Tesi etd-11302020-102817
Link copiato negli appunti
Tipo di tesi
Dottorato
Autore
TRIULZI, ISOTTA
URN
etd-11302020-102817
Titolo
Engaging men to positively impact the adherence and retention of HIV-positive women in Malawi
Settore scientifico disciplinare
SECS-P/08
Corso di studi
SCIENZE MEDICHE - MANAGEMENT
Commissione
relatore TURCHETTI, GIUSEPPE
Parole chiave
- engagement
- gender
- HIV
- involvement
- Malawi
- men
- norms
- PMTCT
Data inizio appello
28/01/2021;
Disponibilità
completa
Riassunto analitico
The aim of this original dissertation is to uncover various aspects related to the engagement of
men in promoting the adherence and retention of HIV-positive women in Malawi, with the
ultimate goals being to design and implement effective intervention. Its originality stems from
the novel inclusion of the issue of male engagement, utilising theories and frameworks from
global health and social science, with particular attention to gender theories. From a gender
perspective, I would say that this thesis aims to realise the potential of engaging men in
promoting gender equality in the Sexual and Reproductive Health and Right Service.
The main question that drove me during this three-year journey was:
How can we design more meaningful interventions and programmes by taking male
support into account, given that one cause of drop-out or low adherence is the scarce male
partner support received by HIV-positive women?
This dissertation consists of two main sections: one theoretical part where I systematically
review the literature to understand which interventions have been implemented so far in terms
of male partner support in sub-Saharan Africa; the empirical portion conducted in the field
includes a quantitative and qualitative study. The quantitative study (Chapter 3) is an
observation study that has been designed with my research group where we determined the
rate of their partner involvement and its determinants. In the qualitative study (Chapter 4), we
conducted focus group discussions and interviews with healthcare workers, expert patients
and couples attending the clinic. The aim is to explore the relationships between partners to
understand what is meant by male partner support in adherence of HIV positive women, its
intersection with gender norms and roles in the household, and finally its implications at policy
level.
The theoretical part (Chapter 2) identifies a scarce number of interventions aimed at involving
men in antenatal clinic and it brings to light that no appropriate indicators exist to measure male
involvement; identifies that single-component interventions are less effective than
multicomponent interventions within communities and congregations. The quantitative study
(Chapter 3) showed a male attendance of 60% and it points out that economic conditions
intersected with gender norms and roles play a crucial role in the engagement of men in care.
This was confirmed by the qualitative study (Chapter 4). It confirms the previous literature
which suggests that male partner support is expressed by providing access to transport to the
clinic and accompaniment to appointments and it highlights that support is more complex than
previous literature reported, and in some cases is an issue of the male partner granting
permission for the woman to access the necessary resources to attend the clinics. This may turn
out to be an act of control rather than an act of support over women further reducing their
agency and freedom. It may have harmful consequences to be considered during the design of
programmes and policies.
The conclusion suggests considering to design and implement robust multicomponent
interventions within communities and congregations targeting specifically couples and men,
and training community healthcare workers and expert patients; to agree on a
male involvement indicator that captures gender norms, roles and masculinities; to carefully
explore how gender roles and norms in the household shape everyday life and raise awareness
of their unintended consequences. To conclude, building interventions aimed at transforming
harmful gender norms and roles to improve adherence is the meaningful strategy to adopt to
enhance male involvement.
This thesis has been possible thanks to the various journeys to Malawi and field works where I
tried to go deeper into Malawian culture. This added incredible value to all my findings.
men in promoting the adherence and retention of HIV-positive women in Malawi, with the
ultimate goals being to design and implement effective intervention. Its originality stems from
the novel inclusion of the issue of male engagement, utilising theories and frameworks from
global health and social science, with particular attention to gender theories. From a gender
perspective, I would say that this thesis aims to realise the potential of engaging men in
promoting gender equality in the Sexual and Reproductive Health and Right Service.
The main question that drove me during this three-year journey was:
How can we design more meaningful interventions and programmes by taking male
support into account, given that one cause of drop-out or low adherence is the scarce male
partner support received by HIV-positive women?
This dissertation consists of two main sections: one theoretical part where I systematically
review the literature to understand which interventions have been implemented so far in terms
of male partner support in sub-Saharan Africa; the empirical portion conducted in the field
includes a quantitative and qualitative study. The quantitative study (Chapter 3) is an
observation study that has been designed with my research group where we determined the
rate of their partner involvement and its determinants. In the qualitative study (Chapter 4), we
conducted focus group discussions and interviews with healthcare workers, expert patients
and couples attending the clinic. The aim is to explore the relationships between partners to
understand what is meant by male partner support in adherence of HIV positive women, its
intersection with gender norms and roles in the household, and finally its implications at policy
level.
The theoretical part (Chapter 2) identifies a scarce number of interventions aimed at involving
men in antenatal clinic and it brings to light that no appropriate indicators exist to measure male
involvement; identifies that single-component interventions are less effective than
multicomponent interventions within communities and congregations. The quantitative study
(Chapter 3) showed a male attendance of 60% and it points out that economic conditions
intersected with gender norms and roles play a crucial role in the engagement of men in care.
This was confirmed by the qualitative study (Chapter 4). It confirms the previous literature
which suggests that male partner support is expressed by providing access to transport to the
clinic and accompaniment to appointments and it highlights that support is more complex than
previous literature reported, and in some cases is an issue of the male partner granting
permission for the woman to access the necessary resources to attend the clinics. This may turn
out to be an act of control rather than an act of support over women further reducing their
agency and freedom. It may have harmful consequences to be considered during the design of
programmes and policies.
The conclusion suggests considering to design and implement robust multicomponent
interventions within communities and congregations targeting specifically couples and men,
and training community healthcare workers and expert patients; to agree on a
male involvement indicator that captures gender norms, roles and masculinities; to carefully
explore how gender roles and norms in the household shape everyday life and raise awareness
of their unintended consequences. To conclude, building interventions aimed at transforming
harmful gender norms and roles to improve adherence is the meaningful strategy to adopt to
enhance male involvement.
This thesis has been possible thanks to the various journeys to Malawi and field works where I
tried to go deeper into Malawian culture. This added incredible value to all my findings.
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