Male involvement in health promotion and uptake can be difficult due to men’s reluctance to engage in health services. This has also been the experience during the on-going Population Effects of Antiretroviral Therapy to Reduce HIV Transmission HPTN071/PopART trial and has thus raised concern among the study researchers about the study outcomes.
In Kitwe, following a review of data, it was discovered that 18 per cent of male household members were absent from the household each time a visit by the Community HIV Care Providers (CHiPs) was scheduled. The trend was gradually affecting the study indicators. Overall, as at 30 September, 2014 after 9 months of implementation, male inclusion in PopART trial was 72% i.e. 28% of males were not contacted with the door-to-door approach.
This prompted key intervention staff in Kitwe to put their heads together and generate innovative initiatives to engage men in the community in an effort to increase their participation and scale up delivery of the PopART intervention package to in Chimwemwe community.
An action plan dubbed “No Missed Opportunity” was soon initiated and the first task was to identify all possible work places and spaces where males could be found within particular zones, including crowded social places that men often frequent and where PopART tents could be mounted. This was followed by orientation of the CHiPs from all the zones about the objectives of the plan and allocate them specific tasks.
No Missed Opportunity was rolled out in 4 days in all parts of Chimwemwe, which has 20 zones. These zones were sub-divided into 5 zones each with the objective of reaching 90 to 100 males. In each zone, the coordination and mobilization was spearheaded by the CHiPs.
The No Missed Opportunity intervention strategy managed to reach 179 people of which 8 were females and 171 were males against the targeted 100 by the end of the initiative. Of the total number of men reached, 147 were enrolled into the study and all the 8 females. All of these were tested and provided with their results on site in mounted tents.
Issues attributed to low male participation in PopART activities included stigma and cultural norms, as well as economic issues where men are the breadwinners of the household. It was also observed that men preferred to be the first in the household to enrol, but would decline enrolment if a female household member had preceded them. Some of the men who accepted to be enrolled from the work places had refused enrolment where previously found at home by the CHiPs.