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Abdelkhalek F, Joseph P, DeRose L, Olamijuwon E, Dladla P, Ngubane T, Hosegood V, van Rooyen H, van Heerden A, McGrath N. Two-way associations between relationship quality and uptake of couples health screening including HIV testing and counselling together: quantitative analysis of a couples cohort in rural South Africa. AIDS Care 2024; 36:187-200. [PMID: 38381809 DOI: 10.1080/09540121.2024.2308741] [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] [Received: 08/14/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024]
Abstract
In the context of a couples cohort established to evaluate an optimised couples-focused behavioural intervention in rural South Africa, we examined: (1) Is couples' relationship quality (RQ) associated with couples HIV testing and counselling (CHTC) uptake? (2) Does CHTC uptake or the intervention components uptake improve subsequent RQ? Enrolled couples, (n = 218), previously naïve to couples HIV testing, were invited to two group sessions and offered four couples counselling sessions (CS1-CS4), as part of the intervention and administered a questionnaire individually at baseline, four weeks, and four months, which included item-scales to measure RQ: satisfaction, intimacy, dyadic trust, conflict, and mutual constructive communication. Logistic models indicated that no baseline RQ measures were significantly associated with CHTC uptake. Linear regression models showed that CHTC uptake before four weeks assessment significantly improved couples' satisfaction and trust at four weeks, and intimacy at four months. Attending at least one CS was associated with increased satisfaction, intimacy, and decreased conflict within couples at four weeks; the improvement in intimacy was sustained at four months. Consistent with the theoretical interdependence model, our findings suggest that CHTC and CS seemed to strengthen aspects of relationship quality, possibly leading to further collaboration in managing lifestyle changes and treatment adherence.
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Affiliation(s)
- Fatma Abdelkhalek
- CHERISH programme, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Faculty of Commerce, Assiut University, Assiut, Egypt
| | - Phillip Joseph
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
| | | | - Emmanuel Olamijuwon
- CHERISH programme, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- School of Geography and Sustainable Development, University of St. Andrews, UK
| | - Pumla Dladla
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
| | - Thulani Ngubane
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
| | - Victoria Hosegood
- Department of Social Statistics & Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
- SAMRC-WITS Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alastair van Heerden
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
- SAMRC-WITS Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nuala McGrath
- CHERISH programme, 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
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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Gutin SA, Ruark A, Darbes LA, Neilands TB, Mkandawire J, Conroy AA. Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence. BMC Public Health 2023; 23:1878. [PMID: 37770885 PMCID: PMC10540419 DOI: 10.1186/s12889-023-16762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. METHODS Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. RESULTS Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. CONCLUSIONS Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.
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Affiliation(s)
- Sarah A Gutin
- Department Of Community Health Systems, School of Nursing, University of California, San Francisco (UCSF), 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Allison Ruark
- Wheaton College, 501 College Avenue, Wheaton, IL, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
| | - James Mkandawire
- Invest in Knowledge, Old Naisi Road, P.O. Box 506, Zomba, Malawi
| | - Amy A Conroy
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
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Conroy AA, Tebbetts S, Darbes LA, Hahn JA, Neilands TB, McKenna SA, Mulauzi N, Mkandawire J, Ssewamala FM. Development of an Economic and Relationship-Strengthening Intervention for Alcohol Drinkers Living with HIV in Malawi. AIDS Behav 2023; 27:2255-2270. [PMID: 36520335 PMCID: PMC9753077 DOI: 10.1007/s10461-022-03956-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Heavy alcohol use among people with HIV in sub-Saharan Africa is driven by household economics such as poverty and unemployment and has negative impacts on couple relationships. Multilevel interventions have the potential to reduce alcohol use and improve relationship outcomes by addressing the web of co-occurring economic, social, and dyadic factors. This objective of this study was to develop an economic and relationship-strengthening intervention for couples in Malawi, consisting of matched savings accounts with financial literacy training and a couples counseling component to build relationship skills. Informed by the ADAPT-ITT framework, we collected multiple rounds of focus group data with key stakeholders and couples to gain input on the concept, session content, and procedures, held team meetings with field staff and an international team of researchers to tailor the intervention to couples in Malawi, and refined the intervention manual and components. The results describe a rigorous adaptation process based on the eight steps of ADAPT-ITT, insights gained from formative data and modifications made, and a description of the final intervention to be evaluated in a pilot randomized clinical trial. The economic and relationship-strengthening intervention shows great promise of being feasible, acceptable, and efficacious for couples affected by HIV and heavy alcohol use in Malawi.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, 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
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | | | | - James Mkandawire
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Naughton B, Bulterys MA, Mugisha J, Mujugira A, Boyer J, Celum C, Weiner B, Sharma M. 'If there is joy… I think it can work well': a qualitative study investigating relationship factors impacting HIV self-testing acceptability among pregnant women and male partners in Uganda. BMJ Open 2023; 13:e067172. [PMID: 36806072 PMCID: PMC9944652 DOI: 10.1136/bmjopen-2022-067172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES Secondary distribution of HIV self-test (HIVST) kits from pregnant women attending antenatal care (ANC) to their male partners is shown to increase HIV couples testing and disclosure, and is being scaled up in sub-Saharan Africa. Understanding couples-level barriers and facilitators influencing HIVST uptake is critical to designing strategies to optimise intervention coverage. DESIGN To investigate these couples-level barriers and facilitiators, we conducted focus group discussions and in-depth interviews. Transcripts were analysed thematically and the interdependence model of communal coping and health behaviour change was adapted to explore factors impacting HIVST acceptability. SETTING We recruited pregnant women attending two public ANC clinics in Kampala, Uganda, and male partners of pregnant women between April 2019 and February 2020. PARTICIPANTS We conducted gender-stratified focus group discussions (N=14) and in-depth interviews (N=10) with pregnant women with and without HIV attending ANC, and male partners of pregnant women (N=122 participants). INTERVENTION We evaluated pregnant women's and male partners' perceptions of HIVST secondary distribution in Uganda, leveraging the interdependence model of communal coping and health behaviour change. PRIMARY AND SECONDARY OUTCOME MEASURES Key areas of focus included HIVST interest and acceptability, perspectives on HIV status disclosure to partners and gender roles. RESULTS Participants felt that predisposing factors, including trust, communication, fear of partner and infidelity, would influence women's decisions to deliver HIVST kits to partners, and subsequent communal coping behaviours such as couples HIV testing and disclosure. Pregnancy was described as a critical motivator for men's HIVST uptake, while HIV status of pregnant women was influential in couples' communal coping and health-enhancing behaviours. Generally, participants felt HIV-negative women would be more likely to deliver HIVST, while women with HIV would be more hesitant due to concerns about discovery of serodifference and relationship dissolution. Participants stressed the importance of counsellor availability throughout the process including guidance on how women should approach their partners regarding HIVST and post-test support in case of a positive test. CONCLUSIONS HIV-negative women in relationships with positive predisposing factors may be most likely to deliver HIVST and leverage interdependent coping behaviours. Women with HIV or those in relationships with negative predisposing factors may benefit from targeted counselling and disclosure support before and after HIVST kit distribution. Results can help support policy guidelines for HIVST kit distribution.
