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Lee JA, Schafer MH. Social network characteristics and HIV testing among older adults in South Africa. AGEING & SOCIETY 2023; 43:499-515. [PMID: 36875285 PMCID: PMC9983780 DOI: 10.1017/s0144686x21000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Drawing from theory and research on the role of social networks in promoting or undermining preventative public health measures, this article considers how structural, compositional and functional aspects of older adults' close social networks are associated with HIV testing in the context of rural South Africa. Analyses use data from the population-based Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) - a sample of rural adults age 40+ (N = 4,660). Results from multiple logistic regression show older South African adults with larger, more heavily non-kin and more literate networks were most likely to report testing for HIV. People whose network members provided frequent information were also most likely to be tested, though interaction effects indicate that this pattern is primarily found among those with highly literate networks. Taken together, the findings reinforce a key insight from social capital perspectives: network resourcefulness - literacy in particular - is crucial for promoting preventative health practice. The synergy between network literacy and informational support reveals the complex interplay between network characteristics in shaping health-seeking behaviour. Continued research is needed on the connection between networks and HIV testing among sub-Saharan older adults, as this population is not currently well served by many public health efforts in the region.
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Affiliation(s)
- Jin A. Lee
- Department of Sociology, University of Toronto, Toronto, Canada
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Conroy AA, McKenna S, Ruark A, Neilands TB, Spinelli M, Gandhi M. Relationship Dynamics are Associated with Self-Reported Adherence but not an Objective Adherence Measure in Malawi. AIDS Behav 2022; 26:3551-3562. [PMID: 35507094 DOI: 10.1007/s10461-022-03636-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
Couple relationships can be leveraged to improve adherence to antiretroviral therapy (ART), but few studies have identified relationship factors to target in interventions in sub-Saharan Africa. We conducted a cross-sectional study with 211 couples in southern Malawi with at least one partner on ART to test for associations between ART adherence and relationship dynamics (intimacy, trust, relationship satisfaction, unity, commitment, and partner support). We measured ART adherence through subjective measures (patient and partner reports) and an objective measure (ART drug levels in hair) and hypothesized that more positive relationship dynamics (e.g., higher intimacy) would be associated with better adherence. Multi-level logistic and linear regression models were used to evaluate study hypotheses, controlling for the clustering of individuals within couples. High levels of adherence were found by all three measures. Unity, satisfaction, and partner support were associated with higher patient and partner reports of adherence, and additional relationship dynamics (intimacy, trust) were associated with higher partner reported adherence. No associations were found between relationship dynamics and drug levels in hair, although drug levels were high overall. Future studies should perform longitudinal assessments of relationship dynamics and objective metrics of adherence, and examine these associations in populations with lower adherence levels such as young women or individuals starting ART.
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Affiliation(s)
- Amy A Conroy
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA.
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | | | - Allison Ruark
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Spinelli
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Tariq S, Kasadha B. HIV and women’s health: Where are we now? WOMEN'S HEALTH 2022; 18:17455065221076341. [PMID: 35107041 PMCID: PMC8814966 DOI: 10.1177/17455065221076341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Shema Tariq
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
- Mortimer Market Centre, CNWL NHS Foundation Trust, London, UK
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Morton K, Mhlakwaphalwa T, Msimango L, van Heerden A, Ngubane T, Joseph P, Ngcobo N, Feng Z, Hosegood V, van Rooyen H, McGrath N. Optimising a couples-focused intervention to increase couples' HIV testing and counselling using the person-based approach: a qualitative study in Kwa-Zulu Natal, South Africa. BMJ Open 2021; 11:e047408. [PMID: 34853099 PMCID: PMC8638156 DOI: 10.1136/bmjopen-2020-047408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This qualitative study explored how to optimise a couples-focused intervention to promote couples HIV testing and counselling (CHTC). SETTING Community setting in Kwa-Zulu Natal, South Africa. PARTICIPANTS Qualitative interviews were conducted with 20 couples who had participated in a couples-focused intervention and five staff members delivering the intervention. Partners were interviewed individually by researchers of the same gender. INTERVENTION A couples-focused intervention comprised of two group sessions and four couples counselling sessions was previously shown to significantly increase uptake to CHTC in Kwa-Zulu Natal, South Africa. However, more than half of couples participating in the intervention still chose not to test together during follow-up. ANALYSIS The transcripts were analysed using the table of changes from the person-based approach. Proposed optimisations were discussed with a community group to ensure the intervention was as persuasive and acceptable as possible. RESULTS Many couples found it challenging to discuss CHTC with their partner due to an implied lack of trust. Optimisations to the intervention were identified to increase readiness to discuss CHTC, including education about serodiscordance, discussions about CHTC by peer mentors and open discussion of personal barriers to CHTC during couples' counselling sessions. Additional training for staff in open questioning techniques could help them feel more comfortable to explore couples' perceived barriers to CHTC, rather than advising couples to test. A logic model was developed to show anticipated mechanisms through which the optimised intervention would increase uptake to CHTC, including increasing knowledge, increasing positive outcome beliefs and managing negative emotions. CONCLUSIONS In-depth qualitative research informed optimisations to a couples-focused intervention for further evaluation in South Africa to encourage uptake to CHTC. Suggestions are made for optimal methods to gain open feedback on intervention experiences where participants may be reluctant to share negative views.
