Abstract
IntroductionMandatory face-to-face counselling is necessary during HIV testing but difficult to implement within the context of HIV self-testing. We investigated adverse psychological effects and coping mechanisms following HIV-positive and HIV-discordant test results amongst self-tested individuals living in couples in urban Blantyre, Malawi.MethodsQualitative data from 35 in-depth interviews with self-tested individuals living in couples for more than 3 months were collected and analysed using thematic content analysis.ResultsAdverse psychological effects seemed to mostly occur among individuals learning for the first-time that they were HIV-positive or living in HIV-discordant relationship. Irrespective of test outcomes, women living in couples expressed difficulty making important decisions about the future of their relationships while men seemed to shoulder the emotional burden associated with feeling or being seen as responsible for introducing HIV into the relationship. Post-test psychosocial support and ascertained positive behaviour change of the perceived index partner allowed some couples to overcome adverse psychological effects linked to test results.ConclusionSelf-tested individuals living in couples may lack collective coping capability to collaboratively manage post-test adverse events after new HIV-positive or HIV-discordant results. Psychosocial support seemed to enable couples to foster both an individual and a collective ability to manage adverse psychological effects within the context of a couple. More research is needed to ascertain the magnitude of the deficiency of collective coping competency in couples following an HIV test.
Highlights
Mandatory face-to-face counselling is necessary during HIV testing but difficult to implement within the context of HIV self-testing
Adverse psychological effects seemed to mostly occur among individuals learning for the first-time that they were HIV-positive or living in HIV-discordant relationship
Self-tested individuals living in couples may lack collective coping capability to collaboratively manage post-test adverse events after new HIV-positive or HIV-discordant results
Summary
Qualitative data from 35 in-depth interviews with self-tested individuals living in couples for more than 3 months were collected and analysed using thematic content analysis. Adverse psychological effects in this study were defined as an uncomfortable feeling towards HIV-positive or HIV-discordant self-test results and could include nervousness or depression. How individuals recover after learning for the first-time that they are HIV-positive or are living in an HIV-discordant relationship may help us understand the immediate post-test reaction and how individuals or sexual partners as a collective unit overcome HIV test-related adverse psychological effects. We employed the self-efficacy theory framed within the social cognitive theory to understand the post-test reactions and coping competency after HIV-positive and HIV-discordant selftest results within a context of individuals living in heterosexual relationships. ‘Coping ability’ in this paper is defined as the capacity to successfully navigate and adequately manage feelings after a HIV-positive and HIV-discordant self-test results
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