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Affiliation(s)
- Brienna Naughton
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Michelle A Bulterys
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jackson Mugisha
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Jade Boyer
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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McGrath N, Ngcobo N, Feng Z, Joseph P, Dladla P, Ngubane T, Hosegood V, Morton K, Van Rooyen H, Van Heerden A. Protocol: evaluation of an optimised couples-focused intervention to increase testing for HIV in rural KwaZulu-Natal, South Africa, the Igugu Lethu ('Our treasure') cohort study. BMC Public Health 2022; 22:1577. [PMID: 35986344 PMCID: PMC9389496 DOI: 10.1186/s12889-022-13894-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Between 2012 and 2015, the Uthando Lwethu (UL) study demonstrated that a theory-based behavioural couples-focused intervention significantly increased participation in couples HIV testing and counselling (CHTC) among South African couples who had never previously tested for HIV together or mutually disclosed their HIV status, 42% compared to 12% of the control group at 9 months follow-up. Although effective, we were nonetheless concerned that in this high prevalence setting the majority (58%) of intervention couples chose not to test together. In response we optimised the UL intervention and in a new study, 'Igugu Lethu', we are evaluating the success of the optimised intervention in promoting CHTC. METHODS One hundred eighty heterosexual couples, who have been in a relationship together for at least 6 months, are being recruited and offered the optimised couples-focused intervention. In the Igugu Lethu study, we have expanded the health screening visit offered to couples to include other health conditions in addition to CHTC. Enrolled couples who choose to schedule CHTC will also have the opportunity to undertake a random blood glucose test, blood pressure and BMI measurements, and self-sample for STI testing as part of their health screening. Individual surveys are administered at baseline, 4 weeks and 4 months follow-up. The proportion of couples who decide to test together for HIV will be compared to the results of the intervention arm in the UL study (historical controls). To facilitate this comparison, we will use the same recruitment and follow-up strategies in the same community as the previous UL study. DISCUSSION By strengthening communication and functioning within the relationship, the Igugu Lethu study, like the previous UL study, aims to transform the motivation of individual partners from a focus on their own health to shared health as a couple. The Igugu Lethu study findings will answer whether the optimised couples-focused behavioural intervention and offering CHTC as part of a broader health screening for couples can increase uptake of CHTC by 40%, an outcome that would be highly desirable in populations with high HIV prevalence. TRIAL REGISTRATION Retrospectively registered. ISRCTN Registry ISRCTN 46162564 Registered on 26th May 2022.
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Affiliation(s)
- Nuala McGrath
- CHERISH programme, 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
| | - Nathi Ngcobo
- Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Zhixin Feng
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, China
| | - Phillip Joseph
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal South Africa
| | - Pumla Dladla
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal South Africa
| | - Thulani Ngubane
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal South Africa
| | - Victoria Hosegood
- Department of Social Statistics & Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Katherine Morton
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Heidi Van Rooyen
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal South Africa
- SAMRC-WITS Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alastair Van Heerden
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, KwaZulu-Natal South Africa
- SAMRC-WITS Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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6
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Leung T, Dacus JD, Johnson MO. Relationship Quality and Health Among Black Same-Sex Male Couples: Protocol for a Symbolic Netnography Study. JMIR Res Protoc 2022; 11:e29589. [PMID: 35657652 PMCID: PMC9206204 DOI: 10.2196/29589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/06/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Across a range of studies, health scientists have found that being in a romantic relationship can have positive and negative influences on one's health. A couple's health outcomes are often influenced by relationship quality-or how they perceive the positive or negative character of their relationship. These findings have important implications for how scientists and interventionists may leverage romantic relationships facilitating good health among couples. However, in general, couples research has not included Black same-sex male couples in large enough numbers to make previous studies' findings relevant to them. This represents a gap in the scientific literature and, more importantly, a missed opportunity to understand how romantic relationships influence health for a group that must navigate distinct, multilevel health and social inequities. OBJECTIVE This study aims to (1) decode and understand the ways in which Black same-sex male couples express their romantic relationships in virtual contexts via symbolic indicators, (2) determine how Black same-sex male couples describe the quality of their romantic relationships, and (3) explore how Black same-sex male couples make meaning of their relationship quality and its impact on their relational and individual health. METHODS We will use joint dyadic interviews embedded within a symbolic netnography research design to accomplish our aims. We will use grounded theory to analyze our qualitative data. We will then triangulate our findings to determine how well they answer our research questions. RESULTS This study received ethical approval on October 8, 2020 and we began data collection in November 2020. Results are expected to be available no later than December 31, 2022. CONCLUSIONS This study will apply novel symbolic netnographic qualitative methods to further our understanding of Black same-sex male couples' romantic relationships and how they contribute to their health. The findings will be used to develop programs to improve Black same-sex male couples' health in community and virtual settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29589.
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Affiliation(s)
| | - Jagadīśa-Devaśrī Dacus
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Metheny N, Stephenson R, Darbes LA, Chavanduka TMD, Essack Z, van Rooyen H. Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia. AIDS Behav 2022; 26:2003-2014. [PMID: 34997385 DOI: 10.1007/s10461-021-03549-6] [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] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.
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Affiliation(s)
- Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Drive, Coral Gables, FL, 33146, USA.
| | - Rob Stephenson
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Lynae A Darbes
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Tanaka M D Chavanduka
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Zaynab Essack
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- School of Law, University of KwaZulu-Natal, KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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8
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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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9
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Giusto AM, Ayuku D, Puffer ES. Learn, Engage, Act, Dedicate (LEAD): development and feasibility testing of a task-shifted intervention to improve alcohol use, depression and family engagement for fathers. Int J Ment Health Syst 2022; 16:16. [PMID: 35246218 PMCID: PMC8896316 DOI: 10.1186/s13033-022-00522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men's depression, alcohol use, and family problems commonly co-occur to create of cluster of mental health problems. Yet, few treatments exist to address these problems, especially in low and middle-income countries (LMICs). This paper describes the development and initial feasibility and acceptability of a novel task-shifted intervention to address this cluster of men's mental health problems with a focus on engaging and retaining men in treatment. METHODS The intervention, Learn, Engage, Act, Dedicate (LEAD), is based in behavioral activation blended with motivational interviewing and was pilot tested in Kenya. To develop LEAD, we engaged in a community-engaged multi-step, collaborative process with local Kenyan stakeholders. LEAD was piloted with nine fathers reporting problem drinking. To assess initial feasibility and acceptability, recruitment and participation were tracked and descriptive statistics were generated given engagement of men was key for proof of concept. Semi-structured interviews were conducted with participants and analyzed using thematic content analysis. RESULTS The development process resulted in a weekly 5-session intervention rooted in behavioral activation, motivational interviewing, and masculinity discussion strategies. These approaches were combined and adapted to fit contextually salient constructs, such as the importance of the man as provider, and streamlined for lay providers. Feasibility and acceptability results were promising with high attendance, acceptability of delivery and intervention content, and perceived intervention helpfulness. CONCLUSION Results describe an acceptable task-shifted treatment that may engage men in care and addresses a cluster of common mental health problems among men in ways that consider social determinants like masculinity. Findings set the stage for a larger trial. Trial registration ISRCTN, ISRCTN130380278. Registered 7 October 2019-Retrospectively registered, http://www.isrctn.com/ISRCTN13038027.
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Affiliation(s)
- Ali M Giusto
- Duke University Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA.
- Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA.
