Table 2 Summary table of barriers to male PMTCT involvement

Societal/cultural barriers

• Perception of antenatal care as a woman’s place [19, 23, 37, 40–43, 45, 46].

• Cultural norm that men should not participate in antenatal care as pregnancy is a woman’s affair [25, 37, 43, 46].

• Societal ridicule of men accompanying their wives to ANC [19, 32, 46]

• Women are not allowed to lead [41, 46].

• Conflict between PMTCT recommendations and cultural norms such as breastfeeding [39].

• Cultural patterns of communication [44]

Male individual factors

• Reluctance to learn ones status [19, 32, 37, 39, 43, 46].

• Lack of time for ANC/PMTCT [25, 37, 41, 43, 46].

• Do not see the benefits of testing [41, 43].

• Self-perception of being in good health [32, 46].

• Avoidance of the burden of care [19, 46].

• Lack of finances [19,46].

• No one left at home to look after the children [44].

Information/knowledge barriers

• Misconception that your partner’s HIV status is a proxy of your own status [37, 41, 44, 46].

• Unawareness of the availability of antenatal VCT by men [19, 43, 46].

• Men’s limited knowledge of PMTCT [19, 43].

• Lack of community awareness on the importance of male PMTCT involvement [25].

Health system barriers

• Long waiting times at the clinic [46, 47].

• ANC services are not male-friendly [37, 43].

• Distrust in confidentiality of the health system [19].

Female factors

• Women not involving their partners due to numerous fears e.g. accusations of infidelity, divorce, stigmatization, domestic violence [16, 25, 35, 42]

Relationship Dynamics

• Weaker relationships [15, 19].

• Fidelity within the relationship [42, 46]

Relationship Dynamics

• Weaker relationships [15, 19].

• Fidelity within the relationship [42, 46]

Disagreement with PMTCT teachings

• Disagreement with PMTCT encouragement of condom use within the couple [39].

• Men perceiving prenatal HIV testing as a late event. They would have been offered the chance to test earlier [40].