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Affiliation(s)
| | - Tembeka Mhlakwaphalwa
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Lindani Msimango
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Alastair van Heerden
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
- School of Clinical Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Thulani Ngubane
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Philip Joseph
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Nathi Ngcobo
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Z Feng
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal, South Africa
- University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Nuala McGrath
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Social Statistics & Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
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Mojola SA, Angotti N, Schatz E, Houle B. "A NOWADAYS DISEASE": HIV/AIDS AND SOCIAL CHANGE IN A RURAL SOUTH AFRICAN COMMUNITY. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2021; 127:950-1000. [PMID: 35967824 PMCID: PMC9365075 DOI: 10.1086/718234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Why do some people adapt successfully to change while others do not? We examine this question in the context of a severe HIV/AIDS epidemic in South Africa, where adapting (or not) to social change has borne life and death consequences. Applying an age-period-cohort lens to the analysis of qualitative life history interviews among middle-aged and older adults, we consider the role of the life course and gendered sexuality in informing Africans' strategies of action, or inaction, and in differentially driving and stalling change in each cohort in response to the HIV/AIDS epidemic. Our study illuminates the unique challenges of adapting to social change that result from dynamic interactions among aging, prevailing social structures, and a cohort's socio-historical orientation to a new period.
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Affiliation(s)
- Sanyu A Mojola
- Princeton University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- American University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Enid Schatz
- University of Missouri Columbia and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Houle
- The Australian National University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Persson A, Kelly-Hanku A, Mek A, Mitchell E, Nake Trumb R, Worth H, Bell S. Making Sense of Serodiscordance: Pathways and Aftermaths of HIV Testing among Couples with Mixed HIV Status in Papua New Guinea. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2021. [DOI: 10.1080/14442213.2021.1942184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. The Symbolic Meaning of HIV: Understanding Lecturers' Ambivalence over Teaching HIV to Dietetic Students. J Int Assoc Provid AIDS Care 2021; 19:2325958220939755. [PMID: 32662324 PMCID: PMC7361481 DOI: 10.1177/2325958220939755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Responding to the increasing reports of health students and professionals demonstrating stigmatized attitudes toward people living with HIV (PLHIV), this article examined the learning process that takes place during their academic training. Using symbolic interactionism as a theoretical framework, we studied the way lecturers in dietetic schools in Indonesia make meaning of their understanding and experience of HIV in relation to their teaching conduct. We found that the current curriculum does not provide adequate opportunities for students to learn and interact with PLHIV. Participants described HIV discussion is mainly limited to the clinical aspects and essential treatment as they were uncomfortable discussing HIV with the students. The ostensible symbolic meaning of HIV among dietetic lecturers in Indonesia was compounded with limitations and restrictions affecting their teaching practices and attitudes to PLHIV. Future intervention is required to help lecturers recognize their degree of awareness and personal values about HIV.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
| | - Sandra Butin Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, KS, USA
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Fonner VA, Ntogwisangu J, Hamidu I, Joseph J, Fields J, Evans E, Kilewo J, Bailey C, Goldsamt L, Fisher CB, O'Reilly KR, Ruta T, Mbwambo J, Sweat MD. "We are in this together:" dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP. BMC Public Health 2021; 21:720. [PMID: 33853559 PMCID: PMC8045366 DOI: 10.1186/s12889-021-10707-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. METHODS This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples' HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples' decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. RESULTS Three major themes were identified: (1) HIV as "two people's secret" and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. CONCLUSIONS The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.
