“男性总是害怕与伴侣进行检测……这就像是把她们带去警察局”：乌干达拉凯地区夫妻接受艾滋病咨询与检测的动机及障碍：一项定性研究
"Men are always scared to test with their partners … it is like taking them to the Police": Motivations for and barriers to couples' HIV counselling and testing in Rakai, Uganda: a qualitative study.
作者信息
Matovu Joseph K B, Wanyenze Rhoda K, Wabwire-Mangen Fred, Nakubulwa Rosette, Sekamwa Richard, Masika Annet, Todd Jim, Serwadda David
机构信息
Department of Community Health & Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda;
Department of Disease Control & Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
出版信息
J Int AIDS Soc. 2014 Sep 18;17(1):19160. doi: 10.7448/IAS.17.1.19160. eCollection 2014.
INTRODUCTION
Uptake of couples' HIV counselling and testing (couples' HCT) can positively influence sexual risk behaviours and improve linkage to HIV care among HIV-positive couples. However, less than 30% of married couples have ever tested for HIV together with their partners. We explored the motivations for and barriers to couples' HCT among married couples in Rakai, Uganda.
METHODS
This was a qualitative study conducted among married individuals and selected key informants between August and October 2013. Married individuals were categorized by prior HCT status as: 1) both partners never tested; 2) only one or both partners ever tested separately; and 3) both partners ever tested together. Data were collected on the motivations for and barriers to couples' HCT, decision-making processes from tested couples and suggestions for improving couples' HCT uptake. Eighteen focus group discussions with married individuals, nine key informant interviews with selected key informants and six in-depth interviews with married individuals that had ever tested together were conducted. All interviews were audio-recorded, translated and transcribed verbatim and analyzed using Nvivo (version 9), following a thematic framework approach.
RESULTS
Motivations for couples' HCT included the need to know each other's HIV status, to get a treatment companion or seek HIV treatment together - if one or both partners were HIV-positive - and to reduce mistrust between partners. Barriers to couples' HCT included fears of the negative consequences associated with couples' HCT (e.g. fear of marital dissolution), mistrust between partners and conflicting work schedules. Couples' HCT was negotiated through a process that started off with one of the partners testing alone initially and then convincing the other partner to test together. Suggestions for improving couples' HCT uptake included the need for couple- and male-partner-specific sensitization, and the use of testimonies from tested couples.
CONCLUSIONS
Couples' HCT is largely driven by individual and relationship-based factors while fear of the negative consequences associated with couples' HCT appears to be the main barrier to couples' HCT uptake in this setting. Interventions to increase the uptake of couples' HCT should build on the motivations for couples' HCT while dealing with the negative consequences associated with couples' HCT.
引言
夫妻艾滋病毒咨询与检测（夫妻艾滋病毒咨询检测）的普及能够对性风险行为产生积极影响，并改善艾滋病毒阳性夫妻与艾滋病毒治疗的衔接情况。然而，不到30%的已婚夫妇曾与伴侣一起进行过艾滋病毒检测。我们探讨了乌干达拉凯地区已婚夫妇进行夫妻艾滋病毒咨询检测的动机和障碍。
方法
这是一项定性研究，于2013年8月至10月期间在已婚人士及选定的关键信息提供者中开展。已婚人士按之前的艾滋病毒咨询检测状况分为：1）夫妻双方均未检测；2）只有一方或双方曾单独检测；3）夫妻双方曾一起检测。收集了有关夫妻艾滋病毒咨询检测的动机和障碍、已检测夫妻的决策过程以及提高夫妻艾滋病毒咨询检测普及率的建议等数据。与已婚人士进行了18次焦点小组讨论，与选定的关键信息提供者进行了9次关键信息提供者访谈，并与曾一起检测的已婚人士进行了6次深入访谈。所有访谈均进行了录音、翻译和逐字转录，并使用Nvivo（9版）按照主题框架方法进行分析。
结果
夫妻艾滋病毒咨询检测的动机包括需要了解彼此的艾滋病毒感染状况、如果一方或双方为艾滋病毒阳性则找一个治疗伙伴或一起寻求艾滋病毒治疗，以及减少伴侣之间的不信任。夫妻艾滋病毒咨询检测的障碍包括担心夫妻艾滋病毒咨询检测带来的负面后果（如担心婚姻解体）、伴侣之间的不信任以及相互冲突的工作安排。夫妻艾滋病毒咨询检测是通过一个过程来协商的，该过程始于一方伴侣先单独检测，然后说服另一方伴侣一起检测。提高夫妻艾滋病毒咨询检测普及率的建议包括需要针对夫妻和男性伴侣进行特定的宣传，以及使用已检测夫妻的证词。
结论
夫妻艾滋病毒咨询检测在很大程度上受个人因素和基于关系的因素驱动，而担心夫妻艾滋病毒咨询检测带来的负面后果似乎是该环境下夫妻艾滋病毒咨询检测普及的主要障碍。增加夫妻艾滋病毒咨询检测普及率的干预措施应基于夫妻艾滋病毒咨询检测的动机，同时应对夫妻艾滋病毒咨询检测带来的负面后果。
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