Abstract
BackgroundA 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.MethodsThis 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.ResultsThree 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.ConclusionsThe 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.
Highlights
A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples
Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples
The sample included eight HIV-negative men (26%), six HIV-positive men (19%), four HIV-negative women (13%), and 13 HIV-positive women (42%). Both members of a couple chose to participate, including two serodiscordant couples recruited from the selftesting component who chose not to participate in dyadic care and three serodiscordant couples who participated in dyadic care
Summary
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. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. Research has found rates of HIV seroconversion within married couples in Tanzania are higher than within the general population, with incidence rates among married women significantly greater than for married men [3] This finding reflects the significant gender differences regarding HIV infection and risk seen across sub-Saharan Africa, [4, 5] with girls and women disproportionately affected due to biological, social, cultural, and economic factors [6,7,8,9]. Choices for prevention are expanding for serodiscordant couples, but their effectiveness may depend on couples’ ability to take coordinated action regarding uptake and adherence
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