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Affiliation(s)
- Virginia A Fonner
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA.
| | - Jacob Ntogwisangu
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Isihaka Hamidu
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juliet Joseph
- Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Joshua Fields
- Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Evans Evans
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jordan Kilewo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claire Bailey
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA
| | - Lloyd Goldsamt
- New York University, Rory Meyers College of Nursing, New York, NY, USA
| | - Celia B Fisher
- Fordham University, Department of Psychology and Center for Ethics Education, Bronx, NY, USA
| | - Kevin R O'Reilly
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA
| | - Theonest Ruta
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael D Sweat
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA
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Starks TJ, I Lovejoy T, Sauermilch D, Robles G, Stratton MJ, Cain D, Naar S, Ewing SWF. Developmental Barriers to Couples' HIV Testing and Counseling Among Adolescent Sexual Minority Males: A Dyadic Socio-ecological Perspective. AIDS Behav 2021; 25:787-797. [PMID: 32944842 DOI: 10.1007/s10461-020-03044-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
Couples HIV Testing and Counseling (CHTC) is now a standard of care for partnered sexual minority men. While adolescent sexual minority men (ASMM; ages 15-19) face disproportionate HIV risk, the emergent nature of relationships and communication skills may present challenges to accessing and engaging in CHTC. This study utilized qualitative data from 28 ASMM recruited in 4 urban centers in the USA during the formative stage of Adolescent Trials Network study ATN-156. Participants were cis-male, HIV-negative, and in a relationship with a similarly-aged cis-male partner. Thematic analysis indicated low and high levels of commitment were barriers to CHTC. Concerns about caregiver attitudes towards HIV testing were salient. Adolescents' perception of structural barriers highlighted reliance on caregiver resources, which limited access to sexual health services. Prevention programming must address structural barriers to access encountered by adolescents. ASMM in relationships may benefit from programming that includes options for individual and dyadic participation.
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Affiliation(s)
- Tyrel J Starks
- Hunter College of the City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, Graduate Center of the City University of New York, New York, NY, USA.
| | - Travis I Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | | | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Mark J Stratton
- Hunter College of the City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Demetria Cain
- Hunter College of the City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Sylvie Naar
- Florida State University, Tallahassee, FL, USA
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Thiabaud A, Triulzi I, Orel E, Tal K, Keiser O. Social, Behavioral, and Cultural factors of HIV in Malawi: Semi-Automated Systematic Review. J Med Internet Res 2020; 22:e18747. [PMID: 32795992 PMCID: PMC7455873 DOI: 10.2196/18747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Demographic and sociobehavioral factors are strong drivers of HIV infection rates in sub-Saharan Africa. These factors are often studied in qualitative research but ignored in quantitative analyses. However, they provide in-depth insight into the local behavior and may help to improve HIV prevention. OBJECTIVE To obtain a comprehensive overview of the sociobehavioral factors influencing HIV prevalence and incidence in Malawi, we systematically reviewed the literature using a newly programmed tool for automatizing part of the systematic review process. METHODS Due to the choice of broad search terms ("HIV AND Malawi"), our preliminary search revealed many thousands of articles. We, therefore, developed a Python tool to automatically extract, process, and categorize open-access articles published from January 1, 1987 to October 1, 2019 in the PubMed, PubMed Central, JSTOR, Paperity, and arXiV databases. We then used a topic modelling algorithm to classify and identify publications of interest. RESULTS Our tool extracted 22,709 unique articles; 16,942 could be further processed. After topic modelling, 519 of these were clustered into relevant topics, of which 20 were kept after manual screening. We retrieved 7 more publications after examining the references so that 27 publications were finally included in the review. Reducing the 16,942 articles to 519 potentially relevant articles using the software took 5 days. Several factors contributing to the risk of HIV infection were identified, including religion, gender and relationship dynamics, beliefs, and sociobehavioral attitudes. CONCLUSIONS Our software does not replace traditional systematic reviews, but it returns useful results to broad queries of open-access literature in under a week, without a priori knowledge. This produces a "seed dataset" of relevance that could be further developed. It identified known factors and factors that may be specific to Malawi. In the future, we aim to expand the tool by adding more social science databases and applying it to other sub-Saharan African countries.
