Global Health Sciences, University of California, San Francisco, C/O Makerere University School of Public Health, Kampala, Uganda.
BMC Public Health. 2012 Sep 18;12:801. doi: 10.1186/1471-2458-12-801.
HIV-negative members of sero-discordant couples are at high risk for HIV acquisition but few behavioral prevention interventions have been implemented in sub-Saharan Africa and discordance is not well understood by couples themselves.
In this nested sub-study, we interviewed 40 HIV sero-discordant couples before and after a 6-month behavioral intervention that was comprised of four group discussions on specific HIV prevention and care topics. The content of the sessions included: 1) understanding HIV serodiscordance and reducing risk, 2) couple communication, 3) reproductive health and HIV serodiscordance, 4) coping with HIV serodiscordance and ongoing support. Couple members were interviewed individually. Data were analyzed thematically using 'Framework Analysis' which incorporated dyadic factors to address couple issues.
Analysis revealed pre-identified concepts and emergent themes that were relevant to the final conceptual model. Four major categories of factors affecting couple relations, beliefs and current risk behaviors emerged: intervention factors, structural/contextual factors, physical health factors, and past risk behavior. The topics within the intervention most relevant were communication and reproductive health. The contextual factors highlighted by couples were gender norms around sexual decision-making and multiple partnerships. Individual beliefs regarding HIV serodiscordance persisted over all time points for some couples. Interestingly, some couple members had divergent views about their HIV status; some believing the HIV-negative member was negative while others described multiple beliefs around the negative member's blood surely being positive for HIV. Couple communication emerged as an important theme mediating beliefs and behavior.
In addition to biomedical and behavioral interventions, HIV-serodiscordant couple interventions must embrace the contextual complexity and cultural understanding of HIV infection and discordance as well as the dynamic nature of couple communication to influence risk behavior.
血清学不一致的夫妇中 HIV 阴性的一方感染 HIV 的风险很高，但在撒哈拉以南非洲地区，几乎没有实施过针对这一人群的行为预防干预措施，而且夫妇双方自身也对不一致的情况认识不足。
在这项嵌套子研究中，我们在一项为期 6 个月的行为干预措施前后对 40 对 HIV 血清学不一致的夫妇进行了访谈，该干预措施包括 4 次关于特定 HIV 预防和护理主题的小组讨论。会议的内容包括：1）了解 HIV 血清不一致和降低风险，2）夫妻沟通，3）生殖健康和 HIV 血清不一致，4）应对 HIV 血清不一致和持续支持。夫妻双方分别接受采访。使用“框架分析”对数据进行主题分析，该分析方法纳入了对偶因素以解决夫妻问题。
分析揭示了与最终概念模型相关的预先确定的概念和新出现的主题。影响夫妻关系、信念和当前风险行为的四个主要类别因素包括：干预因素、结构/背景因素、身体健康因素和过去的风险行为。干预措施中最相关的主题是沟通和生殖健康。夫妇们强调的背景因素是性决策和多伙伴关系方面的性别规范。一些夫妇对 HIV 血清不一致的个人信念在所有时间点都持续存在。有趣的是，一些夫妇成员对他们的 HIV 状况有不同的看法；一些人认为 HIV 阴性的一方是阴性的，而另一些人则描述了关于阴性一方的血液肯定对 HIV 呈阳性的多种信念。夫妻沟通成为影响行为的重要主题，调解信念和行为。
除了生物医学和行为干预措施外，HIV 血清不一致的夫妇干预措施必须包括对 HIV 感染和不一致的背景复杂性和文化理解，以及夫妻沟通的动态性质，以影响风险行为。
