Difficulties faced by HIV mixed status couples in maintaining safe sex

This study aimed to identify the factors that interfere in maintaining safe sex. Data were collected through individual interviews with 11 HIV/AIDS patients living with HIV-negative partners, under clinical treatment at a specialized AIDS clinic. Analysis was based on Prose analysis by André (1983). The concept of vulnerability was used as a theoretical reference framework. The sexual prevention of HIV/AIDS for the non infected partner constitutes one of the largest challenges for the serodiscordant couples, because men and women accept condoms differently. The greater motivation towards condom use among serodiscordant couples does not eliminate the difficulties to use them for maintaining safe sex. The serodiscordant couples deserve specific assistance, and the preventive strategies should contemplate the cultural and psychosocial aspects that constitute important aspects of mixed-status partner vulnerability.     

Relationship Characteristics and HIV Transmission Risk in Same-Sex Male Couples in HIV Serodiscordant Relationships

Unprotected anal intercourse (UAI) remains a main risk factor for HIV among men who have sex with men (MSM) and this is of particular concern for partners of HIV serodiscordant status. However, HIV transmission risk has been demonstrated to vary by the sexual position adopted among partners. Guided by interdependence theory, this study examined how relational factors were differentially associated with risk taking (HIV-positive/insertive and HIV-negative/receptive) and strategic positioning (HIV-positive/receptive and HIV-negative/insertive) UAI within serodiscordant same-sex male couples. HIV-positive men and their HIV-negative partners (n _couples = 91; n _individuals = 182) simultaneously but independently completed computerized questionnaires and HIV-positive men had blood drawn for viral load. A minority of couples (30 %) engaged in risk taking and/or strategic positioning unprotected anal sex. Results of multinomial logistic regression indicated that HIV-negative partners’ levels of relationship commitment were positively associated with the odds of engaging in strategic positioning sexual behaviors. For HIV-negative partners, reports of relationship intimacy, and sexual satisfaction were negatively associated with odds of reporting risk taking behavior. In contrast, HIV-positive partners’ reported sexual satisfaction was positively associated with odds of engaging in risk taking behavior. Findings suggested that aspects of relational quality may be differentially associated with sexual decision making for same-sex male couples in serodiscordant relationships. Study findings lend support for the incorporation of discussions of HIV risk reduction strategies, enhancing communication between partners, and support for general relationship functioning in HIV care.     

‘It [HIV] is part of the relationship’: exploring communication among HIV-serodiscordant couples in South Africa and Tanzania

In many sub-Saharan African countries, a high proportion of people living with HIV are in long-term serodiscordant relationships. This paper explores how HIV serodiscordance shapes communication among couples in long-term HIV-serodiscordant relationships. A total of 36 couples were purposively recruited through healthcare providers and civil society organisations in South Africa (26) and Tanzania (10). We explored couples' portrayal of living in a serodiscordant relationship by conducting semi-structured interviews with each partner separately, followed by a joint interview with both partners. Using an adaptation of Persson's model on sero-silence and sero-sharing, we categorised coping style as ‘sero-silent’ if partners reported that they did not talk much with each other about issues related to their serodiscordant status or as ‘sero-sharing’ if they portrayed HIV as being an issue which they dealt with together. Some couples exhibited features of both coping styles and, at times, partners differed in their ways of coping.     

Love and HIV serodiscordance in gay men's accounts of life with their regular partners

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could 'invest' more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.     

Love and HIV serodiscordance in gay men's accounts of life with their regular partners

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could ‘invest’ more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.     