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Affiliation(s)
- Amaury Thiabaud
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
| | - Isotta Triulzi
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Erol Orel
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
| | - Kali Tal
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institut de Santé Globale, Université de Genève, Genève, Switzerland
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Conroy AA, Ruark A, McKenna SA, Tan JY, Darbes LA, Hahn JA, Mkandawire J. The Unaddressed Needs of Alcohol-Using Couples on Antiretroviral Therapy in Malawi: Formative Research on Multilevel Interventions. AIDS Behav 2020; 24:1599-1611. [PMID: 31456201 PMCID: PMC7044068 DOI: 10.1007/s10461-019-02653-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Alcohol use among HIV-positive individuals in sub-Saharan Africa directly impacts adherence to antiretroviral therapy and HIV outcomes. Few studies have examined approaches to reduce alcohol use among HIV-affected couples, despite evidence that alcohol use is a couple-level concern. We conducted a qualitative study with 23 alcohol-using couples to identify multilevel barriers and facilitators of alcohol use, and potential intervention options with couples. Data were analyzed at individual and dyadic levels using framework analysis. All couples were married and had at least one partner on ART. Men were the primary alcohol drinkers with few women reporting alcohol use. Most women tried to persuade their partners to reduce their alcohol intake and when unsuccessful, enlisted help from relatives and HIV care providers. Effective couple negotiation around men's alcohol use was constrained by negative peer influence and men's desire for friendship to cope with life stressors. Women were primarily concerned about the expense of alcohol and described how alcohol prevented the family from meeting basic needs and investing in the future. Alcohol use was described as a major barrier to ART adherence, but was also viewed as the cause of couple and family violence, extramarital partnerships, food insecurity, and poverty. We conclude that multilevel interventions based on couples' needs and preferences are urgently needed. Couple-based intervention approaches could include provider-led alcohol counseling with couples, alcohol reduction support groups for couples, couples' counseling to bolster couple communication and problem-solving around alcohol, and economic-strengthening interventions for couples.
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Affiliation(s)
- Amy A Conroy
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Allison Ruark
- Department of Medicine, Brown University, Providence, RI, USA
| | | | - Judy Y Tan
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Conroy AA, Ruark A, Tan JY. Re-conceptualising gender and power relations for sexual and reproductive health: contrasting narratives of tradition, unity, and rights. CULTURE, HEALTH & SEXUALITY 2020; 22:48-64. [PMID: 31633456 PMCID: PMC7170748 DOI: 10.1080/13691058.2019.1666428] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
Sexual and reproductive health interventions in sub-Saharan Africa will be most effective if grounded in emic (insider) perspectives of gender and power in intimate relationships. We conducted eight focus group discussions with 62 young adults in Malawi to explore conceptions of gender and power relations and areas of tension between different perspectives. We framed our enquiry according to the three social structures of the Theory of Gender and Power: the sexual division of labour, the sexual division of power, and social norms and affective attachments around femininity and masculinity. Young adults drew on interrelated and competing narratives to describe the state of gender relations, which we named tradition, unity, and rights. Participants used tradition narratives most frequently to describe patriarchal gender roles, norms and ideals. Some participants challenged this predominant discourse using unity and rights narratives. Unity narratives illustrated how love and couple reciprocity were essential sources of 'power with' as opposed to 'power over'. Rights narratives were more contested than other narratives, with some participants acknowledging that women's rights were important to the family's survival and others viewing women's rights as problematic for gender relations. Gender-responsive interventions should consider the tensions and intersections between multiple narratives on gender and power, including unity as a gender-equitable form of power.
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Affiliation(s)
- Amy A. Conroy
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Allison Ruark
- Department of Medicine, Brown University, Providence, RI, USA
| | - Judy Y. Tan
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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Ruark A, Green EC, Nunn A, Kennedy C, Adams A, Dlamini-Simelane T, Surkan P. Navigating intimate sexual partnerships in an era of HIV: dimensions of couple relationship quality and satisfaction among adults in Eswatini and linkages to HIV risk. SAHARA J 2019; 16:10-24. [PMID: 30987536 PMCID: PMC6484492 DOI: 10.1080/17290376.2019.1604254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Couple relationship functioning impacts individual health and well-being, including HIV risk, but scant research has focused on emic understandings of relationship quality in African populations. We explored relationship quality and satisfaction in Eswatini (formerly Swaziland) using data from 148 in-depth interviews (117 life-course interviews with 28 adults and 31 interviews with 29 marriage counselors and their clients) and 4 focus group discussions. Love, respect, honesty, trust, communication, sexual satisfaction, and sexual faithfulness emerged as the most salient characteristics of good relationships, with both men and women emphasising love and respect as being most important. Participants desired relationships characterised by such qualities but reported relationship threats in the areas of trust, honesty, and sexual faithfulness. The dimensions of relationship quality identified by this study are consistent with research from other contexts, suggesting cross-cultural similarities in conceptions of a good relationship. Some relationship constructs, particularly respect, may be more salient in a Swazi context.
