期刊
SEXUALLY TRANSMITTED INFECTIONS
卷 93, 期 -, 页码 -出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/sextrans-2016-052976
关键词
HIV; Couples; Relationships; Tanzania; Malawi; South Africa
资金
- Bill and Melinda Gates Foundation [OPP1082114]
- Wellcome Trust [085477/Z/08/Z]
- National Institute Of Allergy and Infectious Diseases (NIAID)
- Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD)
- National Institute on Drug Abuse (NIDA)
- National Cancer Institute (NCI)
- National Institute of Mental Health (NIMH)
- National Institutes of Health [U01AI069911]
- Population Health Scientist award
- UK Medical Research Council (MRC)
- UK Department for International Development (DFID) under the MRC/DFID Concordat
- European Union
- Bill and Melinda Gates Foundation [OPP1082114] Funding Source: Bill and Melinda Gates Foundation
- MRC [G0902143] Funding Source: UKRI
Objective To explore the interplay between couple dynamics and the engagement of people living with HIV (PLHIV) with HIV care and treatment services in three health and demographic surveillance sites in Tanzania, Malawi and South Africa. Methods A qualitative study was conducted involving 107 in-depth interviews with PLHIV with a range of HIV care and treatment histories, including current users of HIV clinics, and people not enrolled in HIV care. Interviews explored experiences of living with HIV and how and why they chose to engage or not with HIV services. Thematic analysis was conducted with the aid of NVivo 10. Results We found an interplay between couple dynamics and HIV care and treatment-seeking behaviour in Tanzania, Malawi and South Africa. Being in a relationship impacted on the level and type of engagement with HIV services in multiple ways. In some instances, couples living with HIV supported each other which improved their engagement with care and strengthened their relationships. The desire to fulfil societal expectations and attract a new partner, or have a baby with a new partner, or to receive emotional or financial support, strengthened on-going engagement with HIV care and treatment. However, fear of blame, abandonment or abuse resulted in unwillingness to disclose and often led to disputes or discord between couples. There was little evidence of intracouple understanding of each other's lived experiences with HIV, and we found that couples rarely interacted with the formal health system together. Conclusions Couple dynamics influenced engagement with HIV testing, care and treatment for both partners through a myriad of pathways. Couple-friendly approaches to HIV care and treatment are needed that move beyond individualised care and which recognise partner roles in HIV care engagement.
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