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Lelaka CM, Moyo I, Tshivhase L, Mavhandu-Mudzusi AH. Psychosocial support for HIV serodiscordant couples. Health Psychol Behav Med 2022; 10:537-556. [PMID: 35756334 PMCID: PMC9225695 DOI: 10.1080/21642850.2022.2084098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
| | - Idah Moyo
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Livhuwani Tshivhase
- Department of Nursing Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Bantigen K, Kitaw L, Negeri H. Lived Experience and Risk Reduction Behaviors Among Sero-Negative Discordant Male Partners Living with HIV-Positive Women in Addis Ababa, Ethiopia, 2019: A Qualitative Phenomenological Study. HIV AIDS (Auckl) 2022; 14:119-128. [PMID: 35341217 PMCID: PMC8943827 DOI: 10.2147/hiv.s353286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to explore lived experience and risk reduction behaviors among sero-negative, discordant male partners living with HIV-positive women in Addis Ababa, Ethiopia, 2019. Methods A phenomenological study was conducted to explore lived experience and risk reduction behaviors. The study participants were purposively selected 13 sero-negative male partners living with HIV-positive women. An in-depth interview was used to explore important information. A semi-structured interview guide was used to execute the in-depth interview. The in-depth interview was analyzed thematically through the support of ATLAS-ti 7 software. Results Scientific explanation of discordant result is not well understood rather, it is associated with religious, cultural, natural resistance, and passive carrier explanations. Sero-negative partners faced several challenges and lived dilemmatic life related to partner mood or behavioral change, maintaining the marital relationship, the desire of child, psychosocial, sexual life, and lack of support system. Risk reduction behaviors like condom use, safe sex practice, preventing sexually transmitted infection, avoiding substance use, continuous checkup and follow-up were not well reflected in their lived experience and were poorly understood. Personalized use of sharp materials to avoid blood contact and support of a partner in the proper use of ART drugs were positively reported risk reduction behaviors. Conclusion Sero-negative partners need special attention just as HIV-positive partners in couples with the discordant result. Life suffering is not limited to HIV-positive partners, rather sero-negative partners also faced several challenges and dilemmatic life. HIV transmission risk reduction behavior is not well established and understood.
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Affiliation(s)
- Kerebih Bantigen
- Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Kerebih Bantigen, Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251-912-248621, Email
| | - Leul Kitaw
- Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hawine Negeri
- Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
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Antonini M, Pontes PS, Melo ES, de Souza Alves R, Gir E, Sorensen W, Reis RK. Serodiscordance predictors among couples in the HIV context: implications for health care. BMC Public Health 2021; 21:1849. [PMID: 34645401 PMCID: PMC8513240 DOI: 10.1186/s12889-021-11835-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background After HIV diagnosis, people maintain, reestablish their sexual lives, or build new relationships, often with HIV seronegative partners. Therefore, understanding the factors concerning couple-vulnerability is essential in order to design effective HIV preventive strategies. We examined HIV serodiscordant couples prevalence and their associated factors from a Brazilian city. Methods This is a cross-sectional analytical study carried out with people living with HIV (PLHIV) who had an active sex life and were engagement in HIV health care follow-up. Data were collected using a semi-structured questionnaire during individual interviews. We analyzed data using bivariate and multiple logistic regression analyses. Results There was 72.0% of HIV serodiscordant partnerships. Those who inconsistently used condoms (aOR: 0.3[0.13–0.7]) and/or had HIV detectable viral load (aOR: 0.29 [0.12–0.7]) were less likely to have an HIV serodiscordant sexual partner. On other hand, the lack of HIV transmission counseling by the health service (aOR: 5.08 [2.02–12.76]), or those who had a casual partner (aOR: 8.12 [1.7–38.8]) or a steady and casual one concomitantly (aOR: 24.82 [1.46–420.83]), were more likely to indicate an HIV serodiscordant partnership. Conclusion The findings showed a high prevalence of serodiscordant partnerships in PLHIV. Greater visibility among couples in the health services is needed as well as a reassessment in order to provide PLHIV and their sexual partners with care strategies, by the health professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11835-0.
