“Being faithful” in a sexual relationship: perceptions of Tanzanian adolescents in the context of HIV and pregnancy prevention

Abstract

Little is known about what adolescents think about faithfulness and partner reduction for HIV prevention (the "B" in the ABC HIV prevention behavior change strategy), including how they understand its implementation within relationships. In addition, because adolescents face the twin threats of HIV and unintended pregnancy, it is important to understand how adolescents may integrate their thinking on pregnancy prevention if they are using faithfulness or partner reduction as their HIV prevention strategy. This study gathered evidence by conducting 20 focus group discussions (FGDs) with 158 adolescents, aged 14-20. The FGDs were stratified by sex, age, current school attendance, rural or urban residence, and marital status. Results showed that the vast majority of groups felt that "B" messages are important and relevant for unmarried (as well as married) youth to hear for HIV prevention, but the messages need to be explicit (e.g., "being faithful means having only one tested sexual partner at a time"). Faithful relationships are perceived as ideal in terms of romantic expectations and HIV prevention, but were considered unrealistic if the relationship had a power imbalance. Adolescents acknowledged the risks of multiple partners and a few recognized that concurrent partnerships are riskier than serial partnerships. Condoms were given as the primary method for pregnancy prevention among youth, yet faithfulness was usually seen as precluding condom use and many youth considered condom use as evidence of a lack of faithfulness. Overall, adolescents recognized that practicing fidelity is complex. Young people need life skills education for how to establish and maintain faithful relationships with one tested partner and how to integrate condom use for pregnancy prevention within that relationship. Programs also need to more explicitly address the issues of trust and repeat HIV testing within "faithful" relationships which is an uncomfortable but necessary reality for many adolescents.

Adherence and Acceptability in MTN 001: A Randomized Cross-Over Trial of Daily Oral and Topical Tenofovir for HIV Prevention in Women

“…Acceptability data from that trial highlighted the role that gel played in improving sex and increasing partner satisfaction, with this emerging as a more important (and empowering) benefit than product covertness (24). A microbicide product has the potential to be introduced as offering other sexual health benefits that may facilitate its use by women, particularly in the context of relationships where the introduction of a method perceived solely as a disease prevention device raises questions of relationship fidelity (25, 26). Indeed, adoption and use of condoms has been compromised in part because of such stigma.…”

Monogamy, the Protective Fallacy: Sexual versus Emotional Exclusivity and the Implication for Sexual Health Risk

“…In addition to its believed efficacy for reducing the risk of contracting an STI, monogamy also represents the sociocultural ideal of a relationship and signifies that the partners have reached a high level of commitment and trust (Baumgartner, Lugina, Johnson, & Nyamhanga 2010;Conley, Ziegler, Moors, Matsick & Valentine, 2013;Corbett, Dickson-Gomez, Hilario, & Weeks, 2009;Oswalt & Wyatt, 2011). Together these two factors should create a high degree of psychological and social pressure to form these dyadic relationships.…”

“…One explanation for this might be the meaning condom use implies within an ongoing relationship and the belief that relationship status itself confers a safe sexual environment. Therefore, research must begin to study ways to combat the perception that condom use implies a mistrust of one's partner (Baumgartner et al, 2010;Corbett et al, 2009) or that willingness to engage in unprotected sexual intercourse is indicative of an individual's commitment to or love of his or her partner (Bauman & Berman, 2005;Corbett et al, 2009;Rosenthal, Gifford, & Moore, 1998). Individuals seem to have obscured the line between trusting their partners emotionally and trusting that they would not infect them with an STI, something over which ''trust'' has no control.…”

“…We suggest that research focus on developing risk reduction programs targeted specifically to individuals in steady relationships (Baumgartner et al, 2010;Corbett et al, 2009;Vail-Smith et al, 2010) and to the particular psychosocial factors that impede sexual risk interventions with this population. First, interventions should specifically address what constitutes monogamous sexual behavior as well as the assumptions individuals make about a monogamous relationship.…”

Condom Use in the Context of Main and Casual Partner Concurrency: Individual and Relationship Predictors in a Sample of Heterosexual African American Men

“…Fidelity expectations refers to a partner’s beliefs about relationship exclusivity (Eyre, Flythe, Hoffman, & Fraser, 2012), which affects partners’ motivation to use condoms (Baumgartner, Lugina, Johnson, & Nyamhanga, 2010). High levels of criticism from a partner are hypothesized to affect condom use decisions.…”