Should there be mandatory HIV testing for men with partners attending antenatal care?

In Uganda, when a pregnant woman visits majority of the private health facilities for Antenatal care (ANC) with her spouse, baseline laboratory investigations such as HIV test, Hepatitis B test, Syphilis test, blood group/RhD, urinalysis, and complete blood count (CBC) or hemoglobin test among other tests are done for the woman. There are hardly any laboratory tests done for the male spouse/husband, not even finding out the HIV status of the man who has brought his spouse for ANC. This poses a big risk to the pregnant woman who continues to sexually engage with her partner whose HIV status is unknown.

On the other hand, in majority of the public health facilities across Uganda, almost all men who come with their pregnant spouses for ANC are counselled first and subjected to a mandatory HIV test and results shared. It’s on some few occasions when HIV testing kits aren’t adequate that they miss out on such a vital test, however they are given a return date and advised to come for this test. Additionally, for any pregnant woman who comes for ANC in a public health facility without their male spouse, the government of Uganda through the Ministry of Health (MoH) rolled out the HIV oral self-testing kit which is usually given to each woman to take home and can freely test her spouse who wasn’t able to come with her to the health facility due to various reasons. 

HIV remains a major public health issue that affects millions of people worldwide. Although the world has made significant progress in recent decades, important global targets for 2021 are not yet met as we come to the end of the year. Globally, 01^st December marks World AIDS day annually and the theme for this year 2021 is “End inequalities. End AIDS”. 

According to the Uganda AIDS Commission, for the period 2010-2020, Uganda recorded a tremendous improvement in the fight against the HIV and AIDS epidemic.  It is now among the eight countries in the world that had fully achieved the 90–90–90 targets by the end of 2020 with the others being Eswatin, Switzerland, Rwanda, Qatar, Botswana, Slovenia and Malawi. The number of People Living with HIV increased from 1.2M to 1.4M largely due to improved access and utilization of HIV services like testing, care and treatment. There was also tremendous reduction in new HIV infections among the various age and population groups. The AIDS-related 

Deaths significantly reduced, hence reducing the number of AIDS-related orphans.  Also, as a result of Elimination of Mother to Child Transmission (EMTCT) HIV prevention programs, the country realized a reduction in the numbers and proportion of children who contract HIV from their HIV infected mothers. 

According to the MoH Uganda estimates of 2020, the HIV prevalence among adults (15-49 years) in Uganda was 5.4%, with the prevalence higher among females (6.8%) compared to males (3.9%). Kalangala district had the highest HIV prevalence (18%) and Nabilatuk district had the lowest (0.2%). 

The Prevention of Mother to Child Transmission (PMTCT) policy in Uganda states that all pregnant women and their male partners should be offered HIV testing routinely during Antenatal Care. With guidance and support from the Uganda National Association of Private Hospitals, all the private and public professional health regulatory councils, associations, health related NGOs and MoH, I recommend that all private health facilities in Uganda include the HIV, syphilis and Hepatitis tests for male spouses in the general comprehensive Antenatal care package as it is in the public health facilities in Uganda. Together, we can fight HIV/AIDS and save more women and newborns.

The author is Lilian Nuwabaine Luyima; a BSc trained Nurse and MSN-Midwife and Women’s’ Health Specialist; HIHA-Midwife of the Year 2021 working with Aga Khan University as the Continuous Professional Development Coordinator