HIV Serodiscordant Relationships Research Articles

Psychosocial support for counselors working with HIV-Serodiscordant couples

ABSTRACT Living in HIV serodiscordant relationship poses psychosocial challenges to couples. These necessitate proper counseling. This paper explored the psychosocial support for counselors working with HIV-serodiscordant couples at a regional hospital. The study used descriptive and exploratory approaches, underpinned by an interpretative phenomenological analysis design (IPA). Participants were selected using a non-probability snowball sampling technique. A total of nine participants took part in the study. Data were collected using an in-depth interview guide and analyzed using an interpretive phenomenological analysis framework. Three themes emanated: knowledge deficiency on serodiscordancy among the counselors, limited/lack of support and ways to recommend HIV-serodiscordant couples services. The findings indicates that there is need to enhance, strengthen, and provide comprehensive psychosocial support services to discordant couples. To support and improve the knowledge, confidence and skills of counselors, the following should be implemented: provision of training, introducing debriefing sessions to reflect on discordant cases, follow-up on discordant couple’s post diagnosis to offer psychosocial support services, and establishment and strengthening of the support groups.

Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand

Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64–6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48–7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.

Psychosocial- and disclosure-related challenges among HIV-serodiscordant couples: an interpretative phenomenological analysis study

Background: Serodiscordant refers to a couple where one has human immunodeficiency virus (HIV), and the other partner is HIV negative. HIV-serodiscordancy often results in diverse psychological and emotional challenges. Evidence demonstrates that the dynamics of living in an HIV-serodiscordant relationship are often stressful. This study explored the psychosocial- and disclosure-related challenges faced by couples in HIV-serodiscordant relationships in South Africa. Methods: An interpretative phenomenological analysis (IPA) design was followed. A total of 13 HIV-serodiscordant partners were purposively sampled. Data were collected through individual face-to-face interviews and analysed using the IPA framework. Results: The findings indicated that HIV-serodiscordant couples experienced diverse psychosocial challenges such as shock, sadness, hurt, denial and disbelief. Participants also experienced challenges such as selective disclosure and fear of further disclosure. Conclusions: The findings have implications for public health and are critical in programming and designing couple-based HIV care interventions. Couples in HIV-serodiscordant relationships would benefit more from differentiated, client-centred psychosocial support. To contribute to the HIV epidemic control and reduction of new HIV infections, specific interventions such as couples counselling, disclosure counselling, support groups, health education and safer conception risk reduction strategies need to be implemented.

Psychosocial support for HIV serodiscordant couples

ABSTRACT Introduction South Africa has the largest HIV epidemic, with 8.2 million people living with the virus. It has a high HIV prevalence of 13.7% and 230,000 new infections in 2020. It is estimated that HIV serodiscordant couples contribute up to 60% of new HIV infections in sub-Saharan Africa. However, there have been no specific programmes/activities to deliberately cater for couples in HIV serodiscordant relationships. The purpose of this study was to examine the psychosocial support provided for HIV serodiscordant couples both in health care settings and in the community. Methods An interpretative phenomenological analysis (IPA) design was utilised for this study. In-depth interviews were conducted with thirteen HIV serodiscordant couples. Data collection was guided by an interview guide. All audio-recorded interview data were transcribed verbatim into written text. Data analysis was conducted using an interpretative phenomenological analysis framework. A third person-an expert in qualitative research, acted as an independent co-coder and conducted the open coding of each transcript. Findings The findings indicated that HIV serodiscordant couples received psychosocial support from their partners, family, and health care workers. This support was emotional, or in the form of counselling, reminders on taking medication, financial and household chores. The support provided by health care providers proved to be deficient and did not address the diverse needs of this group. Conclusion Psychosocial support plays a critical role in enhancing the quality of life of HIV serodiscordant couples. Therefore, client centred, and tailor-made interventions should be made available to this special with diverse needs group.

