SUMMARY: Kagisio Educational Television (Kagisio) PMTCT activity is focused on male involvement in the prevention of mother-to-child transmission (PMTCT) to increase uptake of PMTCT through the expansion of a grassroots campaign targeting community-based men's groups. The campaign aims to create male awareness of PMTCT to ensure that men understand the implications of mother-to-child transmission (MTCT) and can support and encourage their pregnant partners' to uptake PMTCT services.

BACKGROUND: Low uptake of PMTCT services remains a challenge to successful implementation of PMTCT in South Africa. Although coverage of PMTCT exceeds 80%, PMTCT uptake still hovers around 50%, indicating that more than half of women who need PMTCT services are missed at entry point. The reasons for low uptake vary from health systems issues to social issues. Cultural and social values are prime factors, with fear of violence and abandonment from male partners due to HIV disclosure often cited as the primary reason for choosing not to be tested during antenatal care. Furthermore, many women assume that because they are faithful to their male partners, they cannot be HIV-infected and so choose not test for HIV during antenatal care. MTCT is also affected by the cultural perceptions that breastfeeding is a practice adopted by model mothers and wives. Many HIV-infected mothers report that they breastfeed in the presence of their husbands and mother-in-laws, but formula feed when they are absent. These mothers are not aware that mixed feeding practices increase the risk of vertical transmission. Anecdotal evidence suggests that many men are afraid to undergo HIV testing and use their wives' HIV test results as a proxy for determining their negative status. Conversely, when their wives test positive, they do not assume they are infected. These misconceptions contribute to vertical transmission of HIV, and led to a joint decision by the USG Inter-Agency Task Force and the National Department of Health (NDOH) to target the partners of pregnant women and to develop a PMTCT male involvement campaign targeting grassroots men's groups.

Using FY 2006 funding, this campaign is scheduled to begin implementation by January 2007, and will work directly with non-governmental and community-based organizations, sports clubs and other men's groups at the community level to ensure HIV, AIDS and PMTCT information transfer, and to address gender, stigma and masculinity in the context of South African culture and how it relates to PMTCT. Partners of women attending antenatal care will also be targeted by the campaign. The campaign aims to sensitize men to issues relating to PMTCT, to create a platform from which to address cultural and gender issues that impede the uptake of PMTCT.

A series of workshops will be conducted with male groups. At the conclusion of each workshop, the group will develop community-based activities to improve uptake of PMTCT. These activities will then be implemented by the men. These actions may range from wearing T-shirts with emblems supporting PMTCT, holding community meetings to address myths around PMTCT or encouraging men to go with their partners to antenatal care and to be tested. Using FY 2007 funding, Kagiso (a South African company specializing in community mobilization) will continue to target men's groups and to create awareness on PMTCT. Kagiso's activities will expand the reach of the campaign, ensuring that rural communities are reached. In addition, in FY 2007 the campaign will specifically target male partners of women attending antenatal care and family planning clinics to facilitate their understanding of HIV and AIDS and PMTCT issues, and to encourage them to get tested, "know their HIV status" and to support their partners, even if their results are discordant. Efforts will be made to hold support groups for men whose partners are in the PMTCT program, with a specific focus on the development of skills to reduce stigma, and to support their partners.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Conducting workshops Creative facilitators for the workshops will be identified and trained. Refresher training will be offered periodically, and new facilitators will be trained as they are employed. Trained facilitators/community activists will be responsible for ongoing workshop activity with different male groups in their community. In each workshop or identified community activity, men will be asked to collectively assess the previous community-based action or activity illustrating male support for PMTCT and build on its outcomes. With monitoring and ongoing support from the workshop facilitators, the men will implement the activity in

their communities. These activities will be developed and implemented by the communities and will focus on creating support and awareness for PMTCT.

ACTIVITY 2: Development of a media campaign This activity will facilitate the development of a higher profile media campaign focusing specifically on gender and HIV in the context of male involvement in PMTCT. This will be achieved through the identification of "success stories" from FY 2006 and profiling these stories in community newspapers, pamphlets, radio and television. This campaign will be linked with community meetings to ensure that communities, particularly men, have a platform to discuss issues raised by the campaign. In addition, Kagiso will investigate digital storytelling and website channels and opportunities.

ACTIVITY 3: Support groups Kagiso will target women attending antenatal care and pregnant HIV-infected women attending support groups and encourage them to bring their partners to a discussion group. At the outset, all aspects of pregnancy, not just HIV and PMTCT, will be discussed. Groups will meet regularly and after some time when participants are comfortable with pregnancy issues, PMTCT and HIV will be introduced and become the focus of discussions. Men will be encouraged to attend antenatal care clinics with their partners and accept couple counseling and testing. Men who want to be tested but who do not want to go to the clinic will be referred to alternative sites. The aim of the group sessions will be the development of support networks for men whose partners are enrolled in PMTCT programs, and which will encourage improved support to their partners, ensuring better uptake and adherence of PMTCT service delivery.

Activity 4: Funding will be used to expand the workshops and media campaign by linking the campaign with the South African Football Players Association Union (SAFU). By linking the male involvement in PMTCT campaign to SAFU, Kagiso will be able to reach in excess of 50,000 men and create greater awareness around HIV, AIDS and PMTCT. In addition, this linkage will enable SAFU the opportunity to strengthen it HIV prevention campaign and incorporate messages around PMTCT hence creating greater awareness.

This activity contributes to PEPFAR 2-7-10 goals by increasing awareness of PMTCT, increasing uptake of PMTCT, and reducing vertical transmission. Targeting men and ensuring men identify and implement community-based activities in support of PMTCT will improve community-wide support for PMTCT services. This activity will begin a process by which men begin to understand PMTCT. Increased male involvement and community support for PMTCT will improve uptake of PMTCT service delivery, contributing to the PEPFAR target of averting 7 million new infections.