Perceptions of Male Involvement in the Prevention of Mother-to-Child Transmission of HIV (PMTCT) Services in the Democratic Republic of Congo: Opportunities for Social and Behavior Change Communication

Each year, this population includes approximately 2.5 million pregnant women. The estimated HIV prevalence in DRC is relatively low compared to other African countries, with only 1.2 percent of the general population infected. However, this translates into a large number of people living with HIV/AIDS, including 565,155 women and 168,384 children. Mother-to-child transmission (MTCT) of HIV is the most common way children become infected, and it is completely preventable. In the absence of any intervention, the risk of MTCT ranges from 15 percent to 45 percent globally. Modeling studies conducted in the DRC have estimated the rate in that country to be 30.5 percent. MTCT can take place during pregnancy, childbirth, or through breastfeeding. Comprehensive programs to address prevention of mother-to-child transmission (PMTCT) of HIV include four pillars: primary prevention of HIV in women of reproductive age, reducing unmet need for family planning among HIV-positive women, preventing HIV transmission from HIV-positive women to their infants, and providing care, treatment, and support to HIV-positive women and their children and families. In the DRC, there is an almost complete lack of PMTCT services, and the country has one of the lowest PMTCT coverage rates in sub-Saharan Africa. The few available services are offered through selected antenatal care (ANC) facilities, are generally concentrated in certain health zones, and are largely supported by donor funding. As of 2010, only 851 health facilities in DRC had integrated PMTCT into their services, and less than half of those offered Voluntary Counseling and Testing (VCT). Only 1 percent of ANC facilities had sufficient numbers of staff trained in PMTCT. As a result, just 2.2 percent of pregnant women received some aspect of PMTCT services, such as testing, counseling, ARV treatment, or other care. Only about half of pregnant women in 2010 who received a test and were positive for HIV received Antiretroviral Therapy (ART). PMTCT knowledge and HIV testing levels are very low in DRC. According to the 2013-2014 Demographic and Health Survey (DHS), only 26 percent of women and 23 percent of men knew that HIV can be transmitted through breastmilk and that the risk of MTCT can be reduced by taking medicine during pregnancy. Over three quarters (78 percent) of women of reproductive age had never been tested for HIV, and only 28 percent had received HIV counseling during an ANC visit. The numerous reasons for the low level of PMTCT expansion and uptake in DRC include the implementation of the PMTCT program vertically rather than integrated within other Ministry of Health programs, service-related challenges, social barriers to HIV testing, and poverty.