A national recruitment strategy for HIV-serodiscordant partners living in Canada for the Positive Plus One study: a mixed-methods study

BackgroundWith the recent shift in focus to addressing HIV risk within relationships and couple-based interventions to prevent HIV transmission, successful recruitment of individuals involved in HIV-serodiscordant relationships is crucial. This paper evaluates methods used by the Positive Plus One (PP1) study to recruit and collect data on a diverse national sample of dyads and individuals involved in current or past HIV-serodiscordant relationships, discusses the strengths and limitations of the recruitment approach, and makes recommendations to inform the interpretation of study results and the design of future studies.MethodsPP1 used a multi-pronged approach to recruit adults involved in a current or past HIV-serodiscordant relationship in Canada from 2016 to 2018 to complete a survey and an interview. Upon survey completion, index (first recruited) partners were invited to recruit their primary current HIV-serodiscordant partner. We investigated participant enrollment by recruitment source, participant-, relationship-, and dyad-level sociodemographic characteristics, missing data, and correlates of participation for individuals recruited by their partners.ResultsWe recruited 613 participants (355 HIV-positive; 258 HIV-negative) across 10 Canadian provinces, including 153 complete dyads and 307 individuals who participated alone, and representing 460 HIV-serodiscordant relationships. Among those in current relationships, HIV-positive participants were more likely than HIV-negative participants to learn of the study through an ASO staff member (36% v. 20%, p < 0.001), ASO listserv/newsletter (12% v. 5%, p = 0.007), or physician/staff at a clinic (20% v. 11%, p = 0.006). HIV-negative participants involved in current relationships were more likely than HIV-positive participants to learn of the study through their partner (46% v. 8%, p < 0.001). Seventy-eight percent of index participants invited their primary HIV-serodiscordant partner to participate, and 40% were successful. Successful recruitment of primary partners was associated with longer relationship duration, higher relationship satisfaction, and a virally suppressed HIV-positive partner.ConclusionsOur findings provide important new information on and support the use of a multi-pronged approach to recruit HIV-positive and HIV-negative individuals involved in HIV-serodiscordant relationships in Canada. More creative strategies are needed to help index partners recruit their partner in relationships with lower satisfaction and shorter duration and further minimize the risk of “happy couple” bias.

Disclosure of HIV-serodiscordant relationships and association with viral suppression: results from the Positive Plus One study

ABSTRACT Background. Little is known about the effects of disclosure of HIV-serodiscordant relationships on clinical outcomes. We aimed to evaluate the effect of relationship disclosure on HIV viral suppression, and hypothesized that disclosure by HIV-positive and HIV-negative partners would be associated with viral suppression in the HIV-positive partner. Methods. We conducted a Canadian national online and telephone-administered survey of HIV-positive and HIV-negative partners in serodiscordant relationships. The primary outcome was self-reported viral suppression. Multivariable analyses were undertaken using Firth logistic regression. Results. We recruited 540 participants in current serodiscordant relationships (n = 228 HIV-negative; n = 312 HIV-positive). Similar proportions of HIV-positive and HIV-negative partners disclosed their relationship to healthcare professionals (82% v. 76%, p = 0.13). Among HIV-positive partners, disclosure of the relationship to healthcare professionals increased the odds of viral suppression (aOR = 4.7; CI: 2.13, 10.51) after adjusting for age, education, and relationship turmoil due to HIV. Increasing age (aOR = 1.28; 95% CI = 1.07, 1.55) and education (aOR = 2.43; 95% CI = 1.15, 5.26) were also associated with viral suppression. Among HIV-negative partners, relationship disclosure was not associated with viral suppression and HIV-negative heterosexual men were less likely to report that their HIV-positive partners were virally suppressed (aOR = 0.24; CI: 0.09, 0.61). Conclusions. Disclosure of HIV-serodiscordant status by HIV-positive participants to healthcare professionals was associated with increased odds of viral suppression. Similar effects were not evident among HIV-negative participants. Future work should explore factors that empower relationship disclosure and incorporate them into supportive services for HIV-serodiscordant relationships.

