The forgotten half of the equation

OBJECTIVE: Increased male participation in antenatal care and uptake of couple voluntary counselling and testing (VCT) for HIV could reduce horizontal and vertical HIV transmission in sub-Saharan Africa. METHODS: Randomized controlled trial to compare pregnant women's acceptance of written invitations for VCT and pregnancy information sessions (PISs) - the control group - for their male sexual partners (MSPs) and uptake of VCT among these pregnancy partners in Khayelitsha, South Africa. RESULTS: All women in the study accepted the invitation letters and agreed to invite their pregnancy partners to attend for VCT or PIS as requested. Thirty-five percent (175 of 500) pregnant women given VCT invitations for their partners brought their MSPs for antenatal clinic visit compared with 26% (129 of 500) given PIS invitations [relative risk (RR) 1.36, 95% confidence interval (CI) 1.12-1.64, P = 0.002]. Thirty-two percent (161 of 500) MSPs in the VCT arm underwent HIV testing compared with 11% (57/500) in the PIS arm (RR 2.82, 95% CI 2.14-3.72, P < 0.001). The proportions of women and men reporting unprotected sex during the pregnancy were lower in the MSP VCT arm than in the MSP PIS arm - 25 versus 81% (RR 0.30, 95% CI 0.22-0.42, P < 0.001) and 26 versus 76% (RR 0.34, 95% CI 0.25-0.47, P < 0.001), respectively. No differences were seen in intimate partner violence. CONCLUSION: Providing pregnant women with a written invitation for their partners increased male participation in antenatal care and uptake of couple VCT in a township in Cape Town, South Africa where community sensitization was conducted and antiretroviral therapy was available.