Voices and Choices of HIV-serodiscordant Heterosexual Couples

Constance Matshidiso Lelaka

doi:10.55927/mudima.v4i1.7446

Authors

Constance Matshidiso Lelaka School of Human & Community Development, University of the Witwatersrand

DOI:

https://doi.org/10.55927/mudima.v4i1.7446

Keywords:

HIV, HIV-serodiscordant, Discordancy, Couple

Abstract

There is limited information regarding serodiscordancy. HIV-serodiscordant couples face challenges in their relationships, this is likely to threaten their relationship’s and they need psychosocial support from various sources to strengthen their quality of life and well-being. The study seeks to explore the voices and choices from HIV-serodiscordant heterosexual couples. This was a qualitative study, and thirteen (13) participants were purposively sampled. Data was collected using semi-structure interview guide and all interviews were held face-to-face at the hospital with participants and data was thematically analysed. The main overarching themes emerged from the qualitative included the following: perceptions regarding the limited knowledge on discordant couples, the importance of providing psychosocial to discordant couples, challenges facing discordant couples in relationships, and couple’s sexual and reproductive needs. The results suggests that there is limited knowledge and education on discordancy. There is need for discordant couple’s services and programmes that should be streamed lined to provide comprehensive and sufficient psychosocial support, mitigate challenges faced by discordant couples and promote couples sexual and reproductive health via the safer conception services ensuring reduction of HIV risk practices behaviours among the couples

References

Arrey AE, Bilsen J, Lacor P, Deschepper R (2015) “It’s My Secret”: Fear of Disclosure among Sub-Saharan African Migrant Women Living with HIV/AIDS in Belgium. PLoS ONE 10(3): e0119653. https://doi.org/10.1371/journal.pone.011965.

Burton, J., Darbes, L. A., & Operario, D. (2010). Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of evidence. AIDS and behavior, 14(1), 1–10. https://doi.org/10.1007/s10461-008-9471-4

Carrico, A. W., & Antoni, M. H. (2008). Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: a review of randomized controlled trials. Psychosomatic medicine, 70(5), 575–584. https://doi.org/10.1097/PSY.0b013e31817a5d30.

Denson, D. J., Gelaude, D., & Schoua-Glusberg, A. (2022). “We in This Fight Together…”: HIV Treatment and Prevention Among Couples of HIV-Discordant Black and Latino Men Who Have Sex with Men. Journal of Prevention and Health Promotion, 3(4), 419-444. https://doi.org/10.1177/26320770221074979

Dipeolu I. O. (2014). HIV and AIDS in Workplace: The role of behaviour antecedents on behavioural intentions. African journal of medicine and medical sciences, 43(Suppl 1), 131–140.

Gari S, Doig-Acuna C, Smail T, Malungo JR, Martin-Hilber A, Merten S: Access to HIV/AIDS care: a systematic review of socio-cultural determinants in low- and high-income countries. BMC Health Serv Res. 2013, 13: 198-10.1186/1472-6963-13-198.Giordano TP (2015). The HIV treatment cascade-a new tool in HIV prevention. JAMA Internal Medicine, 175(4), 596–597. http://jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.8199 [PubMed: 25706538]

Greener, R., Milford, C., Bajunirwe, F., Mosery, F. N., Ng, C. K., Rifkin, R., Kastner, J., Pillay, L., Kaida, A., Bangsberg, D. R., Smit, J. A., & Matthews, L. T. (2018). Healthcare providers' understanding of HIV serodiscordance in South Africa and Uganda: implications for HIV prevention in sub-Saharan Africa. African journal of AIDS research: AJAR, 17(2), 137–144. https://doi.org/10.2989/16085906.2018.1462217.

George S, Garth B, Wohl AR, Galvan FH, Garland W, & Myers HF (2009). Sources and types of social support that influence engagement in HIV care among Latinos and African Americans. Journal of Health Care for the Poor and Underserved, 20(4), 1012–1035. https://dx.doi.org/10.1353%2Fhpu.0.0210.

Feigerlová, E., Pascal, V., Ganne-Devonec, M. O., Klein, M., & Guerci, B. (2019). Fertility desires and reproductive needs of transgender people: Challenges and considerations for clinical practice. Clinical endocrinology, 91(1), 10–21. https://doi.org/10.1111/cen.13982.