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, 40 Haven Ave., #171, New York, NY, 10032, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya
| | - Eve S Puffer
- Duke University Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA
- Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA
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10
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Johnson MJ, Darbes LA, Hosegood V, Johnson MO, Fritz K, Ngubane T, van Rooyen H, McGrath N. Social Influence and Uptake of Couples HIV Testing and Counselling in KwaZulu-Natal, South Africa. AIDS Behav 2022; 26:764-774. [PMID: 34417920 PMCID: PMC8840905 DOI: 10.1007/s10461-021-03435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Social influences may create a barrier to couples HIV testing and counselling (CHTC) uptake in sub-Saharan Africa. This secondary analysis of data collected in the 'Uthando Lwethu' randomised controlled trial used discrete-time survival models to evaluate the association between within-couple average 'peer support' score and uptake of CHTC by the end of nine months' follow-up. Peer support was conceptualised by self-rated strength of agreement with two statements describing friendships outside of the primary partnership. Eighty-eight couples (26.9%) took up CHTC. Results tended towards a dichotomous trend in models adjusted only for trial arm, with uptake significantly less likely amongst couples in the higher of four peer support score categories (OR 0.34, 95% CI 0.18, 0.68 [7-10 points]; OR 0.53, 95% CI 0.28, 0.99 [≥ 11 points]). A similar trend remained in the final multivariable model, but was no longer significant (AOR 0.59, 95% CI 0.25, 1.42 [7-10 points]; AOR 0.88, 95% CI 0.36, 2.10 [≥ 11 points]). Accounting for social influences in the design of couples-focused interventions may increase their success.
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Affiliation(s)
- Matthew J. Johnson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Mailpoint 95, Tremona Road, Southampton, SO16 6YD UK
- NIHR ARC Wessex Data Science Hub, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Lynae A. Darbes
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, USA
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, Division of Prevention Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Katherine Fritz
- International Center for Research on Women, Washington, DC USA
| | | | - Heidi van Rooyen
- Human Sciences Research Council, Durban, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nuala McGrath
- Department of Social Statistics and Demography, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Hampanda K, Pelowich K, Chi BH, Darbes LA, Turan JM, Mutale W, Abuogi L. A Systematic Review of Behavioral Couples-Based Interventions Targeting Prevention of Mother-to-Child Transmission in Low- and Middle-Income Countries. AIDS Behav 2022; 26:443-456. [PMID: 34415489 DOI: 10.1007/s10461-021-03401-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
There is increasing focus in HIV prevention and treatment on couples-based approaches. No systematic review has synthesized prospective behavioral couples-based HIV trials targeting prevention of mother-to-child transmission (PMTCT) outcomes in low- and middle-income countries (LMICs). We systematically reviewed published abstracts and articles reporting prospective comparative evaluations of behavioral couples-based HIV interventions delivered during pregnancy to both members of a self-identified heterosexual couple in LMICs following PRISMA. Citations, abstracts, and full texts were double screened for eligibility. References meeting eligibility criteria underwent double data abstraction, quality appraisal, and qualitative synthesis. We identified 295 unique publications. Of these, 5 randomized trials were deemed eligible and synthesized. Studies were conducted in 3 different African countries using three overarching intervention approaches: home-based; group workshops; and faith-based. Studies included various PMTCT outcome measures. We found evidence that behavioral couples-based approaches around the time of pregnancy can positively affect HIV testing among pregnant women and their male partners, infant HIV prophylaxis use, and HIV-free infant survival. The effects on other PMTCT outcomes were not well supported. There was a low to moderate risk of bias among the included studies. Few couples-based PMTCT interventions have been tested in LMICs. Of the interventions we located, workshops/group education and home-based couple counseling and testing were most commonly used to promote PMTCT. Research is needed on the role of relationship dynamics within such interventions and whether couples-based approaches during pregnancy can extend to health outcomes across the PMTCT continuum of care.
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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: 5] [Impact Index Per Article: 1.7] [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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Zaidi HA, Mathenjwa M, Mosery N, O'Neil K, Chitneni P, Psaros C, Khidir H, Safren SA, Bangsberg DR, Sayeed SA, Smit JA, Matthews LT. Overcoming Ethical Challenges to Engaging Men Who Have Sex with Women in HIV Research. AIDS Behav 2021; 25:4055-4060. [PMID: 33582889 PMCID: PMC10698834 DOI: 10.1007/s10461-021-03185-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/28/2022]
Abstract
Men who have sex with women are understudied in HIV research despite the extent to which they experience HIV-related mortality and contribute to the epidemic among women. During our experience of developing and piloting an HIV prevention intervention for men living with HIV in South Africa, and planning to have a child with an HIV-negative woman, ethical questions were posed regarding implementation of a male-centered intervention that did not require female partner participation. Two overarching ethical issues were the potential for (1) compromising women's reproductive and sexual autonomy and (2) increasing HIV-acquisition risks for the woman because the intervention efficacy was unknown. We describe here how these concerns were addressed to facilitate development of a male-centered HIV-prevention intervention. We hope this process manuscript will support researchers, clinicians, and reviewers to engage men who have sex with women in HIV prevention and care.
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Affiliation(s)
- Hussain A Zaidi
- Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
- Lang Center for Social and Civic Responsibility, Swarthmore College, Swarthmore, PA, USA
| | - Mxolisi Mathenjwa
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
| | - Kasey O'Neil
- Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Pooja Chitneni
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | | | - Sadath A Sayeed
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Jennifer A Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa
| | - Lynn T Matthews
- Division of Infectious Disease, University of Alabama at Birmingham, 212 Zeigler Research Building, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Neilands TB, Chakravarty D, Darbes LA, O’Brien NP, Gonzalez IS, Hoff CC. Assessing Self-Efficacy and Communication Regarding Sexual Agreements among Men Who Have Sex with Men in the USA: Development and Validation of Two Novel Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189727. [PMID: 34574657 PMCID: PMC8466800 DOI: 10.3390/ijerph18189727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022]
Abstract
HIV disproportionately impacts men who have sex with men (MSM) in the USA. Building upon research on relationship constructs unique to MSM couples’ HIV-prevention needs, we developed two new scales measuring sexual agreement self-efficacy (SASE) and importance of sexual agreement communication (ISAC). Following qualitative item development, we used two large independent samples of MSM couples (N1 = 441, N2 = 388) to conduct scale validation. Exploratory factor analyses indicated both SASE and ISAC to be unidimensional with 7 and 5 items (eigenvalues = 5.68 and 3.50), respectively, with strong factor loadings. Confirmatory factor analyses yielded satisfactory model fit for SASE (CFI = 0.99; SRMR = 0.03) and ISAC (CFI = 0.99; SRMR = 0.05). Reliability was high for SASE (ω = 0.92) and ISAC (ω = 0.84). Predictive validity analysis revealed a protective association between higher scores on both scales and the outcomes of sexual risk behavior and agreement breaks. Convergent and discriminant validity analyses demonstrated associations in the expected directions between these scales and multiple measures of relationship quality. Therefore, SASE and ISAC are two brief, valid, and reliable scales that can facilitate more in-depth explorations of sexual agreements in MSM and thereby contribute greatly to improving our understanding of and ability to intervene on sexual agreements to improve health and relationship outcomes.
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Affiliation(s)
- Torsten B. Neilands
- Center for AIDS Prevention Studies, Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA 94158, USA;
- Correspondence:
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, Division of Prevention Sciences, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Lynae A. Darbes
- Center for Sexuality and Health Disparities, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI 48104, USA;
| | - Nathan P. O’Brien
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA; (N.P.O.); (I.S.G.); (C.C.H.)
| | - Ilse S. Gonzalez
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA; (N.P.O.); (I.S.G.); (C.C.H.)
| | - Colleen C. Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA 94103, USA; (N.P.O.); (I.S.G.); (C.C.H.)
