Male partners of young women in Uganda: Understanding their relationships and use of HIV testing

Abstract

BackgroundSubstantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15–24) in Eastern and Southern Africa. Yet limited research has been conducted with AGYW’s male sexual partners regarding their perspectives on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order to inform the DREAMS Partnership and similar HIV prevention programs in Uganda.MethodsWe conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS. Analyses focused on men’s current and recent partnerships and HIV service use.ResultsMost respondents (80%) were married and 28 years old on average. Men saw partner concurrency as pervasive, and half described their own current multiple partners. Having married in their early 20s, over time most men continued to seek out AGYW as new partners, regardless of their own age. Relationships were highly fluid, with casual short-term partnerships becoming more formalized, and more formalized partnerships characterized by periods of separation and outside partnerships. Nearly all men reported recent HIV testing and described testing at distinct relationship points (e.g., when deciding to continue a relationship/get married, or when reuniting with a partner after a separation). Testing often stemmed from distrust of partner behavior, and an HIV-negative status served to validate respondents’ current relationship practices.ConclusionsAcross the three regions in Uganda, findings with partners of AGYW confirm earlier reports in Uganda of multiple concurrent partnerships, and demonstrate substantial HIV testing. Yet they also unearth the degree to which these partnerships are fluid (switching between casual and/or more long-term partnerships), which complicates potential HIV prevention strategies. Context-specific findings around these partnerships and risk are critical to further tailor HIV prevention programs.

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

“…In addition, with the HIV epidemic in its third decade in the country, the assumption was that knowledge of HIV testing was near universal and widely accessible everywhere, yet, our findings showed that critical knowledge gaps still exist thereby delaying HIV testing and entry to care. Our findings are consistent with other studies in Africa, [67][68][69] that further show that the risk perception of HIV infection was low among some men as they did not view themselves to be at risk even when engaging in high risk behaviors or altogether lacked self-awareness of risk due excessive consumption of alcohol. In their study, Velloza et al [70] found that individuals who used alcohol had twice the odds of ART non-adherence compared with those who did not use alcohol (34% non-adherence among alcohol users vs. 18% among non-users; pooled odds ratio: 2.25; 95% confidence interval: 1.87-2.69; p < 0.001).…”

Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan

“…Our finding that sexual partners played a role on men’s HIV testing uptake in this study also corroborates another recent study describing how men’s sexual partners in Uganda influence their HIV testing behavior [37]. Consistent with our study, men in Uganda reported that the distrust they had for their sexual partners led them to test for HIV, especially when the men had been away for a long period of time [37].…”

“…Consistent with our study, men in Uganda reported that the distrust they had for their sexual partners led them to test for HIV, especially when the men had been away for a long period of time [37]. In other cases, men who had been away for a long time or suspected to have multiple sexual partners shared that they tested because their women did not trust them and requested them to test [37]. The positive response from men after being requested to test by their sexual partners contrasts with an older study in Uganda that found that some men responded negatively when their wives suggested HIV testing [35].…”

“…The positive response from men after being requested to test by their sexual partners contrasts with an older study in Uganda that found that some men responded negatively when their wives suggested HIV testing [35]. In addition, it was not common for women to discuss HIV testing with their partners in the older study [35] compared to the recent one [37] , indicating a change in women’s ability to raise such topics and men’s responses.…”

Large benefits to youth-focused HIV treatment-as-prevention efforts in generalized heterosexual populations: An agent-based simulation model

“…This can be traced to high rates of infection [2], low testing rates [3], difficulties linking young people to care [4], and low treatment adherence rates compared to older people [5]. HIV infection is distributed unevenly between the sexes at these ages, with young women having 3- to 5-fold higher rates of infection than young men [2, 6–10]. Higher rates of infection in young women are in part due to higher per-act probabilities of infection [11] and age-disparate relationships with older men [12–14] who are more likely to be HIV positive and less likely to use condoms [15–18].…”