Low uptake of HIV testing and no HIV positivity in stable serodiscordant heterosexual partners of long-term treated HIV-infected Thais

The objective of this study was to characterize HIV-serodiscordant heterosexual couples and to evaluate acceptance for HIV testing and HIV prevalence in nonindex partners. We conducted a cross-sectional study with quantitative and qualitative components. Two cohorts of 1767 HIV-positive people were screened to identify heterosexual HIV-serodiscordant couples. HIV-positive partners (index) were administered a questionnaire; CD4, viral load (VL), and antiretroviral therapy (ART) history were gathered from clinical records. HIV-negative/unknown status partners (nonindex) were invited for a similar questionnaire and HIV testing. In-depth interviews with three HIV-serodiscordant couples were conducted. Two hundred and ninety-seven index partners agreed to enroll in this study. The median duration of the relationship was 10 years, and 81% were sexually active. All but two index partners were on ART, and 98% had VL < 1000 copies/mL. Only 111 (37%) nonindex partners came for HIV testing, and all of them tested HIV-negative. In addition, only 41% of nonindex partners had HIV testing in the last one year. The main reasons for the nonindex partners not to come for HIV testing were “no interest” (n = 117, 63%) and “nondisclosure of HIV status” (n = 46, 25%). The latter was substantiated and explained by the qualitative outcome of this study, suggesting relation to stigma against HIV-positive people. Our results support the WHO recommendation for starting ART for treatment and prevention in HIV-serodiscordant couples at any CD4 count. Furthermore, we recommend the dissemination of data showing that no HIV transmission in heterosexual couples through sex practice has been observed provided VL is suppressed. This could be a powerful tool for effective fight against stigma and self-stigma in people living with HIV.     

Neural activity patterns evoked by a spouse's incongruent emotional reactions when recalling marriage‐relevant experiences

Resonance with the inner states of another social actor is regarded as a hallmark of emotional closeness. Nevertheless, sensitivity to potential incongruities between one's own and an intimate partner's subjective experience is reportedly also important for close relationship quality. Here, we tested whether perceivers show greater neurobehavioral responsiveness to a spouse's positive (rather than negative) context‐incongruent emotions, and whether this effect is influenced by the perceiver's satisfaction with the relationship. Thus, we used fMRI to scan older long‐term married female perceivers while they judged either their spouse's or a stranger's affect, based on incongruent nonverbal and verbal cues. The verbal cues were selected to evoke strongly polarized affective responses. Higher perceiver marital satisfaction predicted greater neural processing of the spouse's (rather than the strangers) nonverbal cues. Nevertheless, across all perceivers, greater neural processing of a spouse's (rather than a stranger's) nonverbal behavior was reliably observed only when the behavior was positive and the context was negative. The spouse's positive (rather than negative) nonverbal behavior evoked greater activity in putative mirror neuron areas, such as the bilateral inferior parietal lobule (IPL). This effect was related to a stronger inhibitory influence of cognitive control areas on mirror system activity in response to a spouse's negative nonverbal cues, an effect that strengthened with increasing perceiver marital satisfaction. Our valence‐asymmetric findings imply that neurobehavioral responsiveness to a close other's emotions may depend, at least partly, on cognitive control resources, which are used to support the perceiver's interpersonal goals (here, goals that are relevant to relationship stability). Hum Brain Mapp 36:4164–4183, 2015. © 2015 Wiley Periodicals, Inc.     

Predicting Relationship Help Seeking Prior to a Marriage Checkup

Although the barriers to couples' help seeking can be daunting, to date there is only a small body of literature addressing the factors that motivate couples to seek help. This study examined the association between attitudes toward relationship help seeking and relationship help seeking behaviors, as well as the association between marital quality and help seeking. This study was completed in the context of the Marriage Checkup, a brief intervention designed to reduce the barriers to help seeking. Results indicated that help seeking attitudes and behaviors were not related in couples, and that wives' marital quality was negatively associated with both wives' and husbands' help seeking. Husbands' marital quality was not associated with husbands' help seeking. Overall, this suggests that the process of couples' help seeking is distinct from that of individuals and seems to be driven primarily by the female partner. Further implications for theory and treatment are discussed.     