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15
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Hampanda K, Matenga TFL, Nkwemu S, Shankalala P, Chi BH, Darbes LA, Turan JM, Mutale W, Bull S, Abuogi L. Designing a couple-based relationship strengthening and health enhancing intervention for pregnant women living with HIV and their male partners in Zambia: Interview findings from the target community. Soc Sci Med 2021; 283:114029. [PMID: 34242890 PMCID: PMC10790566 DOI: 10.1016/j.socscimed.2021.114029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/08/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Interpersonal support can promote positive outcomes among people living with HIV. In order to develop an acceptable psychoeducational couples-based intervention aimed at strengthening the relationship context and improving HIV outcomes before and after pregnancy, we conducted qualitative interviews with pregnant women living with HIV and their male partners. METHODS We interviewed a convenience clinic-based sample of pregnant women living with HIV (n = 30) and male partners (n = 18) in Lusaka, Zambia. Interviews included pile sorting relationship topics in order of perceived priority. Interviews also focused on family health concerns. Interviews were audio-recorded, translated, transcribed, and thematically analyzed. Pile sorting data was analyzed using descriptive statistics. RESULTS All female participants were living with HIV; 61% of the male partners interviewed were additionally living with HIV. The most prioritized relationship topic among both genders was communication between couples. Honesty and respect were important relationship topics but prioritized differently based on gender. Female participants considered emotional and instrumental support from male partners critical for their physical and mental health; men did not prioritize support. Intimate partner violence was discussed often by both genders. Family health priorities included good nutrition during pregnancy, preventing infant HIV infection, safe infant feeding, sexual health, and men's alcohol use. CONCLUSIONS A major contribution of this study is a better understanding of the dyad-level factors pregnant women living with HIV and their male partners perceive to be the most important for a healthy, well-functioning relationship. This study additionally identified gaps in antenatal health education and the specific family health issues most prioritized by pregnant women living with HIV and their male partners. The findings of this study will inform the development of an acceptable couples-based intervention with greater likelihood of efficacy in strengthening the relationship context and promoting family health during and after pregnancies that are affected by HIV.
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Affiliation(s)
- K Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Center for Global Health, Colorado School of Public Health, Aurora, CO, USA.
| | - T F L Matenga
- Department of Health Policy, The University of Zambia, Zambia
| | - S Nkwemu
- Department of Health Policy, The University of Zambia, Zambia
| | - P Shankalala
- Department of Health Policy, The University of Zambia, Zambia
| | - B H Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA
| | - L A Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan, USA
| | - J M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, USA
| | - W Mutale
- Department of Health Policy, The University of Zambia, Zambia
| | - S Bull
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - L Abuogi
- Center for Global Health, Colorado School of Public Health, Aurora, CO, USA; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, 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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Matthews LT, Greener L, Khidir H, Psaros C, Harrison A, Mosery FN, Mathenjwa M, O’Neil K, Milford C, Safren SA, Bangsberg DR, Smit JA. "It really proves to us that we are still valuable": Qualitative research to inform a safer conception intervention for men living with HIV in South Africa. PLoS One 2021; 16:e0240990. [PMID: 33765001 PMCID: PMC7993862 DOI: 10.1371/journal.pone.0240990] [Citation(s) in RCA: 5] [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: 02/14/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Many men living with HIV want to have children. Opportunities to reduce periconception HIV transmission include antiretroviral therapy as prevention, pre-exposure prophylaxis, limiting condomless sex to peak fertility, and sperm processing. Whether men have knowledge of or want to adopt these strategies remains unknown. Methods We conducted focus group discussions (FGDs) with men accessing HIV care in South Africa in 2014 to inform a safer conception intervention for men. Eligible men were 25–45 years old, living with HIV, not yet accessing treatment, and wanting to have a child with an HIV-negative or unknown serostatus female partner (referred to as the “desired pregnancy partner”). FGDs explored motivations for having a healthy baby, feasibility of a clinic-based safer conception intervention, and acceptability of safer conception strategies. Data were analyzed using thematic analysis. Results Twelve participants from three FGDs had a median age of 37 (range 23–45) years, reported a median of 2 (range 1–4) sexual partners, and 1 (range 1–3) desired pregnancy partner(s). A third (N = 4) had disclosed HIV-serostatus to the pregnancy partner. Emergent themes included opportunities for and challenges to engaging men in safer conception services. Opportunities included enthusiasm for a clinic-based safer conception intervention and acceptance of some safer conception strategies. Challenges included poor understanding of safer conception strategies, unfamiliarity with risk reduction [versus “safe” (condoms) and “unsafe” (condomless) sex], mixed acceptability of safer conception strategies, and concerns about disclosing HIV-serostatus to a partner. Conclusions Men living with HIV expressed interest in safer conception and willingness to attend clinic programs. Imprecise prevention counseling messages make it difficult for men to conceptualize risk reduction. Effective safer conception programs should embrace clear language, e.g. undetectable = untransmittable (U = U), and support multiple approaches to serostatus disclosure to pregnancy partners.
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Affiliation(s)
- Lynn T. Matthews
- University of Alabama at Birmingham, Birmingham, AL, United States of America
- Center for Global Health and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
| | - Letitia Greener
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hazar Khidir
- Harvard Medical School, Massachusetts General Hospital, Brigham and Women’s Hospital, Combined Residency Program in Emergency Medicine, Boston, MA, United States of America
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA, United States of America
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - F. Nzwakie Mosery
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Mxolisi Mathenjwa
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Kasey O’Neil
- Center for Global Health and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Cecilia Milford
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - David R. Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States of America
| | - Jennifer A. Smit
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
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Hatcher AM, Darbes L, Kwena Z, Musoke PL, Rogers AJ, Owino G, Helova A, Anderson JL, Oyaro P, Bukusi EA, Turan JM. Pathways for HIV Prevention Behaviors Following a Home-Based Couples Intervention for Pregnant Women and Male Partners in Kenya. AIDS Behav 2020; 24:2091-2100. [PMID: 31894444 DOI: 10.1007/s10461-019-02774-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pregnancy is a time of heightened HIV risk, but also a phase when a couple can prioritize family health. We conducted secondary analysis of a home-based intervention in rural Kenya to explore couple-level adherence to HIV prevention behaviors. The intervention included health education, relationship-building skills, and Couples HIV Testing and Counseling. Pregnant women were randomized to the intervention (n = 64) or standard care (n = 63) along with male partners. Of 96 couples, 82 (85.0%) were followed to 3 months postpartum, when 31.0% of couples reported perfect adherence to HIV prevention. In logistic regression, intervention condition couples had three-fold higher odds of perfect adherence (AOR = 3.07, 95% CI = 1.01-9.32). A structural equation model found the intervention had moderate effects on couple communication, large effects on couple efficacy to take action around HIV, which in turn improved HIV prevention behaviors (CFI = 0.969; TLI = 0.955; RMSEA = 0.049). Strengthening couple communication and efficacy may help prevent the spread of HIV to infants or partners around the time of pregnancy.
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Hampanda K, Abuogi L, Musoke P, Onono M, Helova A, Bukusi E, Turan J. Development of a Novel Scale to Measure Male Partner Involvement in the Prevention of Mother-to-Child Transmission of HIV in Kenya. AIDS Behav 2020; 24:291-303. [PMID: 31152357 PMCID: PMC6885105 DOI: 10.1007/s10461-019-02546-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Male partner involvement is an important factor in prevention of mother-to-child transmission (PMTCT). Yet, poor conceptualization has hindered optimal assessment of male involvement. We created and evaluated a brief 10-item male partner involvement scale using principal components analysis and scree plots, Cronbach's alpha, and linear regression with survey data from postpartum women with HIV (n = 200) in Kenya. The scale had a two-factor structure: male encouragement/reminders and active participation. The overall scale and the encouragement/reminders sub-scale displayed strong internal reliability. In the multivariable models, the scales were positively associated with constructive relationship dynamics, HIV status disclosure, and couple HIV testing and counseling, and negatively associated with internalized HIV stigma. The encouragements/reminders sub-scale was also negatively associated with a new HIV diagnosis during pregnancy. This work furthers the conceptualization of male partner involvement in PMTCT and provides a valid measure to assess male involvement as a pathway to better PMTCT outcomes.