Heffron, R., Ngure, K., Velloza, J., Kiptinness, C., Quame-Amalgo, J., Oluch, L., Thuo, N., Njoroge, J., Momanyi, R., Gakuo, S., Mbugua, S., Morrison, S., Haugen, H., Chohan, B., Celum, C., Baeten, J. M., & Mugo, N. (2019). Implementation of a comprehensive safer conception intervention for HIV-serodiscordant couples in Kenya: uptake, use and effectiveness. Journal of the International AIDS Society, 22(4), e25261. https://doi.org/10.1002/jia2.25261

Insight Start Study Group (2015). Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine, 373(9), 795–807. https://dx.doi.org/10.1056%2FNEJMoa1506816 [PubMed: 26192873]

Jones, D., Kashy, D., Chitalu, N., Kankasa, C., Mumbi, M., Cook, R., & Weiss, S. (2014). Risk reduction among HIV-seroconcordant and -discordant couples: the Zambia NOW2 intervention. AIDS patient care and STDs, 28(8), 433–441. https://doi.org/10.1089/apc.2014.0039.

King, R., Wamai, N., Khana, K. et al. (2012). “Maybe his blood is still strong”: a qualitative study among HIV-sero-discordant couples on ART in rural Uganda. BMC Public Health 12, 801. https://doi.org/10.1186/1471-2458-12-801

Larki, M., Bahri, N., Moghri, J., & Latifnejad Roudsari, R. (2020). Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women. International journal of community based nursing and midwifery, 8(2), 103–115. https://doi.org/10.30476/IJCBNM.2020.82845.1093.

Lehavot, K., Stappenbeck, C. A., Luterek, J. A., Kaysen, D., & Simpson, T. L. (2014). Gender differences in relationships among ptsd severity, drinking motives, and alcohol use in a comorbid alcohol dependence and ptsd sample. Psychology of Addictive Behaviors, 28(1), 42-52. doi:10.1037/a0032266.

Lelaka, Constance Matshidiso & Tshivhase, Livhuwani & Moyo, Idah & Ndou, Nthomeni & Mavhandu-Mudzusi, Azwihangwizi. (2022). Psychosocial- and disclosure-related challenges among HIV-serodiscordant couples: an interpretative phenomenological analysis study. F1000Research. 11. 1247. 10.12688/f1000research.125411.1

Lelaka, C. M., Moyo, I., Tshivhase, L., & Mavhandu-Mudzusi, A. H. (2022). Psychosocial support for HIV serodiscordant couples. Health psychology and behavioral medicine, 10(1), 537–556. https://doi.org/10.1080/21642850.2022.2084098

Lelaka, Constance Matshidiso (2014) The experiences of HIV sero-discordant couples at the Perinatal HIV Research Unit in Soweto, Gauteng Province, University of South Africa, Pretoria, http://hdl.handle.net/10500/14385.

Lingappa JR, Lambdin B, Bukusi EA, Ngure K, Kavuma L, Inambao M, … Rees H (2008). Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial. PLoS ONE, 3(1). 10.1371/journal.pone.0001411

Loutfy MR, Hart TA, Mohammed SS, Su D, Ralph ED, Walmsley SL, et al. (2009) Fertility Desires and Intentions of HIV-Positive Women of Reproductive Age in Ontario, Canada: A Cross-Sectional Study. PLoS ONE 4(12): e7925. https://doi.org/10.1371/journal.pone.0007925

Mackelprang, R. D., Bosire, R., Guthrie, B. L., Choi, R. Y., Liu, A., Gatuguta, A., Rositch, A. F., Kiarie, J. N., & Farquhar, C. (2014). High rates of relationship dissolution among heterosexual HIV-serodiscordant couples in Kenya. AIDS and behavior, 18(1), 189–193. https://doi.org/10.1007/s10461-013-0529-6.

Mashaphu, S., Wyatt, G. E., Gomo, E., & Tomita, A. (2018). Intimate partner violence among HIV-serodiscordant couples in Durban, South Africa. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 108(11), 960–964. https://doi.org/10.7196/SAMJ.2018.v108i11.13095.

Mashaphu S, Burns JK. Couples-based interventions in the context of HIV discordance. S Afr J Psychiat. 2017;23(0), a1009. https://doi.org/10.4102/ sajpsychiatry.v23i0.1009.