德宏州HIV单阳夫妻双方丙型肝炎病毒感染状况及影响因素

目的 了解云南省德宏州人类免疫缺陷病毒（human immunodeficiency virus,HIV）单阳夫妻双方（HIV感染者及其阴性配偶）丙型肝炎病毒（viral hepatitis C,HCV）感染情况及其影响因素。方法 收集HIV单阳夫妻的人口学特征、行为学指标和血样,并进行HCV抗体检测,应用χ²检验和Logistic回归分析不同因素对HCV感染率的影响。结果 582对HIV单阳家庭中,夫妻双方均感染HCV有12对（2.1%）,仅一方感染HCV有138对（23.7%）。HIV阳性配偶HCV感染率为23.2%,HIV阴性配偶HCV感染率为4.6%,差异有统计学意义（χ²=83.641,P<0.001）。男性配偶中,HIV阳性者HCV感染率为32.6%,HIV阴性者HCV感染率为4.6%,差异有统计学意义（χ²=56.828,P<0.001）;女性配偶中,HIV阳性者HCV感染率为4.6%,HIV阴性者HCV感染率为4.7%,二者无统计学差异（χ²<0.001,P=0.958）。多因素Logistic回归分析显示,男性配偶中35~46岁、景颇族、HIV阳性、吸毒是HCV感染的危险因素。结论 德宏州HIV单阳夫妻特别是HIV阳性男性配偶中HCV感染率高,HCV存在性传播的潜在威胁,有必要加强对HIV单阳家庭的丙型肝炎防治,对男性和女性配偶采取针对性的预防干预措施。     

Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status

Abstract

Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV ‘risk’ actually means in different cultures and contexts. A ‘socially situated’ approach to HIV risk moves beyond its scientific conceptualisation as an objective ‘fact’, revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of ‘difference’, a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of ‘risk’ arise and, thus, where couples’ sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.     

HIV Status and Gender: A Brief Report from Heterosexual Couples in Thailand

Although the impact of HIV falls on both partners of a married couple, the burden of stress may not be necessarily shared evenly. The researchers in this study examined the relations among HIV status, gender, and depressive symptoms among 152 married or cohabitating couples living with HIV in the northern and northeastern regions of Thailand. Depressive symptoms were assessed using a 15-item depressive symptom screening test that was developed and used previously in Thailand. Among the 152 couples, 59% were couples in which both members were people living with HIV (seroconcordant; both people living with HIV couples), 28% had only female members with HIV (serodiscordant; females living with HIV couples), and 13% had only male members with HIV (serodiscordant; males living with HIV couples). The prevalence of depressive symptoms between seroconcordant and serodiscordant groups was similar. However, females living with HIV reported significantly higher levels of depressive symptoms, regardless of their partners' HIV status. Future prevention programs focusing on serodiscordant couples should be planned to target HIV risk, as well as emphasis on mental health, with a particular focus on women's increased susceptibility to negative mental health outcomes.     

'It [HIV] is part of the relationship': exploring communication among HIV-serodiscordant couples in South Africa and Tanzania

In many sub-Saharan African countries, a high proportion of people living with HIV are in long-term serodiscordant relationships. This paper explores how HIV serodiscordance shapes communication among couples in long-term HIV-serodiscordant relationships. A total of 36 couples were purposively recruited through healthcare providers and civil society organisations in South Africa (26) and Tanzania (10). We explored couples' portrayal of living in a serodiscordant relationship by conducting semi-structured interviews with each partner separately, followed by a joint interview with both partners. Using an adaptation of Persson's model on sero-silence and sero-sharing, we categorised coping style as 'sero-silent' if partners reported that they did not talk much with each other about issues related to their serodiscordant status or as 'sero-sharing' if they portrayed HIV as being an issue which they dealt with together. Some couples exhibited features of both coping styles and, at times, partners differed in their ways of coping.     

Interpersonal issues surrounding HIV counseling and testing, and the phenomenon of "testing by proxy"

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of "testing by proxy"--the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.     

Better Communication Regarding Sexual Agreements Within Serodiscordant Male Couples Leads to Improved Antiretroviral Therapy Adherence Among the HIV-Positive Partner

Sexual agreements (SAs)—guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship—are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.

     

Sexual behavior and HIV risk among age-discrepant,same-sex male couples

Research has suggested that men who have sex with men and who have older sexual partners are at increased risk of HIV infection. However, while several studies have explored risk among men in age-discrepant non-primary partnerships, only two have explored age discrepancy and risk in primary same-sex male relationships. We used data from semi-structured in-depth interviews to explore sexual behaviour and HIV risk among 14 Black, white and interracial (Black/white) same-sex male couples with an age difference of 10 or more years. Most couples regularly used condoms, and sexual positioning tended to lead to lower risk for younger partners. Some serodiscordant couples abstained from anal sex, while others used seropositioning to avoid transmission within the relationship. Within some couples, older partners acted as mentors on HIV prevention and broader life lessons. Future studies should further explore the potential risks and benefits of large age differences in same-sex male primary relationships.     