Longitudinal effects of health-harming and health-protective behaviors within adolescent romantic dyads

Most models exploring adolescent health behavior have focused on individual influences to understand behavior change. The goal of the current study was to assess the role of adolescent romantic partners on the expression of health behavior. Our sample utilized two waves of data from the U.S. National Longitudinal Study of Adolescent Health, which included 80 romantic dyads (160 individuals). A longitudinal multilevel analysis was conducted. We assessed individual and romantic partner health-harming behaviors (i.e., delinquency, alcohol use, smoking, and marijuana use), health-protective behaviors (i.e., physical activity, physical inactivity, sleep patterns, seatbelt use, and contraception motivations), as well as the role of gender and age. Participants average age was 16 years at baseline. We found evidence for partner similarity and partner influence with the majority of health-harming behaviors. Specifically, partner influence was evident for smoking and alcohol use with partner influence approaching significance for marijuana use. We found limited evidence for partner similarity and partner influence for health-protective behaviors. The importance of assessing romantic dyads was evident in these data. Interventions focusing on health-harming behavior for adolescent populations are important public health goals. It is recommended that future intervention efforts with adolescent health-harming behaviors should target not only peers, but also consider the role of romantic partners.     

Pregnancy and HIV-1 incidence in 178 married couples with discordant HIV-1 serostatus: additional experience at an HIV-1 counselling centre in the Democratic Republic of the Congo

To determine the effect of an HIV-1 counselling programme on rates of HIV-1 infection and pregnancy in a large group of married couples in Kinshasa, DRC with discordant HIV-1 infection status, we conducted a baseline cross-sectional HIV-1 seroprevalence study in two large Kinshasa businesses. We identified 178 married couples (mean duration of marriage = 12.3 years) with discordant HIV-1 serostatus (92 M+F-/86 M-F+). Seroincidence and pregnancy rates were observed during 310 person-years of follow-up (PYFU). The 92 M+F- couples had an HIV-1 incidence of 3.7/100 PYFU and a pregnancy rate of 8.6/100. The 86 M-F+ couples had a pregnancy rate of 6.8/100 PYFU and an HIV-1 incidence of 6.8/100 PYFU. Couples seeking to have children but minimize their HIV-1 transmission risk frequently had unprotected sex only during the woman's perceived monthly fertility period. This strategy resulted in the birth of 24 live-born children and only one (4%; 95% CL = 0.0-21.6%) new HIV infection in couples having a child. Only 1 of 6 women who developed HIV-1 infection (16. 7%; 95 C.L. = 0-40.4%) became pregnant. While seronegative men had more extramarital sex once their wives' positive HIV-1 infection status became known, most of these episodes involved safe sex. Divorce was rare. This study provides additional information concerning issues of safe sex in married couples with discordant HIV-1 infection status, the dynamics of HIV transmission within couples and the effect of serostatus notification on the marriage and on intramarital and extramarital sexual behaviour in Kinshasa, Congo.     

Marital Satisfaction and Personality Traits in Long-Term Marriages: An Exploratory Study

This study explored personality dimensions that contribute to marital satisfaction in older couples in long-term marriages (M = 49.2 years). Each spouse completed the Comprehensive Marital Satisfaction Scale, the Horney-Coolidge Tridimensional Inventory (HCTI), and the NEO-Five Factor Inventory (NEO-FFI). There was a moderate correlation between the marital satisfaction scores for husbands and wives. Husbands' marital satisfaction was significantly higher when their self-reported HCTI Detachment scores were lower and their HCTI Aggression scores were higher. Wives' marital satisfaction was higher when their Detachment scores and their husbands' Detachment scores were lower. On the NEO-FFI, only wives' marital satisfaction was significantly related to the more Extraverted and the less Conscientious the husbands reported themselves to be. Clinical implications and research directions are discussed.     

Maximizing the impact of HIV prevention efforts: Interventions for couples

Despite efforts to increase access to HIV testing and counseling services, population coverage remains low. As a result, many people in sub-Saharan Africa do not know their own HIV status or the status of their sex partner(s). Recent evidence, however, indicates that as many as half of HIV-positive individuals in ongoing sexual relationships have an HIV-negative partner and that a significant proportion of new HIV infections in generalized epidemics occur within serodiscordant couples. Integrating couples HIV testing and counseling (CHTC) into routine clinic- and community-based services can significantly increase the number of couples where the status of both partners is known. Offering couples a set of evidence-based interventions once their HIV status has been determined can significantly reduce HIV incidence within couples and if implemented with sufficient scale and coverage, potentially reduce population-level HIV incidence as well. This article describes these interventions and their potential benefits.