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Affiliation(s)
- Allison Ruark
- Department of Medicine, Brown University, Providence, RI, USA
| | - Edward C. Green
- Anthropology, George Washington University, Washington, DC, USA
| | - Amy Nunn
- Brown University School of Public Health, Providence, RI, USA
- Rhode Island Public Health Institute, Providence, RI, USA
| | - Caitlin Kennedy
- Johns Hopkins University Bloomberg School of Public Health, International Health, Baltimore, MD, USA
| | - Alfred Adams
- University of Amsterdam, Amsterdam Institute for Social Science Research, Amsterdam, Netherlands
| | | | - Pamela Surkan
- Johns Hopkins University Bloomberg School of Public Health, International Health, Baltimore, MD, USA
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Harrington BJ, Turner AN, Chemey E, Esber A, Kwiek J, Norris AH. Who Has Yet to Test? A Risk Score for Predicting Never Having Tested for Human Immunodeficiency Virus Among Women and Men in Rural Malawi. Sex Transm Dis 2019; 46:416-421. [PMID: 31095104 PMCID: PMC6589335 DOI: 10.1097/olq.0000000000000989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) status awareness is important for preventing onward HIV transmission, and is one of the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 goals. Efforts to scale up HIV testing have generally been successful, but identifying at-risk individuals who have never tested for HIV-a population necessary to reach improved HIV status awareness-remains challenging. METHODS Using data from a community-based cohort of people living in rural central Malawi, we identified demographic, socioeconomic, and sexual health correlates of never having tested for HIV. Correlates were assigned values from the logistic regression model to develop a risk score that identified who had never tested for HIV. RESULTS Among 1310 ever sexually active participants, 7% of the women and 13% of the men had never tested for HIV. Of those who had tested for HIV, about 30% had tested more than 12 months ago. For women, younger age and poorer sexual health knowledge were correlated with never having tested for HIV, and the c-statistic for the risk score was 0.83. For men, their partner having not tested for HIV, low socioeconomic status, and poor sexual health knowledge were correlated with never testing for HIV (c-statistic, 0.81). Among those with a score of 3 or greater, the sensitivity and specificity for never having tested for HIV were 81% and 77% for women, and 82% and 66% for men, respectively. CONCLUSIONS About 10% of participants had never tested for HIV. This risk score could help health professionals to identify never testers to increase HIV status awareness in line with 90-90-90 goals.
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Affiliation(s)
- Bryna J. Harrington
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abigail Norris Turner
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Child Legacy International, Umoyo wa Thanzi Research Program, Lilongwe, Malawi
| | - Elly Chemey
- Child Legacy International, Umoyo wa Thanzi Research Program, Lilongwe, Malawi
| | - Allahna Esber
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Jesse Kwiek
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Microbiology, The Ohio State University, Columbus, Ohio, USA
| | - Alison H. Norris
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Child Legacy International, Umoyo wa Thanzi Research Program, Lilongwe, Malawi
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Diamond-Smith N, Conroy AA, Tsai AC, Nekkanti M, Weiser SD. Food insecurity and intimate partner violence among married women in Nepal. J Glob Health 2019; 9:010412. [PMID: 30774941 PMCID: PMC6359930 DOI: 10.7189/jogh.09.010412] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Intimate Partner Violence (IPV) is an important public health concern globally, including in Nepal. Food insecurity (being without reliable access to a sufficient quantity of affordable, nutritious food) has been associated with IPV, but no known studies have explored this relationship in South Asia, or Nepal specifically. Women’s level of empowerment is an important factor to consider when understanding the relationship between food insecurity and IPV. Methods Using data from the 2011 Nepal Demographic and Health Survey, we explore the relationship between different levels of food insecurity (none, mild, moderate, severe) and three types of IPV: physical, sexual and emotional. In a second set of models we adjust for indicators of women’s empowerment. We use multi-variable logistic regression to test for an association between these factors, adjusting for individual and household level demographic variables. Findings About half of married women in our sample experience food insecurity and approximately 10% of women experienced each of the three different types of IPV in the past 12 months: emotional, sexual and physical. Food insecurity is significantly associated with increased odds of experiencing emotional (odds ratio OR = 1.75 95% confidence interval CI = 1.06-2.77 for severe food insecurity) or physical (OR = 2.48, 95% CI = 1.52-4.04 for severe food insecurity) IPV, but not sexual IPV, after adjusting for individual and household level demographic variables. After adjusting for empowerment related factors, this relationship still holds, although it is somewhat attenuated. Women’s level of household decision-making power is significantly associated with higher odds of emotional, sexual and physical IPV, and whether she lives with her in-laws is protective against emotional IPV. Conclusions Among married women in Nepal, being food insecure is associated with higher odds of some types of IPV, specifically emotional and physical IPV. Accounting for women’s level of empowerment explains some of the relationship between food insecurity and IPV. It is essential that interventions to prevent IPV address household stressors such as food insecurity among married, Nepalese women, perhaps through cross-sectoral approaches. Such structural interventions are likely to reduce IPV for married women across South Asia who live in a similar levels of gender discrimination and food insecurity.
