Prevalence and factors associated with couple HIV testing as reported by women receiving antenatal care at Kawempe National Referral Hospital, Uganda

In the landscape of global health, few goals are as urgent or as personal as stopping a mother from passing HIV to her unborn child. The virus that causes AIDS has long been a shadow over families in many parts of the world, but science has found a way to lift that shadow. When a pregnant woman knows her status and receives care, the chance of her baby being born with the virus drops dramatically. Yet, knowing one's own status is only half the battle. Public health experts have long argued that the most effective protection comes when both parents know their status together. This approach, known as couple HIV testing, allows partners to make informed decisions about their family's future and to support each other in staying healthy. Despite this clear benefit, the practice remains rare in many African nations, where cultural norms often leave the burden of seeking medical care entirely to women. The question for researchers is not just whether these tests work, but why so many couples are not walking through the clinic doors together.

To answer this, a team of researchers turned their attention to Kawempe National Referral Hospital in Kampala, Uganda. This is a large, busy public hospital where hundreds of pregnant women come for their prenatal checkups every week. The researchers wanted to understand the reality of couple testing in this specific urban setting. They did not simply ask if the policy existed; they went to the women themselves to see what was actually happening. Between December 2025 and February 2026, the team spoke with 181 pregnant women who were receiving care at the hospital. The process was straightforward but careful. After a woman finished her medical appointment, a trained assistant asked her a simple question: had she and her husband been tested for HIV together during this pregnancy? To ensure accuracy, the researchers also checked the woman's medical records to confirm her report. They kept the conversations private to protect the women's dignity and safety, focusing on the woman's experience without requiring the husband to be present for the interview.

The results painted a picture of a system that is working well for individual women but struggling to bring couples together. The study found that nearly all the women, about 97 percent, had been tested for HIV during their pregnancy. This shows that the hospital is successfully reaching the mothers. However, when it came to testing as a pair, the numbers dropped sharply. Only about one in five women reported that she and her partner had been tested together. This means that for every five women who knew their own status, four did not know their partner's status, leaving a significant gap in protection. Among the small group of couples who did test together, the researchers found that a few men were living with HIV, highlighting the real value of bringing partners into the clinic. The data also revealed that when discordant couples were found—where one partner was positive and the other negative—the rate of HIV positivity was higher among the men than the women.

The researchers then looked closely at what made the difference between couples who tested together and those who did not. They found that age played a surprising role. Women who were younger, specifically those under 25, were more likely to have tested with their partners than women who were older. The older women, perhaps feeling more established in their relationships or having different assumptions about their partners' health, were less likely to bring their husbands for testing. Beyond age, the environment of the clinic itself proved to be a powerful factor. Women who said they felt they had enough privacy and received good counseling during their visit were much more likely to have tested as a couple. It seems that when women feel safe and respected, they are more willing to invite their partners into the process. Similarly, simply knowing that the hospital offered this specific service made a huge difference. Women who were aware that couple testing was available were far more likely to use it than those who did not know it existed.

These findings suggest that the barrier to couple testing is not a lack of medical need, but rather a mix of social habits and clinic conditions. The study indicates that even in a large, well-equipped hospital, the old idea that prenatal care is solely a woman's responsibility still holds strong. The researchers noted that the busy nature of the hospital, with its crowds and limited time for staff, might make it harder to engage men who are not used to visiting clinics. The study does not claim to have solved the problem, but it points clearly to where the solution lies. To increase the number of couples testing together, health workers need to create more private, welcoming spaces for these conversations and actively inform women that bringing their partners is an option. By focusing on these practical changes, particularly for older women who may need more encouragement, the hospital can help more families start their journey into parenthood with full knowledge and shared protection.