Importance of Relationship Context in HIV Transmission: Results From a Qualitative Case-Control Study in Rakai, Uganda

Abstract

We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health.

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

“…Our results support more qualitative similarities than differences between couples who were and were not living with HIV. This overarching comparability is affirmed by other recent studies comparing unmet need for contraception and relationship dynamics among samples of HIV positive and HIV negative persons (Bankole et al 2014; Higgins et al 2014). …”

“…Inequities in gender-based power influence multiple behaviours related to HIV risk, such as the negotiation of condom use and female-controlled methods for STI prevention, sexual behaviour within and outside of relationships, and sexual violence (Dunkle et al 2004; Mantell et al 2006; Parikh 2007; Muldoon et al 2014). A case-control study in Uganda compared newly HIV positive young adults to HIV negative “controls,” and found variations in relationship context; for example, the recent seroconverters reported poorer communication and more suspicion about infidelity (Higgins et al 2014). While the balance of power within couples is known to affect women’s reproductive health, few studies have qualitatively examined the ways in which couple power dynamics play out in family planning, particularly among individuals at high risk for unintended pregnancy—such as those living with HIV.…”

Rising School Enrollment and Declining HIV and Pregnancy Risk Among Adolescents in Rakai District, Uganda, 1994–2013

“…Behavior changes included lower rates of alcohol use in the past 30 days, higher rates of consistent condom use, greater use of modern contraception among women and – among men – fewer recent sexual partners and less sexual concurrency. In prior work, school enrollment, gender, timing in sexual experience and marriage, alcohol use, and partner and relationship factors were associated with risk for HIV acquisition among youth and with trends over time in HIV acquisition (Santelli, Edelstein et al 2013; Santelli Edelstein et al 2015; Higgins, Mathur et al 2014). …”

“…The qualitative data for this study came from an ethnographic case-control study of HIV+ (cases) and HIV- (controls) of young men and women aged 15-24 years (Higgins, Mathur et al 2014). In-depth life history interviews were conducted with respondents selected from the RCCS.…”

Re-focusing HIV Prevention Messages: A Qualitative Study in Rural Uganda

“…This study was part of a 5-year research initiative to examine behavioral, biological, and demographic risk and protective factors associated with incident HIV infections among youth in rural south-central Uganda [19][20][21][22][23]. One of the aims of the study was to assess how HIV risk perceptions and understanding of risk reduction strategies has changed over time.…”