If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing - The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda

Aug 26, 2026

Gender shapes prevention of mother-to-child transmission (PMTCT) participation under Option B+ in ways that remain insufficiently studied, even though such insights are essential to reduce losses to follow-up. Qualitative research in Malawi and Uganda examined how gender interacts with individual, interpersonal, health-system, and community factors affecting PMTCT engagement. In-depth interviews with women in care, women lost to follow-up, health workers, and organization stakeholders, plus focus groups with men, used thematic content analysis. Knowledge of ART benefits, social support, and self-efficacy supported participation, while fear of HIV disclosure, stigma, limited social support, male involvement gaps, and gender inequality hindered it.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Introduction

Methods

Findings and Thematic Content Analysis

Facilitators of PMTCT participation

Barriers to PMTCT participation

Implications for Health Ministries

OPEN ACCESS Citation: Flax VL, Yourkavitch J, Okello ES, Kadzandira J, Katahoire AR, Munthali AC (2017) ªIf my husband leaves me, I will go home and suffer, so better cling to him and hide this thingº: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda. PLoS ONE 12(6): e0178298 . [https://doi.org/10.1371/journal.pone.0178298](https://doi.org/10.1371/journal.pone.0178298) [Editor:](Editor: Philip Anglewicz)[ Philip Anglewicz](Editor: Philip Anglewicz), [Tulane University School](Tulane University School)[ ](Tulane University School)of Public Health and Tropical Medicine, UNITED STATES Received: December 25, 2016 Accepted: May 10, 2017 Published: June 8, 2017 Copyright: © 2017 Flax et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data will be registered with USAID's Development Experience Clearinghouse. Researchers can request access to the data by contacting Emily Bobrow, [ebobrow@email.unc.edu](ebobrow@email.unc.edu), the PMTCT team lead for MEASURE Evaluation, or Valerie Flax, flax@unc. edu. RESEARCH ARTICLE ªIf my husband leaves me, I will go home and suffer, so better cling to him and hide this thingº: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda Valerie L. Flax1,2 *, Jennifer Yourkavitch1,3, Elialilia S. Okello4,5, John Kadzandira6, Anne Ruhweza Katahoire5, Alister C. Munthali6 1 MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America, 2 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States, 3 ICF, Fairfax, Virginia, United States of America, 4 Department of Psychiatry, Makerere University, Kampala, Uganda, 5 Centre for Child Health and Development, Makerere University, Kampala, Uganda, 6 Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi * [flax@unc.edu](flax@unc.edu) Abstract The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands' decisions about their PMTCT participation, and some husbands are unsuppo

FAQs

What was the study’s main focus regarding Option B+ PMTCT participation?

The study examined how gender influences participation in PMTCT under Option B+ and how multiple gender-related factors contribute to retention and engagement.

Which factors were identified as key facilitators of PMTCT participation?

Respondents highlighted knowledge of the health benefits of ART, social support, and self-efficacy as major facilitators.

What were the main barriers to PMTCT participation described by respondents?

The main barriers were fear of HIV disclosure and stigma, lack of social support, challenges related to male involvement, and limits in self-efficacy and agency.

Aug 26, 2026

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