Life loaded with threat and vulnerability: a qualitative inquiry into the experiences of HIV negative married women in serodiscordant heterosexual relationships

BackgroundViolence against women is a major, complex, multidimensional and widespread public health concern worldwide. The current qualitative study was conducted to understand the experience of violence among HIV negative married women in heterosexual serodiscordant relationships.MethodsA qualitative description (QD) was conducted from October 2018 to January 2020 in Mashhad, Iran. The participants were 15 HIV negative women, who married and lived with HIV positive men, through purposive sampling method. The data were collected using semi-structured interviews. Data analyzed using conventional content analysis adopted by Graneheim and Lundman.ResultsThe main overarching theme emerged entitled: life loaded with threat and vulnerability. This theme consisted of four categories of self-directed violence, intimate partner violence, cultural violence and structural violence. The violence began soon after awareness of husband's infection with acts such as suicide attempts and a sense of abhorrence for living with an infected person, and continued with confrontation with various types of violence in the family and society, which put women in constant threat and vulnerability.ConclusionsThis study provided an insight into different aspects of violence in Iranian women in HIV serodiscordant relationships. Considering the role of men in the occurrence of violence, policymakers must create and execute family-centered interventions to address attitudes and behaviors that lead to marital conflicts and spousal abuse in order to prevent violence. Health care professionals should also be trained to screen women for violence and refer those who require care to specialists to reduce vulnerability.

Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

IntroductionDespite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua...

Use of fertility awareness methods as a safer conception strategy for women in HIV serodiscordant relationships

To assess the use of fertility awareness methods [FAM] and evaluate the drivers of alignment between indicators of fertility and sexual behavior among HIV serodiscordant couples attempting pregnancy.

Sero-risk neutral and sero-risk averse: perceptions of risk and condom use among Black African heterosexual migrant couples in serodiscordant relationships in the UK.

This paper explores how perceptions of risk of infecting HIV-negative partners influence condom use among Black African heterosexual couples in stable relationships with one partner living with HIV (serodiscordant relationships). Twenty-five in-depth couple and individual interviews were analysed through phenomenological reflection and writing. A major finding was that in attempts to preserve their relationships, couples debated condom use strategies based on their perceptions of risk of infecting HIV-negative partners. We recommend that HIV prevention information among Black African heterosexual couples with a partner living with HIV should be understood from the perceptions of risk from both partners.

The relationship between dyadic coping and dyadic adjustment among HIV-serodiscordant couples

ABSTRACT Living within an HIV-serodiscordant relationship has been recognized as a stressful experience for both HIV-infected and HIV-uninfected partners. However, no study has examined the association between dyadic coping (DC) and dyadic adjustment of such couples. In this study, we analysed the association between DC (positive, negative, and common DC) and dyadic adjustment (consensus, satisfaction, cohesion) among HIV-serodiscordant couples, considering individual and cross-partner effects. This cross-sectional study included a sample of 44 HIV-serodiscordant different-sex couples, in a relationship for an average of 16.46 years. The self-reported measures included the Dyadic Coping Inventory and the Revised Dyadic Adjustment Scale. For HIV-infected partners, their own common DC was significantly associated with cohesion, and a cross-partner effect of common DC on satisfaction was found. For HIV-uninfected partners, individual effects of common DC on all dyadic adjustment subscales and a cross-partner effect of common DC on cohesion were found. Additionally, their own and their HIV-infected partners’ negative DC were significantly associated with cohesion and satisfaction, respectively. These findings suggest that the perception of common DC has a particularly important role in explaining the different components of dyadic adjustment of both partners facing HIV-serodiscordancy, whereas negative DC is linked to the adjustment of HIV-uninfected partners.

Barriers to Testing for Sexually Transmitted Infections among HIV-Serodiscordant Couples: The Influence of Discrimination.

