programmes?

THANK YOU VERY MUCH FOR YOUR PARTICIPATION

106
 14. FOCUS GROUP DISCUSSION GUIDE FOR WOMEN

THE UNIVERSITY OF ZAMBIA

SCHOOL OF MEDICINE
DEPARTMENT OF NURSING

FOCUS GROUP DISCUSSION GUIDE ON MALE INVOLVEMENT AND PARTICIPATION IN PREVENTION OF

MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV/AIDS IN CHIPATA DISTRICT

Name of the institution :……………………………………………………….………………………………………………

Date :…………………………………………………………………………………………………….…

Name of the Moderator :………………………………………………………………………………………………………

Names of recorders :………………………………………………………………………………………………

107
 Participants List
Education Marital Gestation
Age Tribe Residence Level Occupation Status Parity age Denomination

108
1. Welcome / introduction and purpose of the discussion.
2. You have been coming here for 2 times or more and you have had health
education on HIV/AIDS as well as PMTCT. How can a child contact HIV
from the parents?
3. Where in the body can HIV be found?
4. In your opinion, how are men involved and participating PMTCT. Please
substantiate your opinion.
5. How have you communicated PMTCT information to your husbands?
6. What problems have you faced or heard that women encounter on issues
of PMTCT?
7. What traditional practices do you think can promote the spread of HIV to
the baby when parents practice them?
8. How can men get involved and participate in PMTCT?

THANK YOU VERY MUCH FOR YOUR PARTICIPATION!

109
15. APPLICATION LETTER FOR AUTHORITY

110
111
16. ETHICAL APPROVAL LETTER FROM THE DEPARTMENT OF
NURSING

112
17. AUTHORITY LETTER FROM THE MINISTRY OF HEALTH

113
114
18. AUTHORITY LETTER FROM THE DISTRICT

115
19. MAP OF EASTERN PROVINCE

Chama

Lundazi

Mambwe Chipata

Petauke To Malawi
Chipata General Hosp
Katete Chadiza

Nyimba

To Lusaka To Mozambique

KEY

Tarred roads ending in districts

Tarred roads ending Provincial HQ

Un tarred Roads ending in Districts

116
20. MAP OF CHIPATA DISTRICT

117
 21. WORK SCHEDULE

FROM APRIL 2006 TO MARCH 2007

Task to be Responsible Time required

performed person Dates
Literature Researcher & Continuous Continuous
Supervisor
Compiling Researcher 18th April 2006 to 14th 16 Weeks
Research Proposal August 2006
Clearance Researcher 19th June 2006 to 31st 6 Weeks
July 2006
Pilot study Researcher 21st August to 25th 5 days
August 2006
Data collection Researcher 28th August 2006 to 3 Weeks
15th September 2006
Data Analysis Researcher 18th September 2006 4 Weeks
to 13th October 2006
Report Writing Researcher 16th October 2006 to 8 Weeks
15th December 2006
Draft Report Researcher 18th December 2006 to 2 Weeks
31st December 2006
Finalization of Researcher 1st January 2007 to 9th 5 Weeks
Report February 2007
Monitoring & Researcher & Continuous Continuous
evaluation Supervisor
Dissemination of Researcher 12th February 2006 to 7 Weeks
Results 31 March 2006

118
22. GANTT CHART

119
23. BUDGET
JUSTIFICATION FOR THE BUDGET
a) Stationery
Stationery is required for typing the research proposal, writing the final research
report as well as typing and printing the report. Interview schedules will be
produced using the same stationary. The notebooks are needed for record
keeping during data collection and analysis. The scientific calculator is required
for data analysis. The tape recorder is for recording the FGD. The stapler and
staples are needed to put papers together and to maintain their proper
arrangement. Tipex will be used to erase errors. Files and bags will be used for
storing the interview schedules during the data analysis period.

b) Secretarial Services
There will be need for funds to cater for the typing and photocopying services.
Diskettes will be required for data storage. The research bags are needed for
carrying the interview schedules. Money is also required for binding the research
proposal and report.

c) Personnel
Funds for transport will be required to move to and from the area of data
collection. There will also be need for lunch allowance during the data collection
period.

d) Contingency
Contingency is the 10% of the total amount of the budget. It is required to cater
for any unseen expenses during the research.

e) Dissemination Workshop
The dissemination workshop will be required to communicate the research
findings to the stakeholders in the district such as CIDRZ and the DHM and
traditional leaders.

121