福建省HIV/AIDS病例配偶/固定性伴HIV感染情况分析

目的 分析福建省艾滋病病毒(HIV)/艾滋病(AIDS)病例配偶/固定性伴HIV感染情况和影响因素。方法 对2008年1月1日-2013年12月31日福建省新发现的HIV/AIDS病例进行回顾性调查,了解HIV/AIDS病例的配偶/固定性伴的HIV抗体阳转情况,应用单因素和多因素分析法探讨HIV/AIDS病例配偶/固定性伴HIV抗体阳转的影响因素。结果 共调查2008年1月1日-2013年12月31日福建省新发现的HIV/AIDS病例872例,其配偶/固定性伴出现HIV抗体阳转的比例为26.5%(231/872);36.6%(319/872)病例在末次随访时报告最近3个月内与配偶/固定性伴发生性行为,每次均使用安全套的比例为93.4%(298/319);配偶/固定性伴HIV抗体阳转在不同性别、文化程度、CD₄计数和安全套使用间差异均有统计学意义(均P<0.01);多因素logistic回归分析显示,先感染HIV的一方为男性(OR=0.338,95%CI=0.241~0.475,P<0.001)、大专及以上文化程度(OR=0.209,95%CI=0.067~0.654,P=0.007)、CD₄计数>350个/mm³(OR=0.521,95%CI=0.363~0.748,P<0.001)和发生性行为时每次均使用安全套(OR=0.054,95%CI=0.015~0.193,P<0.001)是配偶/固定性伴出现HIV抗体阳转的影响因素。结论 HIV/AIDS病例的配偶/固定性伴已经成为受HIV侵袭的重要人群,应进一步规范HIV抗体检测结果告知,阻断其在配偶/固定性伴间的传播。     

The ‘normality’ of living as a gay serodiscordant couple in Sydney,Australia

Serodiscordant couples are often understood through a discourse of HIV-risk or researched in terms of the psychological stressors they face. However, due to antiretroviral treatments people living with HIV can achieve undetectable viral loads, which not only make them non-infectious to partners, but allow them to think of their lives and relationships as safe and viable. These realisations mean that serodiscordant couples often embrace an HIV ‘normalisation’ discourse. In this article, we argue that this discourse of HIV ‘normalisation’ can overlook the more nuanced complexity of issues still faced by couples today, which reveal how their experiences of ‘normal’ are sometimes challenged and are not necessarily ‘normal’. Utilising semi-structured interviews with 21 gay men in serodiscordant relationships in Sydney, Australia, we draw on the concept of ‘home’ life to explore how men engage with discourses of normalisation to describe and enact their relationships. We argue that although HIV is managed well enough to be insignificant in the context of home life, experiences or anticipation of stigma in public often remind couples that they are yet to be considered ‘normal’ socially.     

Sexual communication among married couples in the context of a microbicide clinical trial and acceptability study in Pune,India

Previous research in India indicates that there is little communication within marriage about sex. Lack of communication about safe sexual behaviours may increase couples' vulnerability to HIV. This study explores couple level sexual communication and socio-cultural norms that influence couples' communication about sex and its implications for HIV prevention. Data derive from in-depth interviews at two points in time with 10 couples. Secondary qualitative analyses of the interviews were conducted using inductive and deductive coding techniques. Half of the couples described improved communication about sex and HIV and AIDS after participation in the clinical trial and/or acceptability study, as well as increased sexual activity, improved relationships by alleviating doubts about their partner's fidelity and forgiving their partners. The findings show that creating safe spaces for couples where they can ask frank questions about HIV and AIDS, sex and sexuality potentially can improve couples' communication about sex and reduce their risk for HIV infection.     