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Affiliation(s)
| | - Amy A Conroy
- University of California, San Francisco, California, USA
| | | | - Manali Nekkanti
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sheri D Weiser
- University of California, San Francisco, California, USA
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Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy. Soc Sci Med 2018; 214:110-117. [PMID: 30172140 DOI: 10.1016/j.socscimed.2018.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/04/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
RATIONALE Despite the importance of primary partners for health, little is known about factors that constrain the ability of couples to work collaboratively towards HIV care and treatment (dyadic coordination). This study examined the interplay of marital infidelity, food insecurity, and couple instability on dyadic coordination and adherence to antiretroviral therapy (ART) in Malawi. METHODS In 2016, we conducted 80 in-depth interviews with 25 couples with at least one partner on ART. Couples were recruited at two HIV clinics in the Zomba district when attending clinic appointments. Participants were asked about their relationship history, relationship dynamics (love, trust, conflict), experiences with HIV care and treatment, and how partners were involved. Using an innovative analysis approach, we analyzed the data at the couple-level by examining patterns within and between couples. RESULTS Three patterns emerged. For some couples, ART led to positive changes in their relationships after men terminated their extramarital partnerships in exchange for love and support. For other couples with power imbalances and ongoing conflict, men's infidelity continued after ART and negatively affected dyadic coordination. Finally, some couples agreed to remain "faithful", but could not overcome stressors related to food insecurity, which directly impacted their adherence. CONCLUSIONS Couples-based interventions targeting ART adherence should improve relationship quality, while also addressing interpersonal stressors such as marital infidelity and food insecurity. Multi-level interventions that address both dyadic and structural levels may be necessary for couples with severe food insecurity.
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Sikstrom L. "There was no love there": Intergenerational HIV disclosure, and late presentation for antiretroviral therapy in Northern Malawi. Soc Sci Med 2018; 211:175-182. [PMID: 29958129 DOI: 10.1016/j.socscimed.2018.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/16/2022]
Abstract
Despite access to antiretroviral testing and treatment, high rates of mortality among HIV infected infants and young children persist, often because they are diagnosed too late to benefit from treatment. Most research assumes that treatment delays are a proxy indicator for ongoing HIV-related stigma. My argument is different. Instead I argue that secrecy and truth-telling are socially produced; that is I consider how gendered and intergenerational dynamics regulate how and to whom secrets should be shared. In this article I draw on two years of ethnographic fieldwork (2008-2010) in Northern Malawi with 35 HIV positive children, their primary caregivers, as well as multiple interviews with their extended therapy networks [N = 96] and community stakeholders [N = 72] to examine how social hierarchies influenced the timing of an HIV diagnosis for infected infants. My findings indicate that it is neither necessary nor strategically advantageous for some women to disclose their HIV status to their husbands. Rather, grandparents play pivotal roles at facilitating HIV disclosure between intimate partners, which in turn leads to timely HIV diagnoses for infected children. This article contributes to a body of literature that questions the usefulness of the concept of "stigma" for understanding late presentation for ART among infants and children.
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Affiliation(s)
- Laura Sikstrom
- Department of Sociology, University of Alberta, 5-25 HM Tory Building, Edmonton, Alberta T6G 2H4, Canada.
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Ruark A, Chase R, Hembling J, Davis VR, Perrin PC, Brewster-Lee D. Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi. PLoS One 2017; 12:e0188561. [PMID: 29190769 PMCID: PMC5708731 DOI: 10.1371/journal.pone.0188561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/09/2017] [Indexed: 11/18/2022] Open
Abstract
Available data suggest that individual and family well-being are linked to the quality of women’s and men’s couple relationships, but few tools exist to assess couple relationship functioning in low- and middle-income countries. In response to this gap, Catholic Relief Services has developed a Couple Functionality Assessment Tool (CFAT) to capture valid and reliable data on various domains of relationship quality. This tool is designed to be used by interventions which aim to improve couple and family well-being as a means of measuring the effectiveness of these interventions, particularly related to couple relationship quality. We carried out a validation study of the CFAT among 401 married and cohabiting adults (203 women and 198 men) in rural Chikhwawa District, Malawi. Using psychometric scales, the CFAT addressed six domains of couple relationship quality (intimacy, partner support, sexual satisfaction, gender roles, decision-making, and communication and conflict management), and included questions on intimate partner violence. We used exploratory factor analysis to assess scale performance of each domain and produce a shortened Relationship Quality Index (RQI) composed of items from five relationship quality domains. This article reports the performance of the RQI. Internal reliability and validity of the RQI were found to be good. Regression analyses examined the relationship of the RQI to outcomes important to health and development: intra-household cooperation, positive health behaviors, intimate partner violence, and gender-equitable norms. We found many significant correlations between RQI scores and these couple- and family-level development issues. There is a need to further validate the tool with use in other populations as well as to continue to explore whether the observed linkages between couple functionality and development outcomes are causal relationships.
