In order to decrease HIV transmission, they recognized that condom use

In order to decrease HIV transmission, they recognized that condom use was challenging for PLHIV. One issue mentioned repeatedly was the inability of women to negotiate for condoms within their relationships due to cultural and gender expectations: . . . she wants to [use condoms], but her PD168393 chemical information husband will not accept, this happens very often with women, this is discussed very often, . . . `I want to use it but my husband will not ?what can I do’ we go back to that story that the man is in ?charge at home . . . . (Female counselor, 28 years old, Zambezia Province) . . . Some say that the husband has no need to use condoms, . . . some because they have not revealed their status to their partner. Especially for women, they do not reveal their cases, and they have no way to require that [their partners] have to use a condom. And then, here [in Mozambique] . . . it is the man who decides. If the woman is HIV-positive she will never tell her husband that we will use a condom. The man has to start it and generally men do not like to come get tested. Women are always showing up to get tested. ?(Female counselor, 32 years old, Zambezia Province) Providers also believe that LM22A-4 web women’s fears of discrimination, abandonment and traditional gender roles constrained their ability to make safe choices. Condom use was also often linked to disclosure. If patients had not disclosed their status, providers reported that it was more difficult to ask for condom use since introducing condoms into the relationship would suggest HIV-positive status. . . . if the husband doesn’t disclose his condition, he will never use condoms. Because then he will have to justify why he is using condoms. A wife who is doing treatment but hasn’t disclosed to the husband will never say, let’s use condoms. If I’m3.4.Challenges and barriersIn-depth interviews with healthcare providers revealed challenges and barriers faced in implementing PP strategies. Barriers directlyJournal of Social Aspects of HIV/AIDSVOL. 12 NO. 1Article Originalyour husband, why condoms? (Male counselor, 32 years old, Maputo Province) Provider’s said that their patients reported that they were using condoms but routinely returned to the facility pregnant, suggesting a lack of condom use or method failure. This often frustrated providers because they wanted PLHIV to protect themselves and their partners. However, they were faced with the fact that condoms as a form of HIV prevention were less than ideal. For example, discordant couples, you know, they come, we counsel them, maybe this man is negative and the woman is positive but they will not use condoms, . . . even those who are couples with the same result, many times pregnant women come . . . . It does not mean that a positive person cannot have them, they should have children, but . . . they have to see a doctor, they have to tell the doctor that they want to have kids . . . (Female counselor, 28 years old, Zam?bezia Province) Present in both the disclosure and condom issues from the provider’s perspective is a lack of male engagement in HIV care and treatment settings. Whereas women might have received prevention messages, it was difficult to reach men with PP messages and promote change without male support. I think it’s easy to pass the message to women . . . who are always the first to seek my services, but [it] is more difficult to invite the male partner to actively participate. When he is not being diagnosed first . . . it is more difficult for the wife.In order to decrease HIV transmission, they recognized that condom use was challenging for PLHIV. One issue mentioned repeatedly was the inability of women to negotiate for condoms within their relationships due to cultural and gender expectations: . . . she wants to [use condoms], but her husband will not accept, this happens very often with women, this is discussed very often, . . . `I want to use it but my husband will not ?what can I do’ we go back to that story that the man is in ?charge at home . . . . (Female counselor, 28 years old, Zambezia Province) . . . Some say that the husband has no need to use condoms, . . . some because they have not revealed their status to their partner. Especially for women, they do not reveal their cases, and they have no way to require that [their partners] have to use a condom. And then, here [in Mozambique] . . . it is the man who decides. If the woman is HIV-positive she will never tell her husband that we will use a condom. The man has to start it and generally men do not like to come get tested. Women are always showing up to get tested. ?(Female counselor, 32 years old, Zambezia Province) Providers also believe that women’s fears of discrimination, abandonment and traditional gender roles constrained their ability to make safe choices. Condom use was also often linked to disclosure. If patients had not disclosed their status, providers reported that it was more difficult to ask for condom use since introducing condoms into the relationship would suggest HIV-positive status. . . . if the husband doesn’t disclose his condition, he will never use condoms. Because then he will have to justify why he is using condoms. A wife who is doing treatment but hasn’t disclosed to the husband will never say, let’s use condoms. If I’m3.4.Challenges and barriersIn-depth interviews with healthcare providers revealed challenges and barriers faced in implementing PP strategies. Barriers directlyJournal of Social Aspects of HIV/AIDSVOL. 12 NO. 1Article Originalyour husband, why condoms? (Male counselor, 32 years old, Maputo Province) Provider’s said that their patients reported that they were using condoms but routinely returned to the facility pregnant, suggesting a lack of condom use or method failure. This often frustrated providers because they wanted PLHIV to protect themselves and their partners. However, they were faced with the fact that condoms as a form of HIV prevention were less than ideal. For example, discordant couples, you know, they come, we counsel them, maybe this man is negative and the woman is positive but they will not use condoms, . . . even those who are couples with the same result, many times pregnant women come . . . . It does not mean that a positive person cannot have them, they should have children, but . . . they have to see a doctor, they have to tell the doctor that they want to have kids . . . (Female counselor, 28 years old, Zam?bezia Province) Present in both the disclosure and condom issues from the provider’s perspective is a lack of male engagement in HIV care and treatment settings. Whereas women might have received prevention messages, it was difficult to reach men with PP messages and promote change without male support. I think it’s easy to pass the message to women . . . who are always the first to seek my services, but [it] is more difficult to invite the male partner to actively participate. When he is not being diagnosed first . . . it is more difficult for the wife.