"Among the pregnant women who come to our hospital, less than 10 percent of them come with their partners," said Etalem Gebrehiwot, head nurse at the prevention of mother-to-child transmission (PMTCT) wing of Gandhi Memorial Hospital. "Those who find out that they are living with the virus usually face a problem while taking medicines, given that most prefer to take it without the knowledge of their partners."
Studies show that low male partner involvement is one of the challenges to the success of the country's PMTCT programme.
According to experts, men's involvement in PMTCT can have a positive impact on PMTCT by encouraging their partners to visit antenatal clinics and have skilled health workers attend the birth of their children. In a 2010 Kenyan study, male partner involvement in PMTCT reduced the risks of vertical transmission and infant mortality by more than 40 percent compared to no involvement.
"The biggest challenge we are currently facing is to convince mothers to get tested in order to determine that they are eligible for PMTCT services... the major reason for their resistance is lack of consent from their husbands or partners, who are more influential in family matters including this," said Aster Shewa, who supervises Zewditu Hospital antiretroviral service centre in Addis Ababa.
"Besides, after they know their status, most HIV-positive mothers refrain from disclosing it, which usually impacts the way they use PMTCT services and their effectiveness," she added.
Many men do not see the advantages of an HIV test; one father, whose wife gave birth to a daughter in November 2011, told IRIN/PlusNews: "We are married - what is there to test about?"
"At the moment, hospitals with PMTCT services are increasing, and we have to work hard in convincing pregnant women, along with their partners, to use health facilities with the service in order to reach zero new infections," said Aster.
New national plan
The national accelerated emergency PMTCT plan - launched in December 2011 - has three objectives: reaching 90 percent of pregnant women with access to antenatal care services; ensuring universal access by pregnant women to a skilled attendant during delivery; and providing ARVs to at least 80 percent of HIV-positive pregnant women.
An estimated 1.2 million Ethiopians are living with HIV, including about 90,000 pregnant women; just 9.3 percent of pregnant women who are eligible for HIV services are currently receiving them. The number of Ethiopian women who visit antenatal clinics is growing - from 616,763 in 2008-2009 to 796,099 in 2009-2010 - and the number of mothers receiving HIV testing as part of PMTCT services has grown to over 70 percent, but just 6 percent of births are attended by a skilled health worker, according to the UN World Health Organization.
"The new plan will focus on increasing the quality of services that expectant mothers get in the health services and also retain those who are using it. We intend to work on both in the demand and supply side of the service," said Tadesse Ketema, a maternal health adviser at the Ministry of Health.
"Through the health extension programme, the country manages to create easy access for family planning services for many families and that has worked so far. We are now planning to copy that in the PMTCT programme to reach out [to] each pregnant woman and give the service at their convenience," he added.
Ethiopia's "health extension programme" employs more than 30,000 lower cadre health workers to provide basic health care at village level. The government also intends to use "health development armies" - community groups mobilized to further government health programmes - to create demand and convince the community, including male partners, to benefit from nearby PMTCT services.