Men Should Attend Antenatal Visits to Receive HIV Counseling, Lancet Letter Says
Restructuring prenatal clinic visits in developing countries -- an idea suggested by a recent World Health Organization study -- provides an opportunity to "introduce as routine a couple's visit" that would allow providers to discuss HIV prevention with male partners, Wendy Holmes of the international unit for women and children's health at Australia's Macfarlane Burnet Center for Medical Research writes in a letter to the Lancet (Holmes, Lancet, 9/15). The WHO study found that women with low-risk pregnancies who live in developing countries can "safely get by" on fewer visits to a health care provider than the "traditional" eight or more visits without affecting maternal and perinatal outcomes (Kaiser Daily Reproductive Health Report, 5/21). The need for an antenatal visit by both female and male partners is "most crucial" in countries with a high prevalence of HIV, Holmes writes, adding that it can be an "effective intervention for preventing mother-to-child transmission of HIV." Many women who test negative at their first prenatal visit could become infected during the intervening time, putting their fetuses at high risk because viral load, the "most important determinant of transmission risk," peaks in the weeks immediately following infection. Holmes notes that it is important for men to attend a visit because many men have sex with other women while their partner is pregnant or during the postpartum period. "Men have a right to know that unprotected sex may lead to the death of their wife and child," Holmes writes, adding that the prenatal visit provides an opportunity to apprise men of this information and to distribute condoms. Holmes says the visits should not be billed as HIV interventions but as an "opportunity to screen and treat other infectious diseases," including other STDs and TB. Setting up evening clinic hours that better accommodate men's schedules would aid attendance, she adds. Although it may take "some years" before couples' visits become routine, "we should remember that other effective interventions, such as vaccination, took several years to become widely accepted," Holmes concludes (Lancet, 9/15).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.