Gendered constructions of the impact of HIV and AIDS in the context of the HIV‐positive seroconcordant heterosexual relationship

Abstract

IntroductionThis article explores the complex, dynamic and contextual frameworks within which men working in a mining community and their live-in long-term partners or spouses (termed “couples” in this study) respond to the introduction of HIV into their heterosexual relationships; the way in which partners adopt gendered positions in enabling them to make sense of their illness; how they negotiate their respective masculine and feminine roles in response to the need for HIV-related lifestyle changes; as well as the gendered nature of partner support in relation to antiretroviral therapy (ARV) adherence.MethodsWe conducted an in-depth qualitative study with a sample of 12 HIV-positive seroconcordant heterosexual couples in a South African mining organization. Transcripts based on semi-structured couple's interviews were analyzed using an inductive emergent thematic analytical method.ResultsThe findings present compelling evidence that the impact of HIV and AIDS is mitigated, in the main, by the nature of the dyadic relationship. Where power and agency were skewed in accordance with traditional gender scripts, the impact of HIV and AIDS was deleterious in terms of negotiating disclosure, meeting expectations of care and support, and promoting treatment adherence. As a corollary, the study also revealed that where the relational dynamic evidenced a more equitable distribution of power, the challenge of negotiating illness was embraced in a way that strengthened the couples’ affiliation in profound ways, manifested not simply in a reduction in risk behaviours, but in both partner's courage to re-visit sensitive issues related to managing their relationship in the context of a debilitating illness.ConclusionsGendered positioning (by self and others) was found to play a crucial role in the way couples experienced HIV and ARV treatment, and underscored the positive role of a couples-counselling approach in the negotiation of the illness experience. However, as part of a broader social project, the findings highlight the need to address the shortcomings of a public health discourse on illness normalization that reifies and reinforces skewed gender relations. In essence, the findings make a compelling case for targeting couples as the primary unit of analysis and intervention in HIV and AIDS praxis, not only to enhance treatment and prevention outcomes, but to impact on and potentially transform the lived identity of such relationships, in AIDS-affected communities. We recommend early intervention with couples in terms of couples HIV testing, risk-reduction counselling and gender-based interventions giving couples opportunities to revisit and challenge their prevailing gendered identities. We note, however, that these efforts will be undermined in the long term, if the structural drivers of HIV risk and vulnerability, contained within macro-level social, economic and cultural practices, are not simultaneously addressed.

Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model

“…Rules and responsibility: HIV-positive people are expected to follow an explicit set of rules in the form of ART and lifestyle—‘positive living’–guidelines [41, 45, 47, 49, 53, 54, 60, 82, 85, 87, 90, 92, 104]. They are advised; to adhere to clinic appointments and the ART treatment schedule; to obey clinic rules [41, 49, 85, 87]; to understand HIV medical terms [47, 60, 82, 87]; to stop drinking alcohol; to reduce sex [82, 85, 87, 93]; to avoid pregnancy [53, 85, 87]; to eat ‘healthy foods’ [44, 45, 54, 87, 90, 104]; to reduce ‘stress’ [43, 77, 87, 97]; to embrace their HIV-positive identity; and to help other HIV-positive people [43, 87]. Staff expect individuals to adhere to these rules [43, 46, 47, 82, 85] and often ignore how the realities of people’s lives may interfere with the ability to be compliant [43, 53, 85, 87, 90].…”

“…Staff expect individuals to adhere to these rules [43, 46, 47, 82, 85] and often ignore how the realities of people’s lives may interfere with the ability to be compliant [43, 53, 85, 87, 90]. For some, this rules-based system works well [45, 55, 86, 87, 91], they adhere and they gain self-confidence [86, 91]; but others who cannot adhere, feel stressed, ashamed, and guilty [43, 60, 66, 94]; and are then labelled ‘drop-outs’, ‘defaulters’ or ‘bad patients’ [47, 49, 96], justifying mistreatment by health workers, who at times see this ‘failure’ as a personal characteristic, and morally judge, blame and inflict punishment [47, 94, 96]. This can drive those who are already struggling to maintain attendance to disengage from care entirely [43, 47, 49, 66, 67, 92, 94].…”

Knowledge of mother-to-child transmission of HIV by pregnant women in Maputo City, Mozambique

“…In the same way, pregnant women who were married or living with a partner were more likely to have high HIV knowledge (AOR = 2.66; 95% CI: 1.30-54.43), suggesting that open discussion of HIV/AIDS issues with partners have a positive effect on women information, as quite often males are more educated and informed than women, although less likely to attend health facility [31][32][33][34]. Both findings pose challenges to the public health sector to improve access to PMTCT/HIV information to younger and single women to benefit from PMTCT/HIV interventions.…”

El uso inconsistente del condón en mujeres mexicanas que viven con VIH: un reto para los servicios de salud

“…En primer lugar, al igual que otros estudios 11,14,16,22 éste constata el valor de la información y la consejería para prevenir la transmisión del VIH y otras ITS, así como la reinfección, a través del sexo protegido. A la vez, identifica discursos sobre la futilidad del uso del condón cuando ambos miembros de la pareja viven con VIH, así como un entendimiento insuficiente de la serodiscordancia y de la posibilidad de mantener el estatus seronegativo en una relación de larga duración con una persona con VIH, lo que también se ha identificado como una barrera para el uso consistente del condón en otros grupos de PVVS.…”

“…Como también se ha visto en otros estudios, 22 el diagnóstico puede representar un parteaguas en la relación de pareja y permitir a la mujer empoderarse en la toma de decisiones sexuales, en particular a través del rechazo al sexo no protegido y no deseado. Sin embargo, si se comparan los testimonios de las MVV que lograron el uso consistente del condón con los de aquéllas que siguieron atrapadas en las mismas construcciones sociales de la sexualidad y del género, las cuales condujeron al sexo no protegido, queda clara la importancia de la cooperación o, por lo menos, de la anuencia de la pareja masculina para lograr el uso del condón.…”