All ETDs from UAB

Advisory Committee Chair

Janet M Turan

Advisory Committee Members

Justin Blackburn

Lynae Darbes

Nataliya V Ivankova

Kari White

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Focusing on male partner engagement in HIV prevention is an important aspect of intervention and policy development and implementation within the sub-Saharan African context. However, engaging male partners safely and effectively to improve the impact and sustainability of HIV prevention modalities remains challenging due to continued impact of traditional gender roles that may affect the willingness and confidence to engage in pregnancy health. Additionally, the lack of knowledge of how best to engage in pregnancy health beyond financial support makes it difficult for male partners to engage. This dissertation’s overall aim is to explore aspects of male partner engagement's influences in the Kenyan context, using a three-manuscript paper model. The first aim of the dissertation (N= 40) explores male partners’ perceptions about engaging in pregnancy health; the second aim (N= 96 couples) examines the association between couple relationship dynamics and the extent couples collaborate confidently to prevent HIV transmission using the actor-partner interdependence model. The third aim of the dissertation (N= 81 couples) uses a sequential explanatory mixed method approach to dyadically explore if couple relationship factors mediate the association between intervention exposure and male partner ANC engagement. Findings indicated that male partners were willing to engage in pregnancy health but felt hindered due to tradition gender norm expectations, logistic and health care level challenges. Further, a couple’s confidence and ability to address an HIV threat appeared dependent on mutual influences of couple relationship quality perceptions. Although we were unable to establish a mediatory relationship between couple relationship quality and male partner ANC attendance, findings suggested that couple relationship quality influenced ANC attendance in both expected and unexpected ways. For example, couples whose male partners appeared more trusting seemed to be less likely to attend ANC. Also, couples randomized to receive the intervention appeared to report higher relationship satisfaction and commitment at follow-up. Overall, these findings may inform how to improve couple relationship-focused interventions, by focusing on leveraging aspects of couple relationships that impact male partner engagement in HIV prevention and can be further tailored for couples who may benefit most.

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