“I think it’s communication and trust and sharing everything”: Qualitative evidence for a model of healthy intimate relationships in Black women living with HIV and men in KwaZulu‐Natal, South Africa

Abstract

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Supporting Treatment for Anti-Retroviral Therapy (START) Together: Protocol for a pilot, randomized, couple-based intervention to promote women's ART adherence and men's engagement in HIV care in KwaZulu-Natal, South Africa

“…Couple's relationship functioning. A 39-item self-report measure assessing factors of relationship functioning was developed based on qualitative work assessing local definitions of healthy relationships with men and women in committed relationships from Cape Town and Vulindlela communities [ 42 , 43 ]. The factors are active relationship building, open communication, and couple-level problem-solving.…”

“… 1 The original conceptualization had emotional support/display as an additional factor of healthy relationships. However, our more recent qualitative work within this community revealed this construct was better subsumed under active relationship building and recategorized as an outcome of the other relationship factors [ 43 ]. …”

Development and empirical test of the research‐informed South African Relationship Functioning Assessment (SARFA)

“…Questions were based on our team's prior qualitative work from Cape Town and Vulindlela (Belus et al, 2019(Belus et al, , 2021 theory. We first pilot tested the items with N = 30 participants, using a different communitybased sample, to ensure the translations were correct and detect any obvious issues with understanding the item contents.…”

“…Across contexts, positive interactions between partners have been described as fostering intimacy, trust, and respect, and leading to less violence (Belus et al, 2019;Starmann et al, 2017). Other important aspects of healthy relationships have included displays of affection and sexual fidelity (Belus et al, 2019(Belus et al, , 2021Crankshaw et al, 2016;Ruark et al, 2019;Ruark, Stern, et al, 2017).…”

“…However, given the possibility that prior experiences with a couple-based intervention influenced participants' perceptions of community norms and definitions of healthy relationships, we subsequently conducted individual interviews with isiZulu-speaking men and women who were naïve to couple-based interventions in the Vulindlela region of KwaZulu-Natal (Belus et al, 2021). Collecting data from two different cultural groups also allowed us to generate findings that were potentially more generalizable.…”