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Persson A, Mek A, Naketrumb R, Mitchell E, Bell S, Kelly-Hanku A. Local Pathways of "Serodiscordant Couples": Unpacking a Global HIV Population Category in Papua New Guinea. Med Anthropol 2024; 43:31-45. [PMID: 37988129 DOI: 10.1080/01459740.2023.2282976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
HIV prevention programs focus on global "key populations" and more localized "priority populations" to ensure effective targeting of interventions. These HIV population categories have been subject to considerable scholarly scrutiny, particularly key populations, with less attention given to critically unpacking priority populations at local levels, for example "serodiscordant couples" (one partner has HIV, but not the other). We examine this population in the context of Papua New Guinea to consider how local configurations, relational pathways, and lived realities of serodiscordant relationships strain the boundaries of this population category and raise intriguing questions about its intersection with contemporary biomedical agendas.
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Affiliation(s)
- Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Agnes Mek
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research Goroka, Papua New Guinea
| | - Richard Naketrumb
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research Goroka, Papua New Guinea
| | - Elke Mitchell
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | - Stephen Bell
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research Goroka, Papua New Guinea
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
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Fu R, Chen C, Gu Y, Wu D, Darbes LA, Yu NX. Communal or Autonomous? Coping Experiences of Chinese Serodiscordant Male Couples to HIV Care: A Dyadic Qualitative Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3553-3564. [PMID: 37365447 DOI: 10.1007/s10508-023-02643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023]
Abstract
Limited empirical evidence exists on the interpersonal challenges faced by Chinese serodiscordant male couples in HIV care. This study aimed to explore their coping experiences in HIV care by applying the communal coping process theoretical framework. A dyadic qualitative study using face-to-face interviews with 20 serodiscordant male couples (n = 40) was conducted between July and September 2021 in two Chinese metropolitan areas through purposive sampling. Eligibility included one partner living with HIV and the other being HIV-negative, both aged 18 or older, born male, gay or bisexual, and in a relationship together for at least 3 months. A hybrid deductive-inductive approach integrated with dyadic interview analysis and framework method was used for data analysis. We identified three themes in the coping process in HIV care: (1) coping as an autonomous process, (2) coping as a dissonant process, and (3) coping as a contextualized communal process. Concerning autonomous coping, most couples adopted either disengaged avoidance or mutual noninvolvement as negative coping strategies. We also identified potential risk factors for dissonant coping, which are a partner living with internalized HIV stigma and the couple's asymmetric relationship goals. Our results indicate the communal coping process of HIV care is contextual, and our expansion of the communal coping theory sheds light on how serodiscordant male couples cope with stressors connected to HIV care. Our findings provide theoretical insights for the development of dyadic interventions based on health psychology for Chinese serodiscordant male couples to engage in HIV care.
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Affiliation(s)
- Rong Fu
- Department of Social and Behavioural Sciences, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Kowloon, Hong Kong, People's Republic of China
| | - Chen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Kowloon, Hong Kong, People's Republic of China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Dan Wu
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, Kowloon, Hong Kong, People's Republic of China.
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Hou J, Fu R, Jiang T, Yu NX. Common Dyadic Coping Mediates the Associations Between We-Disease Appraisal and Relationship Satisfaction and Quality of Life in HIV Serodiscordant Couples: The Common Fate Mediation Model. Ann Behav Med 2023; 57:978-987. [PMID: 37435876 DOI: 10.1093/abm/kaad036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Since HIV has evolved into a lifelong but manageable condition, improving the quality of life (QoL) of persons living with HIV (PLWHs) has become increasingly important. Living with HIV is life-altering and poses substantial challenges for both PLWHs and their partners, so identifying how HIV serodiscordant couples cope with HIV together is crucial. Here, Bodenmann's Systemic Transaction Model highlights common dyadic coping (CDC), which refers to both partners working together to alleviate the negative effects of stress. PURPOSE We examined the mediating role of CDC in linking we-disease appraisal with relationship satisfaction and QoL. METHODS We recruited a convenience sample of 231 HIV serodiscordant couples via local grassroots organizations between June and October 2022. Participants completed measures of we-disease appraisal, CDC, relationship satisfaction, and QoL. We examined the mediation effect of CDC on the association between we-disease appraisal and outcomes using the common fate mediation model. RESULTS The mean age of PLWHs was 32.18 years (standard deviation = 8.61 years), and that of their partners was 32.55 years (standard deviation = 9.24 years). The average time since HIV diagnosis was 4.18 years. Most couples were same-sex male couples. We found that CDC mediated the effect of we-disease appraisal on relationship satisfaction. Moreover, CDC significantly mediated the effect of we-disease appraisal on the QoL of PLWHs and their partners. CONCLUSIONS Our findings highlight the importance of CDC in dyadic illness management among Chinese HIV serodiscordant couples.
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Affiliation(s)
- Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, P. R. China
| | - Rong Fu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, P. R. China
| | - Taiyi Jiang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, P. R. China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, P. R. China
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Hughes SD, Truong HHM. Sero-discovering versus sero-cognisant: initial challenges and needs of HIV-serodiscordant couples in Porto Alegre, Brazil. CULTURE, HEALTH & SEXUALITY 2017; 19:888-902. [PMID: 28074680 DOI: 10.1080/13691058.2016.1269366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper focuses on challenges faced by heterosexual couples of mixed HIV status in Porto Alegre, Brazil, and argues for more conceptual nuance in our understanding of 'serodiscordance'. Couples' stories, collected over 11 months of qualitative research, demonstrate how profoundly serodiscordance involves both partners and suggest that the timing of relationship formation relative to HIV diagnosis influenced the particular challenges they confronted. In recognition of this variation, we propose the distinction of 'sero-discovering' from 'sero-cognisant' couples. Though Brazilian health policy strives to address the needs of individuals diagnosed with HIV, the needs of seronegative partners in this cohort received relatively little attention. In addition, the transformation of HIV from a death sentence to a chronic condition both facilitated the formation of serodiscordant unions and raised special challenges for such couples. Conceiving of any person receiving an HIV diagnosis as 'potentially partnered' may help address some of these lacunae while promoting primary prevention within mixed-status couples, and HIV testing more generally. More research with this population is needed.