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Affiliation(s)
- Allison Ruark
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Rachel Chase
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
| | - John Hembling
- Catholic Relief Services, Baltimore, Maryland, United States of America
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Conroy A, Leddy A, Johnson M, Ngubane T, van Rooyen H, Darbes L. 'I told her this is your life': relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples. CULTURE, HEALTH & SEXUALITY 2017; 19:1239-1253. [PMID: 28398134 PMCID: PMC5626574 DOI: 10.1080/13691058.2017.1309460] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite the important role of social relationships for health and wellbeing, little is known about how primary partners affect adherence to HIV care and treatment. We qualitatively explored how relationship dynamics and partner support influence adherence among couples from KwaZulu-Natal, South Africa. Twenty-four heterosexual couples with at least one HIV-positive partner completed semi-structured interviews on topics including relationship dynamics (intimacy or emotional closeness, communication, violence), experiences with HIV care and treatment and HIV-related social support. The majority of couples were seroconcordant HIV-positive (92%) and both on antiretroviral therapy (ART) (63%). Participants described how primary partners both interfered with and supported adherence. Negative forms of influence included relationship conflict, which resulted in forgetfulness to take pills, and men's attempt to control use of ART. However, participants were more likely to highlight positive forms of influence on adherence, which included social support (instrumental, informational and emotional), intimacy and commitment. The findings also suggest a reciprocal relationship between ART and relationships such that couple ART use may enhance relationship quality. Primary partners are important pillars of support for ART adherence, especially in contexts of high unemployment and poverty. Future interventions that encourage and leverage these supportive relationships could improve ART adherence among heterosexual couples in similar settings.
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Affiliation(s)
- Amy Conroy
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Anna Leddy
- Department of Health, Behavior and Society, John Hopkins University, Baltimore, MD, USA
| | - Mallory Johnson
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Thulani Ngubane
- Human and Social Development Program, Human Sciences Research Council, Msunduzi, South Africa
| | - Heidi van Rooyen
- Human and Social Development, Human Sciences Research Council, Overport, South Africa
| | - Lynae Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, MI, USA
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Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi. J Acquir Immune Defic Syndr 2017; 74:517-522. [PMID: 28045712 PMCID: PMC5340586 DOI: 10.1097/qai.0000000000001273] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: Malawi has embarked on a “test-and-treat” approach to prevent mother-to-child transmission (PMTCT) of HIV, known as “Option B+,” offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional qualitative study was conducted to explore early experiences surrounding “Option B+” for patients and health care workers (HCWs) in Malawi. Methods: Study participants were purposively selected across 6 health facilities in 3 regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in “Option B+” (n = 24), and focus group discussions were conducted with HCWs providing Option B+ services (n = 6 groups of 8 HCWs). Data were analyzed using a qualitative thematic coding framework. Results: Patients and HCWs identified the lack of male involvement as a barrier to retention in care and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to “digest” a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss to follow-up of women initiated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies. Conclusions: As “Option B+” continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time, and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer support and confidentiality.
