Couple Relationship Functioning as a Source or Mitigator of HIV Risk: Associations Between Relationship Quality and Sexual Risk Behavior in Peri-urban Uganda

Abstract

Despite evidence that a greater focus on couples could strengthen HIV prevention efforts, little health-related research has explored relationship functioning and relationship quality among couples in Africa. Using data from 162 couples (324 individuals) resident in a peri-urban Ugandan community, we assessed actor and partner effects of sexual risk behaviors on relationship quality, using psychometric measures of dyadic adjustment, sexual satisfaction, commitment, intimacy, and communication. For women and men, poor relationship quality was associated with having concurrent sexual partners and suspecting that one’s partner had concurrent sexual partners (actor effects). Women’s poor relationship quality was also associated with men’s sexual risk behaviors (partner effects), although the inverse partner effect was not observed. These findings suggest that relationship quality is linked to HIV risk, particularly through the pathway of concurrent sexual partnerships, and that positive relationship attributes such as sexual satisfaction, intimacy, and constructive communication can help couples to avoid risk.

Alcohol use and relationship quality among South African couples

“…Because relationship quality has received even less attention in the African context, our intention was to explore associations with individual constructs of relationship quality and allow for nuanced patterns to emerge. Further, as discussed previously, the one study that has examined alcohol use and relationship quality in Africa (Ruark et al, 2017) also used separate models for each relationship quality domain, and indeed found both gender differences in the association between relationship quality and alcohol use before sex, as well as different findings for different domains of relationship quality.…”

“…There are some experimental data from alcohol administration studies with couples in the U.S. (Frankenstein, Hay, & Nathan, 1985; Smith, et al, 1975) and observational, experience sampling studies (e.g., aan het Rot, Russell, Moskowitz, & Young, 2008) in support of the intrepretation that alcohol use facilitaties positive affective expression. It is also possible that the measure of intimacy we used was more an approximation of caregiving (“I get so close to my partner I find it hard to separate from him”; “I think in terms of we/us instead of I/me”), rather than emotional intimacy as assessed by Ruark et al (2017) (“I receive/give considerable emotional support to my partner”; “I feel that I really understand my partner”), who found alcohol use before sex to be unrelated to women’s feelings of intimacy.…”

“…We could find only one study that has examined alcohol use and relationship quality in all of SSA. The association of alcohol use before sex and dyadic adjustment, sexual satisfaction, commitment, intimacy, and communication was examined with a sample of 162 married or cohabiting couples from a peri-urban area near Kampala, Uganda (Ruark, Kajubi, Ruteikara, Green, & Hearst, 2017). Findings revealed that women who reported alcohol use with sex also reported significantly lower relationship quality in all domains except intimacy; women with a male partner who reported alcohol use with sex also reported lower dyadic adjustment and worse communication.…”

“…These findings are consistent with the U.S.-based data previously discussed indicating that women are more negatively affected by their male partner’s alcohol use than men are by their female partner’s alcohol use. The study by Ruark et al (2017), combined with the gender discrepancy (WHO, 2014), heavy episodic pattern (WHO, 2014), and high prevalence of drinking in bars/venues in South Africa (Morojele et al, 2006), suggests that the role of alcohol in relationships in SSA may approximate the conditions under which it is most detrimental in the U.S.-based literature: heavy, discrepant, and outside the home.…”

Re-conceptualising gender and power relations for sexual and reproductive health: contrasting narratives of tradition, unity, and rights

“…Research among South African couples enrolled in an HIV prevention trial found that shared power was a stronger correlate of relationship quality (e.g., trust, intimacy) than women's own power or men's beliefs about equitable gender norms (Conroy et al 2016). Relationship quality is also associated with positive health behaviours such as condom use and medication adherence (Ruark, Kajubi et al 2017;Conroy, Ruark, and Darbes 2018). Connell's (1987) theory of gender and power provides the theoretical basis for the vulnerability paradigm and argues that three social structures characterise the relationship between men and women: (1) the sexual division of labour; (2) the sexual division of power; and (3) cathexis, or social norms and affective attachments around femininity and masculinity.…”