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Affiliation(s)
- Karen Hampanda
- Department of Community and Behavioral Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Center for Global Health, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lisa Abuogi
- Center for Global Health, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Pamela Musoke
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Helova
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Janet Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, 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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Willcox M, King E, Fall E, Mubangizi V, Nkalubo J, Natukunda S, Nahabwe H, Goodhart C, Graffy J. Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients. Stud Fam Plann 2019; 50:159-178. [DOI: 10.1111/sifp.12088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Darbes LA, McGrath NM, Hosegood V, Johnson MO, Fritz K, Ngubane T, van Rooyen H. Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV. J Acquir Immune Defic Syndr 2019; 80:404-413. [PMID: 30730356 PMCID: PMC6524952 DOI: 10.1097/qai.0000000000001948] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although couples HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC. SETTING The Vulindlela district of KwaZulu-Natal, South Africa. METHODS Couples were recruited from the community (eg, markets and community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other's primary partner and relationship length was at least 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after intervention. Eligible couples attended a group session (3-4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by 4 couples' counseling sessions (1-2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behavior. RESULTS Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, their time to participate in CHTC was significantly shorter (logrank P ≤ 0.0001) (N = 332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (P = 0.18). There were no group differences in unprotected sex. CONCLUSIONS Our intervention improved CHTC uptake-a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV.
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Affiliation(s)
- Lynae A Darbes
- Center for AIDS Prevention Studies, Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA
- Currently, Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI
| | - Nuala M McGrath
- Division of Primary Care and Population Sciences, Faculty of Medicine, Southampton, United Kingdom
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom
| | - Victoria Hosegood
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Division of Prevention Sciences, University of California, San Francisco, San Francisco, CA
| | | | | | - Heidi van Rooyen
- Human Social Development, Human Sciences Research Council, Durban, South Africa
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Yah CS, Tambo E. Why is mother to child transmission (MTCT) of HIV a continual threat to new-borns in sub-Saharan Africa (SSA). J Infect Public Health 2018; 12:213-223. [PMID: 30415979 DOI: 10.1016/j.jiph.2018.10.008] [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: 07/27/2018] [Revised: 09/30/2018] [Accepted: 10/14/2018] [Indexed: 11/15/2022] Open
Abstract
Sub-Saharan Africa (SSA) accounts for more than two thirds of the world's HIV infection. Despite scaled-up prevention of mother-to-child transmission of HIV (PMTCT) programmes, mother to child transmission of HIV (MTCT) continues to escalate. We describe the challenges faced by PMTCT in MTCT in SSA. The study reviewed articles and reports published online. The most common barriers and challenges were non-disclosure of HIV status, late initiation of ARVs treatment/adherence, STIs screening, long clinics waiting time, non-involvement of men in ANC/PMTCT, infant feeding methods and sensitization of community members on ANC/PMTCT programmes. The study highlights the need to expand PMTCT coverage and the implementation of the 90-90-90 programme toward MTCT elimination in SSA. That is " ≥90% of pregnant and breast-feeding mothers must know their HIV status; ≥90% of those that are positive are enrolled on ARVs treatment and care; ≥90% of those on ARVs treatment and care are virally suppressed.
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Affiliation(s)
- Clarence S Yah
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Science, University of the Witwatersrand, Johannesburg, P/Bag 3, Wits 2050, South Africa.
| | - Ernest Tambo
- Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon; Africa Intelligence and Surveillance, Communication and Response (Africa DISCoR) Institute, Yaoundé, Cameroon.
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Woolf-King SE, Conroy AA, Fritz K, Johnson MO, Hosegood V, van Rooyen H, Darbes L, McGrath N. Alcohol use and relationship quality among South African couples. Subst Use Misuse 2018; 54:651-660. [PMID: 30407888 PMCID: PMC6487654 DOI: 10.1080/10826084.2018.1531428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 07/16/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The HIV literature has largely ignored the importance of alcohol use in the quality of intimate relationships in sub-Saharan Africa (SSA), despite evidence of alcohol's role in relational behaviors that increase risk for HIV infection and other harms. The present study explored the association of alcohol use with relationship functioning among heterosexual couples from rural South Africa. METHOD Dyadic analyses were conducted with 443 sexually active, heterosexual, South African couples (886 individuals) to examine the association between male partners' alcohol use (abstinent, nonhazardous, and hazardous), and male and female partners' reports of relationship intimacy, trust, mutually constructive communication, demand/withdraw communication, and satisfaction. Five structural equation models were fit using male partner alcohol use as a predictor of male and female reports of relationship quality. RESULTS Women with a hazardous-drinking male partner (compared to an abstainer) reported significantly higher levels of intimacy (p <.05) and significantly more demand/withdraw communication (p <.001); men who were hazardous drinkers reported significantly less trust in their relationship compared to men who were abstainers (p < .01). CONCLUSIONS Hazardous alcohol use among South African couples is positively correlated with women's relationship intimacy and maladaptive communication patterns, yet negatively correlated with men's perceived trust.
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Affiliation(s)
- Sarah E. Woolf-King
- Syracuse University, Department of Psychology, Syracuse, New York, United States
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States
| | - Amy A. Conroy
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States
| | - Katherine Fritz
- International Center for Research on Women, Washington DC, United States
| | - Mallory O. Johnson
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States
| | - Victoria Hosegood
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council, Sweetwaters, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lynae Darbes
- University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States
- University of Michigan, Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, Ann Arbor, Michigan, United States
| | - Nuala McGrath
- Academic Unit of Primary Care and Population Sciences and Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- Africa Health Research Institute, School of Nursing & Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- Research Department of Epidemiology & Public Health, University College London, London, United Kingdom
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Yah CS. Nurturing the Continuum of HIV Testing, Treatment and Prevention Matrix Cascade in Reducing HIV Transmission. Ethiop J Health Sci 2018; 27:621-630. [PMID: 29487471 PMCID: PMC5811941 DOI: 10.4314/ejhs.v27i6.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Despite the shift in antiretroviral therapy (ARVs) eligibility cascade from CD4 ≤ 200 to CD4 ≤ 350 to CD4 ≤ 500 mm3, HIV related morbidity and mortality continue to escalate annually, as do HIV infections. The new paradigm of treatment for all HIV positives individual irrespective of CD4 count may significantly reduce HIV and related illnesses. The author assumes that all HIV infected partners should be eligible for HIV treatment and care, irrespective of CD4 count. A second assumption is that high risk HIV negative partners have free access to continuum of HIV pre-exposure prophylaxis (PrEP), post exposure prophylaxis (PEP) and other prevention packages. Methods A literature review search was used to extract evidence-based ARVs-HIV treatment and prevention interventions among HIV positives and high risk partners respectively. Only articles published in English and indexed in journal nuclei were used for the study. The information was used to nurture understanding of HIV treatment and prevention approaches as well as HIV incidence multiplier effect among HIV serodiscordant partners. The imputed HIV incident reference was assumed at 1.2 per 100 person-years (2). This was based on the imputation that retention in care, adherence and other predetermined factors are functions of an effective health care delivery system. Result The model showed a reduced HIV transmission from 1.2 per 100 person-years to 1.032 per 100 person-years in 6 months. The average threshold period of HIV suppressed partners on ARVs to an undetectable level. The combined multiplier protective-effect probability of transmitting HIV from HIV positive partners on ARVs-suppressed viremic load to HIV negative partners on PrEP/PEP-prevention was detected at 86% Conclusion The model showed a significant reduction in HIV incidence. Placing serodiscordant sexual partners in HIV treatment and prevention plays a significant role in reducing and controlling HIV infection. Therefore, the policy of enrolling all HIV positives irrespective of CD4 count on ARVs and high risk partners on prevention if adopted and sustained may underpin reduction and control of HIV genotype and HIV related morbidity, mortality and opportunistic infections.