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Matovu JKB, Todd J, Wanyenze RK, Kairania R, Serwadda D, Wabwire-Mangen F. Evaluation of a demand-creation intervention for couples' HIV testing services among married or cohabiting individuals in Rakai, Uganda: a cluster-randomized intervention trial. BMC Infect Dis 2016; 16:379. [PMID: 27502776 PMCID: PMC4977664 DOI: 10.1186/s12879-016-1720-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Uptake of couples' HIV counseling and testing (couples' HCT) services remains largely low in most settings. We report the effect of a demand-creation intervention trial on couples' HCT uptake among married or cohabiting individuals who had never received couples' HCT. METHODS This was a cluster-randomized intervention trial implemented in three study regions with differing HIV prevalence levels (range: 9-43 %) in Rakai district, southwestern Uganda, between February and September 2014. We randomly assigned six clusters (1:1) to receive the intervention or serve as the comparison arm using computer-generated random numbers. In the intervention clusters, individuals attended small group, couple and male-focused interactive sessions, reinforced with testimonies from 'expert couples', and received invitation coupons to test together with their partners at designated health facilities. In the comparison clusters, participants attended general adult health education sessions but received no invitation coupons. The primary outcome was couples' HCT uptake, measured 12 months post-baseline. Baseline data were collected between November 2013 and February 2014 while follow-up data were collected between March and April 2015. We conducted intention-to-treat analysis using a mixed effects Poisson regression model to assess for differences in couples' HCT uptake between the intervention and comparison clusters. Data analysis was conducted using STATA statistical software, version 14.1. RESULTS Of 2135 married or cohabiting individuals interviewed at baseline, 42 % (n = 846) had ever received couples' HCT. Of those who had never received couples' HCT (n = 1,174), 697 were interviewed in the intervention clusters while 477 were interviewed in the comparison clusters. 73.6 % (n = 513) of those interviewed in the intervention and 82.6 % (n = 394) of those interviewed in the comparison cluster were interviewed at follow-up. Of those interviewed, 72.3 % (n = 371) in the intervention and 65.2 % (n = 257) in the comparison clusters received HCT. Couples' HCT uptake was higher in the intervention than in the comparison clusters (20.3 % versus 13.7 %; adjusted prevalence ratio (aPR) = 1.43, 95 % CI: 1.02, 2.01, P = 0.04). CONCLUSION Our findings show that a small group, couple and male-focused, demand-creation intervention reinforced with testimonies from 'expert couples', improved uptake of couples' HCT in this rural setting. TRIAL REGISTRATION ClinicalTrials.gov, NCT02492061 . Date of registration: June 14, 2015.
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Affiliation(s)
- Joseph K B Matovu
- Department of Community Health and Behavioral Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Robert Kairania
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - David Serwadda
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Fred Wabwire-Mangen
- Regional Center for Quality of Health Care, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Fedor TM, Kohler HP, Behrman JR. The Impact of Married Individuals Learning HIV Status in Malawi: Divorce, Number of Sexual Partners, and Condom Use With Spouses. Demography 2015; 52:259-80. [PMID: 25582891 DOI: 10.1007/s13524-014-0364-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This article assesses how married individuals' knowledge of HIV status gained through HIV testing and counseling (HTC) affects divorce, the number of sexual partners, and the use of condoms within marriage. This study improves upon previous studies on this topic because the randomized incentives affecting the propensity to be tested for HIV permit control for selective testing. Instrumental variable probit and linear models are estimated, using a randomized experiment administered as part of the Malawi Longitudinal Study of Families and Health (MLSFH). The results indicate that knowledge of HIV status (1) does not affect chances of divorce for either HIV-negative or HIV-positive respondents; (2) reduces the number of reported sexual partners among HIV-positive respondents; and (3) increases reported condom use with spouses for both HIV-negative and HIV-positive respondents. These results imply that individuals actively respond to information about their HIV status that they learn during HTC, invoking protective behavior against future risk of HIV/AIDS for themselves and their actual and potential sexual partners. Some limitations of this study are a small sample size for those who are HIV-positive and dependence on self-reported sexual behaviors.
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Affiliation(s)
- Theresa M Fedor
- University of Pennsylvania, 3718 Locust Walk, 266 McNeil Building, Philadelphia, PA, 19104-6298, USA,
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Frye M, Trinitapoli J. Ideals as Anchors for Relationship Experiences. AMERICAN SOCIOLOGICAL REVIEW 2015; 80:496-525. [PMID: 27110031 PMCID: PMC4838189 DOI: 10.1177/0003122415581333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Research on young-adult sexuality in sub-Saharan Africa typically conceptualizes sex as an individual-level risk behavior. We introduce a new approach that connects the conditions surrounding the initiation of sex with subsequent relationship well-being, examines relationships as sequences of interdependent events, and indexes relationship experiences to individually held ideals. New card-sort data from southern Malawi capture young women's relationship experiences and their ideals in a sequential framework. Using optimal matching, we measure the distance between ideal and experienced relationship sequences to (1) assess the associations between ideological congruence and perceived relationship well-being, (2) compare this ideal-based approach to other experience-based alternatives, and (3) identify individual- and couple-level correlates of congruence between ideals and experiences in the romantic realm. We show that congruence between ideals and experiences conveys relationship well-being along four dimensions: expressions of love and support, robust communication habits, perceived biological safety, and perceived relationship stability. We further show that congruence is patterned by socioeconomic status and supported by shared ideals within romantic dyads. We argue that conceiving of ideals as anchors for how sexual experiences are manifest advances current understandings of romantic relationships, and we suggest that this approach has applications for other domains of life.
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