African Americans face challenges in accessing services for sexually transmitted infections (STIs). From 2012-2016, the EBAN II intervention was funded by the NIH to test the effectiveness of implementing a culturally congruent, evidence-based HIV/AIDS prevention program in Los Angeles and Oakland, California. This study examined the impact of personal characteristics and experiences of discrimination on the likelihood of being tested for STIs. Participants (N=91) completed a baseline survey. Descriptive statistics were used to test for differences between those who did and did not obtain STI testing. Factors included HIV serostatus, sociodemographic variables, STI history, the presence of outside partners, and discrimination experiences. Multiple logistic regressions were conducted for men and women separately. Participants with no recent experiences of discrimination were more than 3 (3.4) times more likely to obtain a baseline STI test than those who reported discrimination experiences. HIV-positive women with no recent experiences of discrimination were 11 times more likely than those with reports of recent discrimination to obtain STI tests. It is often women who are the gatekeepers for health seeking in families and the same may be for these couples. Experiences of discrimination may impede STI testing, and heighten several health risks, particularly among HIV-positive African American women in HIV-serodiscordant relationships. Addressing the impact of discrimination experiences may be important for STI prevention and treatment efforts in interventions promoting health care utilization.

Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women.

ABSTRACTBackground: Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives. The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions. The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships.Methods: This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered.Results: The main overarching theme which emerged from the qualitative study was “threats to family life”, consisting of five categories along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family.Conclusion: This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also, our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.

Caring Masculinities in the Context of HIV Serodiscordant Relationships in Papua New Guinea

Globally, there is limited research exploring the positive role men play in reducing HIV vulnerability or in the care and support of women living with HIV. This paper draws on interviews conducted with men and women in heterosexual HIV serodiscordant relationships as part of a longitudinal qualitative study exploring the social aspects of biomedicine among serodiscordant couples in two high HIV-burden areas in Papua New Guinea (PNG). Findings highlight that some HIV negative men in heterosexual relationships are resisting hegemonic masculine norms they see as harmful and are embracing caring masculine identities as they seek to support their HIV-positive wives. We suggest that understandings of masculinity in the context of the HIV epidemic in PNG should be broadened from simplistic discourses and representations of men as largely uncaring and violent to incorporate deeper understanding of how men can and are embracing caring masculinities.

Partner HIV Serostatus Impacts Viral Load, Genital HIV Shedding, and Immune Activation in HIV-Infected Individuals.

Studies of seronegative individuals in HIV discordant relationships provide important insights into the effects of HIV exposure on the seronegative partner, but few have examined the impact of partner serostatus on disease progression in seropositive individuals. We investigated the impact of HIV serostatus on clinical and biological factors influencing HIV disease progression in 337 HIV-infected heterosexual individuals in stable long-term HIV-seroconcordant or HIV-serodiscordant relationships. Seroconcordant individuals had significantly higher plasma viral loads (pVLs) than HIV-infected partners in serodiscordant partnerships [4.4 log10 copies RNA/mL (interquartile range 3.7-5.0) versus 3.9 (3.3-4.5), P < 0.0001], irrespective of gender. pVLs correlated inversely with CD4 T-cell counts, although CD4 counts did not differ significantly between seroconcordant and serodiscordant individuals. HIV+ seroconcordant individuals had higher frequencies of CCR5 CD4 and CD8 T cells (P = 0.03 and P = 0.02, respectively) than HIV+ individuals in serodiscordant relationships and higher concentrations of plasma IL-1β (P = 0.04), TNF-α (P = 0.02), and IL-10 (P = 0.02). Activated CD4 T-cell frequencies and TNF-α were the most influential in determining variation in pVLs, independently of CD4 counts. In addition, HIV+ seroconcordant women had significantly higher genital VLs (gVLs) than HIV+ women in serodiscordant relationships (P < 0.001), with pVLs correlating significantly with gVLs (Rho = 0.65, P < 0.0001). Cervical and blood T-cell activation tended to correlate positively, although partner seroconcordance did not influence genital T-cell activation. We conclude that HIV+ seroconcordant individuals have higher frequencies of activated, CCR5-expressing T cells in blood and higher pVLs and gVLs than their HIV+ counterparts in discordant relationships, which could translate to faster disease progression or larger viral reservoir.

