Digital Theses Archive


Tesi etd-11302020-102817

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