Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy

Conroy, Amy A.; McKenna, Stacey A.; Comfort, Megan; Darbes, Lynae A.; Tan, Judy Y.; Mkandawire, James

doi:10.1016/j.socscimed.2018.08.006

Cited by 31 publications

(39 citation statements)

References 44 publications

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“…There was a statistically signi cant association between depression and spousal extra marital affairs among our study participants which echoes ndings of previous studies done in LMICs [13,14,43]. Many men involved in extramarital relationships show inadequate love, offer no emotional support and care to their wives which increases the risk of separation and divorce, stress, and anxiety among couples [13,44]. Culturally, divorce is not common in Uganda setting with only 7% of the population getting divorce [45].…”

Section: Discussionsupporting

confidence: 79%

Intimate partner violence, spouse extramarital affairs, and depression among women in rural Uganda

Kaggwa

Namatanzi

Kule

et al. 2021

Preprint

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Background Depression is highly prevalent among women compared to men. Women in rural areas are more at risk of depression compared to their peers in urban areas. Some of the factors associated with depression among married women are spouse related factors including extramarital affairs and intimate partner violence (IPV).Objective To determine the prevalence of depression and factors associated with depression among married women in rural Southwestern Uganda.Methods This was a cross-sectional study in rural southwestern Uganda among married/cohabiting women aged 18 to 45 years. We used the Patient Health Questionnaire 9 (PHQ-9) to assess for depression, composite abuse scale (Revised) – Short Form (CASR-SF to measure IPV. Logistic regression was used to estimate the associations between depression and several factors including spouse extramarital affair, IPV, and sociodemographic factors.Results We enrolled 153 women, mean (standard deviation) age of 33.3 (6.7) and the majority were unemployed. The mean number of children between the couple was 4.05 (2.17). More than half (65,4%) had depressive symptoms and 64.1% had experienced intimate spouse violence. The reported spouses’ mean (SD) age was 43.4 (9.5). Almost half (49.65%) were known to be involved in an extramarital affair. There was a statically significant association between depression among women and spouse extramarital affairs (adjusted odds ratio (AOR) 24.93; 95% CI 1.25–498.34]; p-value = 0.04).Conclusion There was a high prevalence of depression and intimate partner violence among women in rural Uganda. The high prevalence was associated with spouse extramarital affairs. There should be routine screening for depression and intimate partner violence among married women at lower-level health facilities in rural settings especially those whose husbands are involved in extramarital affairs to ensure early diagnosis and access to appropriate mental health care to maintain functionality in society and family level since women are the backbone of their families.

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Section: Discussionsupporting

confidence: 79%

Intimate partner violence, spouse extramarital affairs, and depression among women in rural Uganda

Kaggwa

Namatanzi

Kule

et al. 2021

Preprint

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“…Couple-based interventions for HIV prevention have demonstrated that strengthening interpersonal communication can lead to increased HIV testing and reduced sexual risk behavior [ 33 – 35 ]. These findings, along with a growing body of research, [ 13 , 23 , 24 , 33 – 42 ] demonstrate the importance of dyadic-level influence on HIV prevention and treatment.…”

Section: Introductionmentioning

confidence: 73%

“…Follow-up interviews with participants found that decisions were strongly influenced by perceived support or disapproval from partners, families, and communities [ 21 , 22 ]. Research among heterosexual couples in sub-Saharan Africa have found several distinct patterns of partner influence on ART adherence—both positive (e.g., providing support) and negative (e.g., control and conflict)—that are informed by relationship quality, power dynamics, and structural factors [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…Given the expanding HIV prevention options for heterosexual serodiscordant couples that leverage the interconnectedness between prevention and treatment, it is critical to understand how serodiscordant couples make decisions to protect their own health and that of their partner(s), and it is equally critical to understand how to honor and appropriately involve both members of couples in research studies affecting them. Although research has demonstrated dyadic-level influence in decision-making regarding uptake of ART and PrEP when viewed as separate interventions among HIV serodiscordant couples in sub-Saharan Africa, [ 23 , 24 , 36 , 37 , 41 , 42 ] to our knowledge no study has examined decision-making among couples who were offered dyadic enrollment in a research study involving access to both PrEP and ART simultaneously. To fill this gap, we conducted a qualitative study among HIV serodiscordant couples in Tanzania to understand dyadic-based decision-making as relevant to 1) participation in a research study providing access to PrEP and referral to ART and 2) uptake of HIV-related prevention (PrEP) and treatment (ART).…”

Section: Introductionmentioning

confidence: 99%

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“We are in this together:” dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP

et al. 2021

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Background A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. Methods This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples’ HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples’ decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. Results Three major themes were identified: (1) HIV as “two people’s secret” and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. Conclusions The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.

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“…10 , 12 , 46 Usually, men involving in extramarital relationships show inadequate love and offer no emotional support and care to their wives, which increases the risk of separation and divorce, and ultimately turns mental instabilities among couples. 12 , 47 Culturally, divorce is not common in Uganda, with only 7% of the population getting a divorce. 48 As such, most women choose to stay in these relationships with increased exposure to stress and hence depression.…”

Section: Discussionmentioning

confidence: 99%

Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use

Kaggwa¹,

Namatanzi²,

Kule³

et al. 2021

IJWH

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Background Rural women are highly prevalent to depression, where spouse-related factors, including extramarital affairs and poverty, intensify its likelihood of occurrence. However, women engaged with a Money-Saving Group (MSG) are financially self-dependent, which can reduce the risk of depression suffering. Despite this, there is less study among this cohort, which led us to investigate the prevalence and associated factors of depression among the Ugandan women involved in MSG. Methods This was a cross-sectional study in Uganda among rural married or cohabiting women aged 18 to 45 years engaged in MSG. The survey was carried out within a total of 153 participants (33.3 ± 6.7 years) in April 2021. Information related to socio-demographic of the participants, their spouse characteristics, and depression were collected. Results About 65.4% of the participants had depressive symptoms (based on the cutoff 10/27 at the PHQ-9). But, 8.15 times (CI: 2.83–23.44, p <0.001) and 16.69 times (CI: 4.85–57.39, p <0.001), higher risk of depression were observed, if the participants’ spouses were using an addictive substance and had been involved in an extramarital relationship, respectively. Similarly, there was an increased likelihood of depression when the participant or spouse was unemployed. Conclusion This study observed a higher prevalence of depression, which suggests paying attention to this cohort. Thus, there should be routine screening for depression among married women involved in MSG at lower-level health facilities in rural settings, especially those with spouses engaged in substance use, having an extramarital relationship, and being unemployed.

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Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy

Cited by 31 publications

References 44 publications

Intimate partner violence, spouse extramarital affairs, and depression among women in rural Uganda

Intimate partner violence, spouse extramarital affairs, and depression among women in rural Uganda

“We are in this together:” dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP

Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use

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