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Affiliation(s)
- Marcela Antonini
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil.
| | - Priscila Silva Pontes
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
| | - Elizabete Santos Melo
- Paulista University at São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Regina de Souza Alves
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
| | - Elucir Gir
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
| | - William Sorensen
- Department of Health and Kinesiology, University of Texas at Tyler, Tyler, TX, USA
| | - Renata Karina Reis
- Department of General and Specialized Nursing, University of São Paulo, Ribeirão Preto College of Nursing, Bandeirantes Ave, 3900, Vila Monte Alegre SP, CEP, Ribeirão Preto, 14040-902, Brazil
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Comrie-Thomson L, Mavhu W, Makungu C, Nahar Q, Khan R, Davis J, Stillo E, Hamdani S, Luchters S, Vaughan C. Male involvement interventions and improved couples' emotional relationships in Tanzania and Zimbabwe: 'When we are walking together, I feel happy'. CULTURE, HEALTH & SEXUALITY 2020; 22:722-739. [PMID: 31429674 DOI: 10.1080/13691058.2019.1630564] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 06/07/2019] [Indexed: 06/10/2023]
Abstract
Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men's and women's experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples' emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men's behaviour change, to improve care-seeking and home care practices. Men's and women's subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships - both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions.
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Affiliation(s)
- Liz Comrie-Thomson
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Webster Mavhu
- Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe
- International Public Health Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rasheda Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Stanley Luchters
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Bannink Mbazzi F, Namukwaya Z, Amone A, Ojok F, Etima J, Byamugisha J, Katabira E, Fowler MG, Homsy J, King R. "[Repeat] testing and counseling is one of the key [services] that the government should continue providing": participants' perceptions on extended repeat HIV testing and enhanced counseling (ERHTEC) for primary HIV prevention in pregnant and lactating women in the PRIMAL study, Uganda. BMC Public Health 2020; 20:694. [PMID: 32414405 PMCID: PMC7227345 DOI: 10.1186/s12889-020-08738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 04/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The 'Primary HIV Prevention among Pregnant and Lactating Ugandan Women' (PRIMAL) randomized controlled trial aimed to assess an enhanced counseling strategy linked to extended postpartum repeat HIV testing and enhanced counseling among 820 HIV-negative pregnant and lactating women aged 18-49 years and 410 of their male partners to address the first pillar of the WHO Global Strategy for the Prevention of Mother-to-Child HIV transmission (PMTCT). This paper presents findings of qualitative studies aimed at evaluating participants' and service providers' perceptions on the acceptability and feasibility of the intervention and at understanding the effects of the intervention on risk reduction, couple communication, and emotional support from women's partners. METHODS PRIMAL Study participants were enrolled from two antenatal care clinics and randomized 1:1 to an intervention or control arm. Both arms received repeat sexually transmitted infections (STI) and HIV testing at enrolment, labor and delivery, and at 3, 6, 12, 18 and 24 months postpartum. The intervention consisted of enhanced quarterly counseling on HIV risk reduction, couple communication, family planning and nutrition delivered by study counselors through up to 24 months post-partum. Control participants received repeat standard post-test counseling. Qualitative data were collected from intervention women participants, counsellors and midwives at baseline, midline and end of the study through 18 focus group discussions and 44 key informant interviews. Data analysis followed a thematic approach using framework analysis and a matrix-based system for organizing, reducing, and synthesizing data. RESULTS At baseline, FGD participants mentioned multiple sexual partners and lack of condom use as the main risks for pregnant and lactating women to acquire HIV. The main reasons for having multiple sexual partners were 1) the cultural practice not to have sex in the late pre-natal and early post-natal period; 2) increased sexual desire during pregnancy; 3) alcohol abuse; 4) poverty; and 5) conflict in couples. Consistent condom use at baseline was limited due to lack of knowledge and low acceptance of condom use in couples. The majority of intervention participants enrolled as couples felt enhanced counselling improved understanding, faithfulness, mutual support and appreciation within their couple. Another benefit mentioned by participants was improvement of couple communication and negotiation, as well as daily decision-making around sexual needs, family planning and condom use. Participants stressed the importance of providing counselling services to all couples. CONCLUSION This study shows that enhanced individual and couple counselling linked to extended repeat HIV and STI testing and focusing on HIV prevention, couple communication, family planning and nutrition is a feasible and acceptable intervention that could enhance risk reduction programs among pregnant and lactating women. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT01882998, date of registration 21st June 2013.