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Affiliation(s)
- Shana D Hughes
- a Department of Anthropology , University of South Florida , Tampa , USA
| | - Hong-Ha M Truong
- b Center for AIDS Prevention Studies , University of California-San Francisco , San Francisco , USA
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Hoff CC, Campbell CK, Chakravarty D, Darbes LA. Relationship-Based Predictors of Sexual Risk for HIV Among MSM Couples: A Systematic Review of the Literature. AIDS Behav 2016; 20:2873-2892. [PMID: 27048237 DOI: 10.1007/s10461-016-1350-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Behavioral and epidemiological studies report high risk for HIV among MSM couples. Over the last decade, studies have examined relationship dynamics associated with sexual risk for HIV. It is important to examine the impact this research has had on HIV prevention and what is still needed. We conducted a review of the literature focusing on relationship dynamics associated with sexual risk for HIV among MSM couples. Procedures used for this review were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses established to provide a framework for collecting, reviewing and reporting studies systematically (Mohler et al. in Ann Intern Med 151(4):264-269, 2009). We found that positive relationship dynamics are associated with less risk with partners outside the relationship, but were associated with greater odds of unprotected anal intercourse with primary partners. We also discuss other factors including sexual agreements about outside partners and make recommendations for next steps in HIV prevention research among MSM couples.
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Affiliation(s)
- Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA.
| | - Chadwick K Campbell
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Deepalika Chakravarty
- Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street Suite 523, San Francisco, CA, 94103, USA
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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Starks TJ, Tuck AN, Millar BM, Parsons JT. Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples. AIDS Behav 2016; 20:439-48. [PMID: 26552658 PMCID: PMC4831131 DOI: 10.1007/s10461-015-1248-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of the current study was to examine whether syndemic stress in partnered gay men might undermine communication processes essential to the utilization of negotiated safety and other harm reduction strategies that rely on partners' HIV status disclosure. Participants included 100 gay male couples (N = 200 individuals) living in the U.S., who responded to an online survey. Participants completed measures of five syndemic factors (depression, poly-drug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity). They also reported on whether condoms were used during first intercourse together and the timing of first condomless anal intercourse (CAI) relative to HIV disclosure in their relationship. Results of binary logistic regression analyses supported the hypothesis that the sum of partners' syndemic stress was negatively associated with condom use at first intercourse and with HIV disclosure prior to first CAI. Syndemic stress may contribute to HIV transmission risk between main partners in part because it accelerates the progression to CAI and interferes with communication processes central to harm reduction strategies utilized by gay men in relationships. Implications for prevention strategies and couples interventions, such as couples HIV counseling and testing, that facilitate communication skill-building, are discussed.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York (CUNY), 365 5th Ave, New York, NY, 10016, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W 36th St. 9th Floor, New York, NY, 10018, USA
| | - Andrew N Tuck
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W 36th St. 9th Floor, New York, NY, 10018, USA
| | - Brett M Millar
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York (CUNY), 365 5th Ave, New York, NY, 10016, USA
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W 36th St. 9th Floor, New York, NY, 10018, USA
| | - Jeffrey T Parsons
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York (CUNY), 365 5th Ave, New York, NY, 10016, USA.
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 W 36th St. 9th Floor, New York, NY, 10018, USA.
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Beougher SC, Bircher AE, Chakravarty D, Darbes LA, Gómez Mandic C, Neilands TB, Garcia CC, Hoff CC. Motivations to test for HIV among partners in concordant HIV-negative and HIV-discordant gay male couples. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:499-508. [PMID: 25550145 PMCID: PMC4323847 DOI: 10.1007/s10508-014-0403-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/08/2014] [Accepted: 09/13/2014] [Indexed: 05/23/2023]
Abstract
Previous studies of HIV testing among gay men describe the motivations, facilitators and barriers, behaviors, and demographic characteristics of individuals who test. What little research focuses on HIV testing among gay men in relationships shows that they do not test regularly or, in some cases, at all-their motivations to test have not been investigated. With so little data on HIV testing for this population, and the continued privileging of individually focused approaches, gay men in relationships fall into a blind spot of research and prevention efforts. This study examined motivations to test for HIV using qualitative data from both partners in 20 gay male couples. Analysis revealed that the partners' motivations were either event-related (e.g., participants testing at the beginning of their relationship or HIV-negative participants in an HIV-discordant relationship testing after risky episode with their discordant primary partner) or partner-related (e.g., participants testing in response to a request or suggestion to test from their primary partner or participants testing out of concern for their primary partner's health and well-being). These data provide insight into relationship-oriented motivations to test for HIV for gay men in relationships and, in doing so, evidence their commitment to their primary partner and relationship. These motivations can be leveraged to increase HIV testing among gay men in relationships, a population that tests less often than single gay men, yet, until recently, has been underserved by prevention efforts.
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Affiliation(s)
- Sean C. Beougher
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Anja E. Bircher
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Deepalika Chakravarty
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, USA
| | - Lynae A. Darbes
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, USA
| | - Carmen Gómez Mandic
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, USA
| | - Carla C. Garcia
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
| | - Colleen C. Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, USA
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