Mbuagbaw L, Thabane L, Ongolo-Zogo P, et al. Trends and determining factors associated with adherence to antiretroviral therapy (ART) in Cameroon: a systematic review and analysis of the CAMPS trial. AIDS Res Ther 2012; 9:1–10. doi:10.1186/1742-6405-9-37

McCrady, B. S., Tonigan, J. S., Ladd, B. O., Hallgren, K. A., Pearson, M. R., Owens, M. D., & Epstein, E. E. (2019). Alcohol behavioral couple therapy: In-session behaviour, active ingredients, and mechanisms of behavior change. Journal of Substance Abuse Treatment, 99, 139-148. doi:10.1016/j.jsat.2019.01.018.

McKenna, S. L., Muyinda, G. K., Roth, D., Mwali, M., Ng'andu, N., Myrick, A., Luo, C., Priddy, F. H., Hall, V. M., von Lieven, A. A., Sabatino, J. R., Mark, K., & Allen, S. A. (1997). Rapid HIV testing and counseling for voluntary testing centers in Africa. AIDS (London, England), 11 Suppl 1, S103–S110.

Morton, J. F., Celum, C., Njoroge, J., Nakyanzi, A., Wakhungu, I., Tindimwebwa, E., Ongachi, S., Sedah, E., Okwero, E., Ngure, K., Odoyo, J., Bulya, N., Haberer, J. E., Baeten, J. M., Heffron, R., & Partners Demonstration Project Team (2017). Counselling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention. Journal of acquired immune deficiency syndromes (1999), 74 Suppl 1(Suppl 1), S15–S22. https://doi.org/10.1097/QAI.0000000000001210

Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A, Merten S: A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Publ Health. 2013, 13: 220-10.1186/1471-2458-13-220

Ngure, K., Mugo, N., Celum, C., Baeten, J. M., Morris, M., Olungah, O., Olenja, J., Tamooh, H., & Shell-Duncan, B. (2012). A qualitative study of barriers to consistent condom use among HIV-1 serodiscordant couples in Kenya. AIDS care, 24(4), 509–516. https://doi.org/10.1080/09540121.2011.613911

Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8(1), 161-187. doi:10.1146/annurev-clinpsy032511-143109.

Rapid Response Service. Rapid Response: Disclosure of HIV-Positive Status. Toronto, ON: Ontario HIV Treatment Network: March 2013. Updated November 2014.

Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Van Lunzen J, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Asboe D, Viciana P, Gutiérrez F, Clotet B, Pradier C, Gerstoft J, Weber R, Westling K, Wandeler G, … Lundgren J (2016). Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 316(2), 171–181. 10.1001/jama.2016.5148 [PubMed: 27404185]

Saraswat, N., Chopra, A., Kumar, S., Agarwal, R., Mitra, D., & Kamboj, P. (2019). A Cross-sectional Study to Analyze the Social, Sexual, and Reproductive Challenges among Serodiscordant Couples. Indian journal of dermatology, 64(5), 377–382. https://doi.org/10.4103/ijd.IJD_367_18.

Schlebusch, L., & Vawda, N. (2010). HIV-infection as a self-reported risk factor for attempted suicide in South Africa. African journal of psychiatry, 13(4), 280–283. https://doi.org/10.4314/ajpsy.v13i4.61877

Ware, N. C., Wyatt, M. A., Haberer, J. E., Baeten, J. M., Kintu, A., Psaros, C., ... & Bangsberg, D. R. (2012). What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV serodiscordant couples. Journal of acquired immune defic

Ware NC, Idoko J, Kaaya S, et al. (2009), Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS;6:e11. doi:10.1371/journal.pmed.1000011 defiency syndromes (1999), 59(5).

West N, Schwartz S, Phofa R, Yende N, Bassett J, Sanne I, & Van Rie A (2016). “I don’t know if this is right … but this is what I’m offering”: healthcare provider knowledge, practice, and attitudes towards safer conception for HIV-affected couples in the context of Southern African guidelines. AIDS Care, 28(3), 390–6. 10.1080/09540121.2015.1093596

WHO. (2012b). Guidance on pre-exposure oral prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: Recommendations for use in the context of demonstration projects. Geneva: 10.1162/LEON_r_00510