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Affiliation(s)
- Clarence S Yah
- Implementation Science Unit, Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rosenberg NE, Gross R, Mtande T, Maman S, Golin CE, Saidi F, Manthalu O, Hoffman I, Hosseinipour MC, Miller WC. "We have heard it together": a qualitative analysis of couple HIV testing and counselling recruitment in Malawi's Option B+ programme. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 16:215-223. [PMID: 28978289 DOI: 10.2989/16085906.2017.1362017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Encouraging HIV-infected pregnant women to recruit male partners for couple HIV testing and counselling (CHTC) is promoted by the World Health Organization, but remains challenging. Formal strategies for recruiting the male partners of pregnant women have not been explored within an Option B+ programme. Our objective was to learn about experiences surrounding CHTC recruitment within a formal CHTC recruitment study. A randomised controlled trial comparing two CHTC recruitment strategies was conducted among HIV-infected pregnant women presenting to Bwaila Antenatal Unit in 2014. Women were randomised to receive an invitation to attend the clinic as a couple or this invitation plus clinic-led phone and community tracing. A qualitative study was conducted with a subset of participants to learn about recruitment. This paper describes experiences of a subset of HIV-infected pregnant women (N = 20) and male partners (N = 17). One on one in-depth interviews were audio-recorded, transcribed, translated, and coded using content analysis. Nearly all women presented the invitation and disclosed their HIV-positive status to their partners on the day of HIV diagnosis, often to facilitate pill-taking. Men and women in both arms perceived the messages to be more compelling since they came from the clinic, rather than the woman herself. Couples who attended CHTC displayed greater care for one another and mutual support for HIV-related behaviours. Facilitating CHTC with invitations and tracing can support CHTC uptake and support for HIV-affected couples. In an Option B+ context, inviting partners for CHTC can facilitate male involvement and have important benefits for families.
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Affiliation(s)
- Nora E Rosenberg
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.,b School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,c School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Rebecca Gross
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Tiwonge Mtande
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Suzanne Maman
- c School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Carol E Golin
- b School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,c School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Friday Saidi
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Olivia Manthalu
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Irving Hoffman
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.,b School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Mina C Hosseinipour
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.,b School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - William C Miller
- a University of North Carolina Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi.,b School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,c School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,d Department of Epidemiology , Ohio State University , Columbus , Ohio , USA
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Lesch E, de Bruin K, Anderson C. A Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2018. [DOI: 10.1080/15332691.2017.1417940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elmien Lesch
- Psychology Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Kathryn de Bruin
- Marital and Family Therapist, Private Practice, San Diego, California, USA
| | - Colleen Anderson
- Clinical Psychologist, Private Practice, Cape Town, South Africa
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The Impact of Couple HIV Testing and Counseling on Consistent Condom Use Among Pregnant Women and Their Male Partners: An Observational Study. J Acquir Immune Defic Syndr 2017; 75:417-425. [PMID: 28426440 DOI: 10.1097/qai.0000000000001398] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In sub-Saharan Africa couple HIV testing and counseling (CHTC) has been associated with substantial increases in safe sex, especially when at least one partner is HIV infected. However, this relationship has not been characterized in an Option B+ context. SETTING The study was conducted at the antenatal clinic at Bwaila District Hospital in Lilongwe, Malawi in 2016 under an Option B+ program. METHODS Ninety heterosexual couples with an HIV-infected pregnant woman (female-positive couples) and 47 couples with an HIV-uninfected pregnant woman (female-negative couples) were enrolled in an observational study. Each couple member was assessed immediately before and 1 month after CHTC for safe sex (abstinence or consistent condom use in the last month). Generalized estimating equations were used to model change in safe sex before and after CHTC and to compare safe sex between female-positive and female-negative couples. RESULTS Mean age was 26 years among women and 32 years among men. Before CHTC, safe sex was comparable among female-positive couples (8%) and female-negative couples (2%) [risk ratio (RR): 3.7, 95% confidence interval (CI): 0.5 to 29.8]. One month after CHTC, safe sex was higher among female-positive couples (75%) than among female-negative couples (3%) (RR: 30.0, 95% CI: 4.3 to 207.7). Safe sex increased substantially after CTHC for female-positive couples (RR 9.6, 95% CI: 4.6 to 20.0), but not for female-negative couples (RR: 1.2, 95% CI: 0.1 to 18.7). CONCLUSIONS Engaging pregnant couples in CHTC can have prevention benefits for couples with an HIV-infected pregnant woman, but additional prevention approaches may be needed for couples with an HIV-uninfected pregnant woman.
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Matthews LT, Burns BF, Bajunirwe F, Kabakyenga J, Bwana M, Ng C, Kastner J, Kembabazi A, Sanyu N, Kusasira A, Haberer JE, Bangsberg DR, Kaida A. Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care. PLoS One 2017; 12:e0183131. [PMID: 28880892 PMCID: PMC5589112 DOI: 10.1371/journal.pone.0183131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/31/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. METHODS We recruited HIV-positive men and women on antiretroviral therapy (ART) ('index') from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner ('partner'), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. RESULTS 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner's HIV status. Similarly, the partner's HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner's desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. CONCLUSIONS Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.
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Affiliation(s)
- Lynn T. Matthews
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, United States of America
| | - Bridget F. Burns
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
| | | | | | - Mwebesa Bwana
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Courtney Ng
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Jasmine Kastner
- Research Institute McGill University Health Centre, Montreal, Canada
| | - Annet Kembabazi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Naomi Sanyu
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adrine Kusasira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - David R. Bangsberg
- OHSU-PSU School of Public Health, Portland, OR, United States of America
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis. J Int AIDS Soc 2016; 19:21224. [PMID: 27887669 PMCID: PMC5124108 DOI: 10.7448/ias.19.1.21224] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/14/2016] [Accepted: 10/24/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV infection is frequently transmitted within stable couple partnerships. In order to prevent HIV acquisition in HIV-negative couples, as well as improve coping in couples with an HIV-positive diagnosis, it has been suggested that interventions be aimed at strengthening couple relationships, in addition to addressing individual behaviours. However, little is known about factors that influence relationships to impact joint decision-making related to HIV. METHODS We conducted qualitative in-depth interviews with 40 pregnant women and 40 male partners in southwestern Kenya, an area of high HIV prevalence. Drawing from the interdependence model of communal coping and health behaviour change, we employed thematic analysis methods to analyze interview transcripts in Dedoose software with the aim of identifying key relationship factors that could contribute to the development of a couples-based intervention to improve health outcomes for pregnant women and their male partners. RESULTS In accordance with the interdependence model, we found that couples with greater relationship-centred motivations described jointly engaging in more health-enhancing behaviours, such as couples HIV testing, disclosure of HIV status, and cooperation to improve medication and clinic appointment adherence. These couples often had predisposing factors such as stronger communication skills and shared children, and were less likely to face potential challenges such as polygamous marriages, wife inheritance, living separately, or financial difficulties. For HIV-negative couples, joint decision-making helped them face the health threat of acquiring HIV together. For couples with an HIV-positive diagnosis, communal coping helped reduce risk of interspousal transmission and improve long-term health prospects. Conversely, participants felt that self-centred motivations led to more concurrent sexual partnerships, reduced relationship satisfaction, and mistrust. Couples who lacked interdependence were more likely to mention experiencing violence or relationship dissolution, or having difficulty coping with HIV-related stigma. CONCLUSIONS We found that interdependence theory may provide key insights into health-related attitudes and behaviours adopted by pregnant couples. Interventions that invest in strengthening relationships, such as couple counselling during pregnancy, may improve adoption of beneficial HIV-related health behaviours. Future research should explore adaptation of existing evidence-based couple counselling interventions to local contexts, in order to address modifiable relationship characteristics that can increase interdependence and improve HIV-related health outcomes.
