Male involvement is key to this PEPFAR-funded program operated by the USAID partner, IntraHealth/The Capacity Project at 27 Rwandan health facilities. Heterosexual couples are the country’s largest at-risk groups for HIV infection. Convincing male partners to come with the mothers of their children to the PMTCT program means both the man and woman will be tested for HIV, and together will be counseled on protecting themselves and future children, general health matters, and family planning.

Initially, male partners who do not accompany their wives are sent a signed, written “invitation” from the health center, and the letter’s official tone usually prompts his attendance. Despite whatever misgivings he may have had at first, he finds at the health center a safe, welcoming environment staffed by trained, caring people. In the fewer than four years that IntraHealth has been operating this program, favorable word-of-mouth and increased community sensitization have dramatically decreased the need for such letters. Now at all the centers, most if not all the wives in the PMTCT program are accompanied by their husbands, and both partners receive HIV counseling and testing.

At the end of 2002, the program’s first year, there was only 3% male involvement; by the end of the third quarter of 2006, that rate had been increased to 74%, with 5,566 women and 4,107 male partners tested. However, while there is a 3% prevalence of HIV among both women and men separately, in 7% of couples, one partner is HIV-positive, and the other negative. This points up the need for continued couples participation in testing and counseling to avoid infection of the negative partner and their children.