Uthando Lwethu (‘our love’): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa

Darbes, Lynae A.; Rooyen, Heidi van; Hosegood, Victoria; Ngubane, Thulani; Johnson, Mallory O.; Fritz, Katherine; McGrath, Nuala

doi:10.1186/1745-6215-15-64

Cited by 45 publications

(50 citation statements)

References 51 publications

(71 reference statements)

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“…If relationship quality is the main pathway through which healthy behaviors in couples can occur (Karney et al, 2010; Lewis et al, 2006), efforts could harness shared power at the couple level—a construct that emerged as the most consistent correlate of relationship quality. Interventions that intervene with couples to improve relationship dynamics as a pathway to improved HIV-related behaviors, such as Uthando Lwethu (Darbes et al, 2014), have the potential to empower couples in the process. This will require new ways of conceptualizing power at the couple level and ways to change dyadic power that go beyond the individual level.…”

Section: Discussionmentioning

confidence: 99%

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Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions

Conroy

McGrath

Rooyen

et al. 2016

Social Science & Medicine

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Introduction Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. Methods This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012–2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners’ perceptions of power influences their own (i.e., actor effect) and their partner’s reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). Results For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women’s reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men’s reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women’s reports of intimacy and negatively associated with women’s reports of conflict. Conclusions Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men’s perspectives into account to ensure positive relationship outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Study procedures have been described elsewhere (Darbes et al, 2014). To summarize, heterosexual couples were recruited through the community by mixed-gender recruiters using both active recruitment (e.g., approaching couples in the markets) and passive recruitment (e.g., posting fliers at community-based agencies) strategies.…”

Section: Methodsmentioning

confidence: 99%

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions

Conroy

McGrath

Rooyen

et al. 2016

Social Science & Medicine

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“…Interdependence is a key construct in this theoretical approach, and it refers to the ways in which interacting partners mutually influence each other's outcome [19]. This approach has been used previously in SSA settings [20, 21]. …”

Section: Introductionmentioning

confidence: 99%

Couple interdependence impacts HIV‐related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis

Rogers

Achiro

Bukusi

et al. 2016

Journal of the International AIDS Society

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IntroductionHIV infection is frequently transmitted within stable couple partnerships. In order to prevent HIV acquisition in HIV-negative couples, as well as improve coping in couples with an HIV-positive diagnosis, it has been suggested that interventions be aimed at strengthening couple relationships, in addition to addressing individual behaviours. However, little is known about factors that influence relationships to impact joint decision-making related to HIV.MethodsWe conducted qualitative in-depth interviews with 40 pregnant women and 40 male partners in southwestern Kenya, an area of high HIV prevalence. Drawing from the interdependence model of communal coping and health behaviour change, we employed thematic analysis methods to analyze interview transcripts in Dedoose software with the aim of identifying key relationship factors that could contribute to the development of a couples-based intervention to improve health outcomes for pregnant women and their male partners.ResultsIn accordance with the interdependence model, we found that couples with greater relationship-centred motivations described jointly engaging in more health-enhancing behaviours, such as couples HIV testing, disclosure of HIV status, and cooperation to improve medication and clinic appointment adherence. These couples often had predisposing factors such as stronger communication skills and shared children, and were less likely to face potential challenges such as polygamous marriages, wife inheritance, living separately, or financial difficulties. For HIV-negative couples, joint decision-making helped them face the health threat of acquiring HIV together. For couples with an HIV-positive diagnosis, communal coping helped reduce risk of interspousal transmission and improve long-term health prospects. Conversely, participants felt that self-centred motivations led to more concurrent sexual partnerships, reduced relationship satisfaction, and mistrust. Couples who lacked interdependence were more likely to mention experiencing violence or relationship dissolution, or having difficulty coping with HIV-related stigma.ConclusionsWe found that interdependence theory may provide key insights into health-related attitudes and behaviours adopted by pregnant couples. Interventions that invest in strengthening relationships, such as couple counselling during pregnancy, may improve adoption of beneficial HIV-related health behaviours. Future research should explore adaptation of existing evidence-based couple counselling interventions to local contexts, in order to address modifiable relationship characteristics that can increase interdependence and improve HIV-related health outcomes.

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“…The ABC frame, situated within the descriptive paradigm -with its focus on The evidence that couples testing is more effective than single sex HCT is growing exponentially (Darbes, van Rooyen, Hosegood, Ngubane, Johnson, Fritz & McGrath, 2014 60%, or more, infections occur while people are in steady relationships (Tanser et al 2011, Fox 2014 'Recommendation 5.2.6: Encourage the social unacceptability of age-disparate relationships.' (descriptive)…”

Section: Is There a Value Add?mentioning

confidence: 99%

Reducing the overall HIV-burden in South Africa: is ‘reviving ABC’ an appropriate fit for a complex, adaptive epidemiological HIV landscape?

Burman

Aphane

Delobelle

2015

African Journal of AIDS Research

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This article questions the recommendations to 'revive ABC (abstain, be faithful, condomise)' as a mechanism to 'educate' people in South Africa about HIV prevention as the South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, suggests. We argue that ABC was designed as a response to a particular context which has now radically changed. In South Africa the contemporary context reflects the mass roll-out of antiretroviral treatment; significant bio-medical knowledge gains; a generalised population affected by HIV that has made sense of and embodied those diverse experiences; and a government committed to confronting the epidemic. We suggest that the situation can now be plausibly conceptualised as a complex, adaptive epidemiological landscape that could benefit from an expansion of the existing, 'descriptive' prevention paradigm towards strategies that focus on the dynamics of transmission. We argue for this shift by proposing a theoretical framework based on complexity theory and pattern management. We interrogate one educational prevention heuristic that emphasises the importance of risk-reduction through the lens of transmission, called A-3B-4C-T. We argue that this type of approach provides expansive opportunities for people to engage with the epidemic in contextualised, innovative ways that supersede the opportunities afforded by ABC. We then suggest that framing the prevention imperative through the lens of 'dynamic prevention' at scale opens more immediate opportunities, as well as developing a future-oriented mind-set, than the 'descriptive prevention' parameters can facilitate. The parameters of the 'descriptive prevention' paradigm, that maintain - and partially reinforce - the presence of ABC, do not have the flexibility required to develop the armamentarium of tools required to contribute to the management of a complex epidemiological landscape. Uncritically adhering to both the 'descriptive paradigm', and ABC, represents an historically dislocated form of prevention - with restrictive options for reducing the overall burden of HIV-related challenges in South Africa.

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Uthando Lwethu (‘our love’): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa

Cited by 45 publications

References 51 publications

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions

Couple interdependence impacts HIV‐related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis

Reducing the overall HIV-burden in South Africa: is ‘reviving ABC’ an appropriate fit for a complex, adaptive epidemiological HIV landscape?

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