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Crankshaw TL, Voce A, Butler LM, Darbes L. Expanding the relationship context for couple-based HIV prevention: Elucidating women's perspectives on non-traditional sexual partnerships. Soc Sci Med 2016; 166:169-176. [PMID: 27566046 DOI: 10.1016/j.socscimed.2016.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 07/17/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION HIV prevention interventions targeting couples are efficacious, cost-effective and a key strategy for preventing HIV transmission. Awareness of the full spectrum of relationship types and underlying complexities, as well as available support mechanisms in a given context, are critical to the design of effective couple-based interventions. OBJECTIVE This paper is based on a sub-analysis of a qualitative research study investigating HIV disclosure dynamics amongst pregnant women living with HIV in Durban, South Africa. The sub-analysis explored the nature of participants' social and relationship contexts and consequences of these dynamics on women's feelings of trust towards partners and perceptions of partner commitment. METHODS Between June and August 2008, we conducted in-depth interviews with 62 pregnant women living with HIV and accessing Prevention of Mother-to-Child Transmission (PMTCT) services in Durban, South Africa. Transcripts were coded for emergent themes and categories using a grounded theoretical approach. RESULTS The median age of participants was 26 years (interquartile range: 22-29 years). Three major themes with accompanying sub themes were identified: 1) relationship types (sub themes included unmarried status, minimal cohabitation with partners, presence of concurrent relationships), 2) relationship quality/functioning (sub themes included low trust and expectation of partner commitment, relationship turbulence, and lack of communication/ability to negotiate protective behaviours), and 3) factors underlying the relationship functioning (sub themes included dynamics of concurrent relationships coinciding with concurrent pregnancies, gender roles and unequal relationship power, intimate partner violence or threat thereof, and lack of social support). CONCLUSIONS Our research findings indicate a lack of many of the dyadic relationship elements underlying couple-counselling frameworks for successful risk reduction coordination. Understanding sexual behaviour and the accompanying relationship dynamics within different types of partnerships is crucial for the optimal design of couple-based HIV prevention interventions.
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Affiliation(s)
- T L Crankshaw
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban 4041, South Africa; Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa.
| | - A Voce
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban 4041, South Africa
| | - L M Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - L Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109, USA
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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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Conroy AA, McGrath N, van Rooyen H, Hosegood V, Johnson MO, Fritz K, Marr A, Ngubane T, Darbes LA. Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions. Soc Sci Med 2016; 153:1-11. [PMID: 26859436 PMCID: PMC4788545 DOI: 10.1016/j.socscimed.2016.01.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 01/09/2016] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. METHODS This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). RESULTS For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict. CONCLUSIONS Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men's perspectives into account to ensure positive relationship outcomes.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Nuala McGrath
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Mailpoint 805, South Academic Block, Level C Room AC23, Tremona Road, Southampton SO16 6YD, UK; Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa.
| | - Heidi van Rooyen
- Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa.
| | - Victoria Hosegood
- Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa; Division of Social Statistics and Demography, University of Southampton, Southampton SO17 1BJ, UK.
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Katherine Fritz
- Global Health, International Center for Research on Women, 1120 20th Street NW, Suite 500 North, Washington, D.C., USA.
| | - Alexander Marr
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Thulani Ngubane
- Social, Behavioural and Biomedical Interventions Unit, HIV/AIDS, STIs and Tuberculosis Programme, Human Sciences Research Council, P.O Box 90, Msunduzi 3200, South Africa.
| | - Lynae A Darbes
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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King R, Min J, Birungi J, Nyonyintono M, Muldoon KA, Khanakwa S, Kaleebu P, Moore DM. Effect of Couples Counselling on Reported HIV Risk Behaviour among HIV Serodiscordant Couples by ART Use, HIV Status and Gender in Rural Uganda. PLoS One 2015; 10:e0136531. [PMID: 26384103 PMCID: PMC4575207 DOI: 10.1371/journal.pone.0136531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background We examined several measures of self-reported HIV risk behaviour in mutually disclosed sero-discordant couples over time to see if a couples counselling intervention was associated with changes in these behaviors. Methods We analysed data from a prospective cohort study of HIV sero-discordant couples in Jinja, Uganda collected between June 2009 and December 2011. Participants received couples counselling, at 3-monthly intervals. We examined trends in reported condom-use, number of concurrent sexual partners, knowledge of HIV serostatus of concurrent partners and condom use of concurrent partners using Generalized Estimating Equation models, comparing responses at study enrollment with responses at six, 12 18 and 24 months of follow-up. Results A total of 586 couples were enrolled and the female member was HIV positive in 255 (44%) of them. The median age for female participants was 35 years and 42 years for men. Reported condom use at last sex with spouse increased over time (p<0.001) with the largest increases found among couples where the positive participant never received ART during the study(an increase from 68.8% at enrollment to 97.1% at 24 months). Male participants reported reductions in the number of concurrent sexual partners (p<0.001), increase in the knowledge of the HIV serostatus of these partners (p = 0.001) and a trend towards improved condom-use among non-primary partners (p = 0.070). Reported reduced risky behaviors did not wane over the study period. Conclusion Couples counselling resulted in increased condom use among all participants and among men the intervention resulted in reductions in risk behaviour with concurrent sexual partners. Routine counselling for serodiscordant couples should be integrated in routine ART care programs.