Perceptions of pregnancy occurring among HIV-serodiscordant couples in Kenya

BackgroundAmong HIV serodiscordant couples, most conception involves condomless sex and may confer a period with increased HIV transmission risk if HIV viral load is not suppressed and other precautions are not used. Safer conception strategies enable HIV serodiscordant couples to attain their pregnancy goals while markedly reducing this risk. We explored the perceptions and beliefs held by HIV serodiscordant couples and health care providers concerning pregnancy among HIV serodiscordant couples in Kenya and gathered their thoughts about how these might influence use of safer conception methods.MethodsWe conducted 20 Key Informant Interviews (KIIs) with health care providers offering safer conception counseling and 21 In-Depth Interviews (IDIs) and 4 Focus Group Discussions (FGDs) with members of HIV serodiscordant couples with immediate pregnancy goals in Thika, Kenya. Data were analyzed using an inductive approach that identified two emergent themes: perceptions towards pregnancy among HIV serodiscordant couples and access to safer conception services.ResultsThe perceptions held by the community towards couples in HIV serodiscordant relationships having children were largely negative. The participants were aware of the increased HIV transmission risk to the HIV uninfected partners while trying to become pregnant. In the community, having biological children was cherished yet the majority of the couples shied away from accessing safer conception services offered at health facilities due to stigma and lack of knowledge of the existence of such services. Some providers had limited knowledge on safer conception strategies and services and consequently discouraged HIV serodiscordant couples from natural conception.ConclusionsNegative perceptions towards HIV serodiscordant couples becoming pregnant has hindered access to safer conception services. Therefore, there is need to create a supportive environment for HIV serodiscordant couples with fertility intentions that normalizes their desire to have children and informs the community about the availability of safer conception services.

Prevalence and factors associated with fertility desires/intentions among individuals in HIV-serodiscordant relationships: asystematic review of empirical studies.

IntroductionBetter knowledge about fertility desires/intentions among HIV‐serodiscordant partners who face unique challenges when considering childbearing may be helpful in the development of targeted reproductive interventions. The aim of this systematic review was to synthesize the published literature regarding the prevalence of fertility desires/intentions and its associated factors among individuals in HIV‐serodiscordant relationships while distinguishing low‐ and middle‐income countries (LMIC) from high‐income countries (HIC).MethodsA systematic search of all papers published prior to February 2017 was conducted in four electronic databases (PubMed/MEDLINE, PsycINFO, Web of Science and Cochrane Library). Empirical studies published in peer‐reviewed journals with individuals in HIV‐serodiscordant relationships assessing the prevalence of fertility desires/intentions and/or the associated factors were included in this systematic review. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.Results and discussionAfter screening 1852 references, 29 studies were included, of which 21 were conducted in LMIC and eight in HIC. A great variability in the prevalence of fertility desires/intentions was observed in LMIC (8% to 84% (one member of the dyad included)). In HIC, the results showed a smaller discrepancy between in the prevalence (32% to 58% (one member of the dyad included)); the prevalence was higher when the couple was the unit of analysis (64% to 73%), which may be related to the fact that all these studies were conducted in the context of assisted reproduction. Few studies examined the factors associated with fertility desires/intentions, and all except one were conducted in LMIC. Individuals (e.g. number of children), couple‐level (e.g. belief that the partner wanted children) and structural factors (e.g. discussions with health workers) were found to be associated.ConclusionsThe results of this systematic review suggest that many individuals in HIV‐serodiscordant relationships have fertility desires/intentions, although the prevalence is particularly heterogeneous in LMIC in comparison to HIC. Well‐known factors such as younger age and a fewer number of living children were consistently associated with increased fertility desires/intentions. Different couple‐level factors emerged, reflecting the importance of considering both the individual and the couple. However, further studies that specifically focus on the dyad as the unit of analysis are warranted.