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Affiliation(s)
- Femke Bannink Mbazzi
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
- Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
| | - Zikulah Namukwaya
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Alexander Amone
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Juliane Etima
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, Kampala, Uganda
| | - Elly Katabira
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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Mthembu J, Hamilton AB, Milburn NG, Sinclair D, Mkabile S, Mashego M, Manengela T, Wyatt GE. "It Had a Lot of Cultural Stuff in It": HIV-Serodiscordant African American Couples' Experiences of a Culturally Congruent Sexual Health Intervention. Ethn Dis 2020; 30:269-276. [PMID: 32346272 DOI: 10.18865/ed.30.2.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective The increased life expectancy of people living with HIV has brought about an increase in serodiscordant couples, in which there is risk of HIV transmission. Therefore, interventions that promote sexual health and reduce risk are critical to develop for these couples. Given the disproportionate burden of HIV among populations of color, it is also critical that these interventions are culturally congruent. The EBAN intervention for African American serodiscordant couples recognizes the centrality of culture in shaping sexual behaviors and helps couples develop intimacy and positive prevention behaviors. The analytic objective of our study was to examine the knowledge and awareness gained by participants in the intervention. Participants Participants (n=17) who completed at least half of the eight intervention sessions. Methods Brief post-implementation semi-structured interviews were conducted between January 1, 2016 and December 31, 2016. Team-based, targeted content analysis focused on knowledge and awareness gains. Results Participants described learning about sexual health, expanded sexual options, and sexual communication. The "EBAN café," a component that gives couples a menu of options for safer sex behaviors, was particularly popular. Participants also noted the value of learning how to communicate with one another about their sexual health-related concerns and preferences. They appreciated the "cultural stuff" that was infused throughout the sessions, including the emphasis on learning from one another as couples. Conclusions Couples at risk for HIV transmission benefit from strengthening skills and knowledge related to healthy sexuality. A behavioral intervention that aligns with cultural values and imparts culturally congruent sexual health information appeals to couples who seek ways to enhance their intimacy and sexual options while also reducing risk.
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Affiliation(s)
- Jacqueline Mthembu
- Social Aspects of Public Health Research Programme, Human Sciences Research Council, South Africa
| | - Alison B Hamilton
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Norweeta G Milburn
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Deborah Sinclair
- Child and Family Studies, University of the Western Cape, South Africa.,Department of Special Needs Education, Ghent University, Belgium
| | - Siyabulela Mkabile
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mmathabo Mashego
- University of Venda, Limpopo, South Africa.,Department of Community Strengthening Systems, HIV South Africa, South Africa
| | | | - Gail E Wyatt
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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Manyaapelo T, Sifunda S, Ruiter RA, Nyembezi A, van den Borne B, Reddy P. Feeling Under Pressure: Perspectives of the Meaning of Love and Sexual Relationships Amongst Young Men in KwaZulu-Natal Province, South Africa. Am J Mens Health 2019; 13:1557988319836632. [PMID: 30895845 PMCID: PMC6440041 DOI: 10.1177/1557988319836632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 01/11/2023] Open
Abstract
This study aimed to explore perspectives on the meaning of love and sexual relations amongst young men in KwaZulu-Natal province of South Africa. Gaining insights into these perspectives will help to understand the sexual behaviors of these young men better and to eventually develop more effective HIV prevention interventions. Focus group discussions were conducted in two study areas using a predetermined semistructured discussion guide. The findings indicate that the phenomenon of romantic relationship try-outs together with the idea of "feeling under pressure" to propose love to more than one woman seem to be accepted practices that often lead to multiple concurrent sexual partners and therefore potentially risky sexual behaviors. The fear of impregnating a woman is seen to be of a more significant concern than acquiring a sexually transmitted infection due to the stigma and embarrassment associated with pregnancy outside marriage. Given these findings, it is recommended that future studies investigate perspectives on sexuality and reproductive health in male populations in great detail prior to the development of behavioral change interventions because failure to do so may hamper well-intended but poorly targeted health interventions.
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Affiliation(s)
- Thabang Manyaapelo
- Human Sciences Research Council, Population Health, Health Systems and Innovation, Pretoria, South Africa
| | - Sibusiso Sifunda
- Human Sciences Research Council, HIV/AIDS, STIs and TB, Pretoria,
Gauteng, South Africa
| | - Robert A.C. Ruiter
- Department of Work & Social Psychology, Maastricht University, Netherlands
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Bart van den Borne
- Department of Health Education & Health Promotion, Maastricht University, Netherlands
| | - Priscilla Reddy
- Human Sciences Research Council, Population Health, Health Systems and Innovation, Cape Town, Western Cape, South Africa
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