Psychosocial and behavioural interventions towards HIV risk reduction for serodiscordant couples in Africa: A systematic review

Abstract

BackgroundSexual transmission of HIV frequently occurs in the context of a primary relationship between two partners; however, HIV prevention interventions generally focus on individuals at risk, rather than specifying couples as a unit of change and analysis, neglecting the crucial role that partners may play in sexual behaviour. This article reviews published scientific literature addressing couple-oriented HIV counselling and testing and other behavioural interventions using an online search for peer-reviewed papers.MethodsA systematic review was conducted to evaluate what has been published on psychosocial interventions in HIV serodiscordant couples in Africa. Electronic databases were searched from January 1990 to December 2015. Quality assessment of included studies was conducted using the Systematic Appraisal of Quality in Observational Research tool.ResultsThe electronic database searches initially retrieved 493 records; after cross-referencing, removing duplicates and applying strict inclusion and exclusion criteria, only eight papers were included in this review. All the studies under review showed that couples-focused counselling and educational programmes were associated with positive outcomes including reduced HIV transmission, reduced unprotected sex, increased rates of status disclosure and high levels of treatment adherence.ConclusionsThe literature on interventions for HIV serodiscordant couples is sparse. However, most interventions indicate that couples-focused interventions are effective in HIV risk reduction. In spite of the limited available data and repeated recommendations by different health authorities, couple-centred approaches to HIV prevention have not been implemented on a large scale.

“It Had a Lot of Cultural Stuff in It”: HIV-Serodiscordant African American Couples’ Experiences of a Culturall y Congruent Sexual Health Intervention

“…11 Group psychoeducation has been effective in reducing depression and anxiety and in increasing marital satisfaction. 12 However, although partners play a key role in sexual behavior and disease transmission, and couples-focused interventions stand to reduce the elevated rates of HIV transmission in long-term relationships, 13 HIV prevention interventions with couples, particularly serodiscordant couples, remain underutilized, 14,15 particularly outside of Africa. Furthermore, interventions tend to place more emphasis on reducing risk rather than heightening sexual pleasure and creativity.…”

“…16 Factors contributing to the success of interventions include cultural congruence, communication and skills building for sexual health, intimacy, negotiation, and decision-making around sexual health (eg, condom use). Cultural congruence, an oft-neglected component of HIV risk reduction for serodiscordant couples, 15,17 yields positive health outcomes through meaningful, sustainable change more so than interventions that emphasize behavior change only. 18 Interventions other than those focused on biomedical treatment should consider the cul-tural setting of participants, as well as the cultural constructs that govern health care behaviors, sex, and sexuality.…”

“…intervention for African American serodiscordant couples is an evidencebased intervention that addresses these key constructs. 23 EBAN was developed to address the disproportionate rates of HIV/AIDS in African Americans, 3 and in recognition of the importance of working with both partners for HIV prevention in serodiscordant relationships 14,15 and the centrality of culture in shaping sexual behavior and acceptable options for behavior change. 24 EBAN is an eight-session intervention that encourages the development of intimacy and positive-prevention.…”

“[ Repeat ] testing and counseling is one of the key [ services ] that the government should continue providing”: Participants’ Perceptions on Extended Repeat HIV Testing and Enhanced Counseling (ERHTEC) for Primary HIV Prevention in Pregnant and Lactating Ugandan Women

“…The recommendation of participants to provide couple counselling and testing at all ANC services, with an emphasis of couple counselling and testing, supports the national couple counselling guidelines and WHO strategy [4,13,26]. The literature on HIV sero-discordant couples has shown that couple counselling and testing is associated with positive outcomes including reduced HIV transmission and unprotected sex, and increased rates of status disclosure and levels of treatment adherence [30]. Rosenberg et al (2016) has shown that couple HIV counseling and testing (HCT) is more protective than individual HCT for HIV acquisition [31].…”

Ubudoda Abukhulelwa – Responsible Manhood

“…Risky sexual behaviours such as inconsistent and incorrect condom use, engaging in sex while drunk or under the influence of illicit drugs as well as engaging in multiple concurrent partners behaviour continue to persist to cause new infections (Davis et al, 2016;Jama Shai, Jewkes, Levin, Dunkle, & Nduna, 2010;Turner et al, 2009;Yamanis et al, 2013). What is clear though is that interventions that promote male partner involvement in prevention of mother to child transmission (PMTCT) and those that promote adherence to anti-retroviral therapy (ART) show better outcomes in morbidity and mortality Mashaphu, Burns, Wyatt, & Vawda, 2018). Furthermore, interventions that seek to remove some of the structural barriers to testing result in more people testing overall and connecting more people to care programs.…”