A High-throughput Bead-based Affinity Assay Enables Analysis of Genital Protein Signatures in Women At Risk of HIV Infection

Women at high risk of HIV infection, including sex workers and those with active genital inflammation, have molecular signatures of immune activation and epithelial barrier remodeling in samples of their genital mucosa. These alterations in the local immunological milieu are likely to impact HIV susceptibility. We here analyze host genital protein signatures in HIV uninfected women, with high frequency of condom use, living in HIV-serodiscordant relationships. Cervicovaginal secretions from women living in HIV-serodiscordant relationships (n = 62) were collected at three time points over 12 months. Women living in HIV-negative seroconcordant relationships (controls, n = 25) were sampled at one time point. All study subjects were examined for demographic parameters associated with susceptibility to HIV infection. The cervicovaginal samples were analyzed using a high-throughput bead-based affinity assay. Proteins involved in epithelial barrier function and inflammation were increased in HIV-serodiscordant women. By combining several methods of analysis, a total of five proteins (CAPG, KLK10, SPRR3, elafin/PI3, CSTB) were consistently associated with this study group. Proteins analyzed using the affinity set-up were further validated by label-free tandem mass spectrometry in a partially overlapping cohort with concordant results. Women living in HIV-serodiscordant relationships thus had elevated levels of proteins involved in epithelial barrier function and inflammation despite low prevalence of sexually transmitted infections and a high frequency of safe sex practices. The identified proteins are important markers to follow during assessment of mucosal HIV susceptibility factors and a high-throughput bead-based affinity set-up could be a suitable method for such evaluation.

Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era

The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.

Sexual Health Consequences of Forced Sexual Debut Among Ugandan Women in HIV Serodiscordant Partnerships: Results From the HAARP Study.

Sexual coercion, especially forced sexual debut, is associated with lifelong adverse health consequences. This is compounded in regions, such as Uganda, where the dual impact of HIV and violence critically shapes women's sexual health risks. Among a sample of women in HIV serodiscordant relationships, we investigated the prevalence and consequences of forced sexual debut. Data for this analysis come from the Highly Active Antiretroviral Treatment as Prevention (HAARP) Study, a cohort of HIV serodiscordant couples in Jinja, Eastern Uganda, and investigates the role of forced sexual debut on two outcomes: age of sexual debut and having more than three lifetime sexual partners. Bivariate and multivariate linear regressions were used to model age at sexual debut using β and adjusted (A) β and 95% confidence intervals (CIs). Bivariate and multivariate logistic regressions were used to model having more than three lifetime sexual partners and used odds ratios (ORs) and adjusted OR (AOR) and 95% CI. A total of 574 women were included in this analysis, median age 35 years, and 241 (41.99%) were living with HIV. A quarter (24.21%) of women experienced forced sexual debut at the median age of 16 years. Forced sexual debut was significantly associated with earlier age of sexual debut (β = -1.17, 95% CI: [-1.64, -0.68]). Forced sexual debut was significantly associated with having more than three sexual partners (AOR: 1.99, 95% CI: [1.33, 2.99]), in addition to older age (AOR: 1.02, 95% CI: [1.01, 1.05]). Speaking Lusoga, the primary language in Jinja (the study site) was associated with lower odds of having more than three sexual partners (AOR: 0.63, 95% CI: [0.43, 0.92]). Forced sexual debut was a common experience significantly associated with younger age of sexual debut and higher number of lifetime sexual partners. Safe and consensual first sexual experiences for young women play an important role in reducing HIV risk and lay the foundation for healthy and safe sexual health.