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Affiliation(s)
- Rachel King
- University of California San Francisco, Kampala, Uganda
- * E-mail:
| | - Jeong Min
- British Colombia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | | | - Katherine A. Muldoon
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Pontiano Kaleebu
- Uganda Virus Research Institute/ Medical Research Council Research Unit on AIDS, Entebbe, Uganda
| | - David M. Moore
- British Colombia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Colombia, Vancouver, Canada
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Conroy AA, Wong LH. How reliable are self-reports of HIV status disclosure? Evidence from couples in Malawi. Soc Sci Med 2015; 144:28-37. [PMID: 26379084 DOI: 10.1016/j.socscimed.2015.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 08/20/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The majority of research on human immunodeficiency virus (HIV) disclosure utilizes the perspective from a single individual, which cannot be substantiated in the absence of supporting data such as from a primary partner. OBJECTIVES The objectives of this study were to evaluate: (1) the extent to which self-reported HIV disclosure was confirmed by a primary partner; (2) individual and relationship-level predictors of self-reported versus confirmed disclosure; and (3) whether confirmed disclosure was a stronger predictor of correctly assessing a partner's HIV status compared to self-reported disclosure. METHODS As part of an 8-wave longitudinal study from 2009 to 2011 in southern Malawi, 366 individuals (183 couples) were interviewed about their primary relationship (wave 3), individually tested for HIV (wave 4), and then asked whether they disclosed to their primary partner (wave 5). RESULTS While 93% of respondents reported that they disclosed, only 64% of respondents had confirmed reports from their partner. Having communicated with partner about HIV was positively associated with self-reported disclosure; this association remained significant but became more precise in the models for confirmed disclosure. Confirmed disclosure, but not self-report, was a significant predictor of correctly assessing a partner's HIV status. Being male, having lower perceived partner infidelity, having higher relationship unity, and testing HIV-negative were positively and significantly associated with correct assessment. Dyadic data from two partners provide an improved measure of disclosure as compared to a single individual's self-report and could be used to identify behavioral and biomedical opportunities to prevent HIV transmission within couples.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
| | - Lauren H Wong
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
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Mpondo F, Ruiter RA, van den Borne B, Reddy PS. Self-determination and gender-power relations as predictors of condom use self-efficacy among South African women. Health Psychol Open 2015; 2:2055102915598676. [PMID: 28070366 PMCID: PMC5193249 DOI: 10.1177/2055102915598676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article identifies correlates of condom use self-efficacy using concepts from self-determination theory and gender–power measures. A cross-section of Xhosa-speaking women (n = 238) from Eastern Cape, South Africa, was used to conduct bivariate correlations and multivariate linear regression analyses. Gender equality beliefs and HIV knowledge were positively associated with condom use self-efficacy generally and in risky situations. Condom use self-efficacy generally was also positively associated with power balance attitudes, negative beliefs about intimate partner violence, and positive growth perspective, while the association with hopeless personal perspective was negative. Surprisingly, lack of social support was positively associated with condom use self-efficacy in risky situations. The predictors of condom use self-efficacy identified in this study that may serve as change objectives for future sexual health promotion interventions.
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Implementation of couples' voluntary HIV counseling and testing services in Durban, South Africa. BMC Public Health 2015; 15:601. [PMID: 26136116 PMCID: PMC4489128 DOI: 10.1186/s12889-015-1959-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/22/2015] [Indexed: 01/21/2023] Open
Abstract
Background Couples’ voluntary HIV counseling and testing (CVCT) is an evidence-based intervention that significantly reduces HIV incidence in couples. Despite the high prevalence of HIV and HIV couple serodiscordance in South Africa, there are few CVCT services. Methods From February-June 2013, The Rwanda Zambia HIV Research Group provided support, training, and technical assistance for local counselors and promoters to pilot CVCT services in five hospital-based clinics in Durban, South Africa. Client-level data (age, gender, years cohabiting, pregnancy status, previous testing, antiretroviral treatment (ART) status, neighborhood, and test site) collected as a component of routine CVCT service operation is presented stratified by couple serostatus. Results Twenty counselors and 28 promoters completed training. Of 907 couples (1,814 individuals) that underwent CVCT, prevalence of HIV was 41.8 % and prevalence of HIV serodiscordance was 29.5 % (19.3 % M-F+, 10.3 % M + F-). Most participants were 25–34 years of age, and this group had the highest prevalence. Previous individual HIV testing was low (50 % for men, 63 % for women). Only 4 % of couples reported previous CVCT. Most (75 %) HIV+ partners were not on ART, and HIV+ individuals in discordant couples were more likely to be on ART than those in concordant positive couples. Pregnancy among HIV+ women was not associated with previous HIV testing or ART use. Conclusions Implementation of standard CVCT services was found to be feasible in Durban. The burden of HIV and couple serodiscordance in Durban was extremely high. CVCT would greatly benefit couples in Durban as an HIV prevention strategy.
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Wagner GJ, Hoover M, Green H, Tohme J, Mokhbat J. Social, Relational and Network Determinants of Unprotected Anal Sex and HIV Testing Among Men Who Have Sex with Men in Beirut, Lebanon. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2015; 27:264-275. [PMID: 26535073 PMCID: PMC4628817 DOI: 10.1080/19317611.2014.969467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/06/2014] [Accepted: 09/22/2014] [Indexed: 06/01/2023]
Abstract
Social, relational and network determinants of condom use and HIV testing were examined among 213 men who have sex with men (MSM) in Beirut. 64% reported unprotected anal intercourse (UAI), including 23% who had UAI with unknown HIV status partners (UAIU); 62% had HIV-tested. In multivariate analysis, being in a relationship was associated with UAI and HIV testing; lower condom self-efficacy was associated with UAIU and HIV testing; gay discrimination was associated with UAIU; MSM disclosure was associated with UAI, UAIU and HIV testing; and network centralization was associated with HIV testing. Multi-level social factors influence sexual health in MSM.
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Affiliation(s)
| | | | | | - Johnny Tohme
- Lebanese AIDS Society, Beirut, Lebanon ; Marsa, Sexual Health Centre, Beirut, Lebanon
| | - Jacques Mokhbat
- Lebanese AIDS Society, Beirut, Lebanon ; Division of Infectious Diseases, University Medical Center Rizk Hospital, Beirut, Lebanon
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Lee L, Bastos FI, Bertoni N, Malta M, Kerrigan D. The role of HIV serostatus disclosure on sexual risk behaviours among people living with HIV in steady partnerships in Rio de Janeiro, Brazil. Glob Public Health 2014; 9:1093-106. [PMID: 25223980 DOI: 10.1080/17441692.2014.952655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Understanding partnership dynamics is a crucial step in the process of HIV serostatus disclosure to partners. This study examines the relational characteristics associated with HIV serostatus disclosure and the role of disclosure on sexual behaviours within steady partnerships among people living with HIV (PLHIV) in Rio de Janeiro, Brazil. The overall study surveyed 900 participants from six large public health facilities to investigate psychosocial and structural factors associated with sexual health and well-being. This analysis focuses on 489 individuals reporting being in steady partnerships, 86% of whom reported HIV serostatus disclosure to steady partners. After adjusting for demographic variables, attitudes towards disclosure, having an HIV-positive partner, living with partner and longer relationships were significantly associated with reported disclosure in multivariable logistic regression. Living with partner was negatively associated with partner concurrency. However, having an HIV-positive partner, sex under the influence of drugs or alcohol and experiencing physical aggression by a steady partner were negatively associated with consistent condom use. Interventions supporting PLHIV to safely and voluntarily disclose to partners may be an effective prevention approach between steady partners; however, partner violence and substance use should be addressed in future work.
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Affiliation(s)
- Lana Lee
- a Department of Paediatrics , Johns Hopkins School of Medicine , Baltimore , MD , USA
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Lippman SA, Treves-Kagan S, Gilvydis JM, Naidoo E, Khumalo-Sakutukwa G, Darbes L, Raphela E, Ntswane L, Barnhart S. Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa. PLoS One 2014; 9:e102904. [PMID: 25028976 PMCID: PMC4100930 DOI: 10.1371/journal.pone.0102904] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa. METHOD The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews. RESULTS We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV. CONCLUSIONS Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.
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Affiliation(s)
- Sheri A. Lippman
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Sarah Treves-Kagan
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Jennifer M. Gilvydis
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Evasen Naidoo
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Gertrude Khumalo-Sakutukwa
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Lynae Darbes
- University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America
| | - Elsie Raphela
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Lebogang Ntswane
- University of Washington, International Training and Education Center for Health (ITECH) – South Africa, Pretoria, South Africa
| | - Scott Barnhart
- University of Washington, International Training and Education Center for Health, Seattle, Washington, United States of America
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