Sexual Risk for HIV Among Gay Male Couples: A Longitudinal Study of the Impact of Relationship Dynamics

While the relationship context itself is increasingly being examined to understand sexual risk behavior among gay male couples, few studies have examined relationship dynamics and HIV risk longitudinally. We aimed to investigate relationship dynamics and psychosocial predictors of unprotected anal intercourse (UAI) with outside partners of serodiscordant or unknown HIV serostatus (UAIOUT) over time as well as UAI with primary partner in serodiscordant couples (UAIPP). We recruited a sample of 566 ethnically diverse, seroconcordant and serodiscordant couples and interviewed them six times over the course of 3 years. The surveys encompassed relationship dynamics between the partners and sexual behavior with primary and outside partners. We fit generalized linear mixed models for both the UAI outcomes with time and relationship dynamics as predictors while controlling for relationship length. Analyses of the longitudinal data revealed that, in both categories of couples, those with higher levels of positive relationship dynamics (e.g., commitment, satisfaction) were less likely to engage in UAIOUT. Higher investment in sexual agreement and communication were among the factors that significantly predicted less UAIOUT for seroconcordant couples, but not for the serodiscordant couples. For serodiscordant couples, greater levels of attachment and intimacy were associated with greater odds of UAIPP while increased HIV-specific social support was associated with lower odds of UAIPP. These results underscore the importance of creating and tailoring interventions for gay couples that help maintain and strengthen positive relationship dynamics as they have the potential to produce significant changes in HIV risk behavior and thereby in HIV transmission.     

Gay Male Couples’ Attitudes Toward Using Couples-Based Voluntary HIV Counseling and Testing

Many men who have sex with men acquire HIV from their primary male partners while in a relationship. Studies with gay couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, couples-based voluntary HIV counseling and testing (CVCT) has become available to male couples throughout the U.S. However, HIV-negative couples’ attitudes toward using CVCT and how their relationship characteristics may affect their use of CVCT remain largely unknown. This information is particularly relevant for organizations that offer CVCT. To assess couples’ attitudes, and associated factors toward using CVCT, a cross-sectional study design was used with a novel Internet-based recruitment method to collect dyadic data from a national sample of 275 HIV-negative gay couples. Multivariate multilevel modeling was used to identify factors associated with differences between and within couples about their attitudes towards using CVCT. Findings revealed that couples were “somewhat” to “very likely” to use CVCT. More positive attitudes toward using CVCT were associated with couples who had higher levels of relationship satisfaction and commitment toward their sexual agreement and among those who had at least one partner having had sex outside of the relationship. Less positive attitude toward using CVCT was associated with couples who had higher levels of trust toward their partners being dependable. Differences within couples, including age between partners, whether sex had occurred outside of the relationship, and value toward a sexual agreement also affected their attitudes toward using CVCT. Providing additional testing methods may help HIV-negative gay couples better manage their HIV risk.     

Sexual Risk Behavior of HIV-Positive Methamphetamine-Using Men Who Have Sex with Men: The Role of Partner Serostatus and Partner Type

This study examined the role of partner serostatus and partner type in relation to the sexual risk behaviors and disclosure practices of HIV-positive methamphetamine (meth)-using men who have sex with men (MSM). The sample consisted of 132 HIV-positive meth-using MSM who reported having both serodiscordant (i.e., HIV-negative and unknown serostatus) and seroconcordant (i.e., HIV-positive) partners. HIV-positive meth-using MSM engaged in significantly fewer acts of anal sex with serodiscordant partners as compared to seroconcordant partners. However, mean levels of unprotected anal and oral sex were high, and mean levels of protected sex were low for both seroconcordant and serodiscordant partners. Oral sex was practiced twice as often as anal sex; however, both types of sex were primarily unprotected. This pattern of risky sexual behavior was reported for steady, casual, and anonymous partners, regardless of partner serostatus. Despite high rates of unprotected sex, rates of HIV serostatus disclosure were consistently high for HIV-positive and HIV-negative steady, casual, and anonymous partners. However, rates of disclosure to unknown serostatus partners were low, particularly in relation to anonymous partners. Future research should address the reasons why HIV-positive meth-using MSM engage in risky sexual activity with serodiscordant partners, and HIV prevention programs for this population should emphasize the risks associated with unprotected sex with seroconcordant partners.