The Influence of Relationship Power Dynamics on HIV Testing in Rural Malawi

Conroy, Amy A.

doi:10.1080/00224499.2014.883590

Cited by 26 publications

(19 citation statements)

References 57 publications

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“…Relationship factors including decision-making and communication have long been identified as critical determinants of whether men and women seek HIV testing and disclose results to partners, as well as whether women experience negative reactions to disclosure such as violence [ 5 ]. Previous research in rural Malawi found that women and men who reported higher relationship unity (defined as discussing important matters, displaying care, and offering assistance when needed) were less likely to test for HIV [ 36 ]. Disclosure of HIV status to a sexual partner has been associated with a “smooth relationship” in Ethiopia [ 38 ], while fear of conflict with a partner and lack of relationship stability were associated with non-disclosure among pregnant women in Tanzania [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi

et al. 2017

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Available data suggest that individual and family well-being are linked to the quality of women’s and men’s couple relationships, but few tools exist to assess couple relationship functioning in low- and middle-income countries. In response to this gap, Catholic Relief Services has developed a Couple Functionality Assessment Tool (CFAT) to capture valid and reliable data on various domains of relationship quality. This tool is designed to be used by interventions which aim to improve couple and family well-being as a means of measuring the effectiveness of these interventions, particularly related to couple relationship quality. We carried out a validation study of the CFAT among 401 married and cohabiting adults (203 women and 198 men) in rural Chikhwawa District, Malawi. Using psychometric scales, the CFAT addressed six domains of couple relationship quality (intimacy, partner support, sexual satisfaction, gender roles, decision-making, and communication and conflict management), and included questions on intimate partner violence. We used exploratory factor analysis to assess scale performance of each domain and produce a shortened Relationship Quality Index (RQI) composed of items from five relationship quality domains. This article reports the performance of the RQI. Internal reliability and validity of the RQI were found to be good. Regression analyses examined the relationship of the RQI to outcomes important to health and development: intra-household cooperation, positive health behaviors, intimate partner violence, and gender-equitable norms. We found many significant correlations between RQI scores and these couple- and family-level development issues. There is a need to further validate the tool with use in other populations as well as to continue to explore whether the observed linkages between couple functionality and development outcomes are causal relationships.

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Section: Discussionmentioning

confidence: 99%

Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi

et al. 2017

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“…We carried out a literature review using Pubmed with following keywords -Malawi, HIV test, socioeconomic status equality and equity [21]. After refining the search results several times based on the literature review [21], we obtained 7 relevant article [20,[22][23][24][25][26][27]. Among these, 3 articles were relevant about the association between socioeconomic status and HIV testing.…”

Section: Introductionmentioning

confidence: 99%

“…They found that there is tendency that more women than men used HIV testing and counselling and an urban bias in provision of HIV testing and counselling. Conroy et al [23] found women's uptake on HIV test were more strongly affected by perceptions of a partner on HIV than their women's own. As a result, our understanding of the potential barriers to achieving global goals in Malawi remains incomplete.…”

Section: Introductionmentioning

confidence: 99%

A method for measuring spatial effects on socioeconomic inequalities using the concentration index

Kim

Haghparast‐Bidgoli

Skordis‐Worrall

et al. 2020

Int J Equity Health

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Background: Although spatial effects contribute to inequalities in health care service utilisation and other health outcomes in low and middle income countries, there have been no attempts to incorporate the impact of neighbourhood effects into equity analyses based on concentration indices. This study aimed to decompose and estimate the contribution of spatial effects on inequalities in uptake of HIV tests in Malawi. Methods: We developed a new method of reflecting spatial effects within the concentration index using a spatial weight matrix. Spatial autocorrelation is presented using a spatial lag model. We use data from the Malawi Demographic Health Survey (n = 24,562) to illustrate the new methodology. Need variables such as 'Any STI last 12 month', 'Genital sore/ulcer', 'Genital discharge' and non need variables such as Education, Literacy, Wealth, Marriage, and education were used in the concentration index. Using our modified concentration index that incorporates spatial effects, we estimate inequalities in uptake of HIV testing amongst both women and men living in Malawi in 2015-2016, controlling for need and non-need variables. Results: For women, inequalities due to need variables were estimated at − 0.001 and − 0.0009 (pro-poor) using the probit and new spatial probit estimators, respectively, whereas inequalities due to non-need variables were estimated at 0.01 and 0.0068 (pro-rich) using the probit and new spatial probit estimators. The results suggest that spatial effects increase estimated inequalities in HIV uptake amongst women. Horizontal inequity was almost identical (0.0103 vs 0.0102) after applying the spatial lag model. For men, inequalities due to need variables were estimated at − 0.0002 using both the probit and new spatial probit estimators; however, inequalities due to non-need variables were estimated at − 0.006 and − 0.0074 for the probit and new spatial probit models. Horizontal inequity was the same for both models (− 0.0057). Conclusion: Our findings suggest that men from lower socioeconomic groups are more likely to receive an HIV test after adjustment for spatial effects. This study develops a novel methodological approach that incorporates estimation of spatial effects into a common approach to equity analysis. We find that a significant component of inequalities in HIV uptake in Malawi driven by non-need factors can be explained by spatial effects. When the spatial model was applied, the inequality due to non need in Lilongwe for men and horizontal inequity in Salima for women changed the sign. This approach can be used to explore inequalities in other contexts and settings to better understand the impact of spatial effects on health service use or other health outcomes, impacting on recommendations for service delivery.

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“…As such, positive relationship dynamics (e.g., intimacy, trust) enhance couples’ capacity for successful coordination of health behaviors, while negative relationship dynamics (e.g., IPV) make it difficult for couples to work together. In South Africa and Malawi, relationship dynamics such as commitment, unity, equality, trust, and communication have been linked to increased HIV testing and disclosure in couples (Darbes, Dladla, and Mogale 2006, Conroy 2014a, b, van Rooyen et al 2014, Conroy and Wong 2015). Less is known about the intersection between relationship dynamics and adherence in sub-Saharan Africa; however; evidence from resource-rich settings suggests that higher relationship quality is positively associated with ART adherence and virologic control (Knowlton et al 2011, Johnson et al 2012).…”

Section: Introductionmentioning

confidence: 99%

‘I told her this is your life’: relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples

Conroy

Leddy

Johnson

et al. 2017

Culture, Health & Sexuality

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Despite the important role of social relationships on health and well-being, little is known about how primary partners affect adherence to HIV care and treatment. We qualitatively explored how relationship dynamics and partner support influence adherence among couples from KwaZulu-Natal, South Africa. Twenty-four heterosexual couples with at least one HIV-positive partner completed semi-structured interviews on topics including relationship dynamics (intimacy or emotional closeness, communication, violence), experiences with HIV care and treatment, and HIV-related social support. The majority of couples were seroconcordant HIV-positive (92%) and both on ART (63%). Participants described how primary partners both interfered with and supported adherence. Negative forms of influence included relationship conflict, which resulted in forgetfulness to take pills, and men’s attempt to control use of ART. However, participants were more likely to highlight positive forms of influence on adherence, which included social support (instrumental, informational, and emotional support), intimacy, and commitment. The findings also suggest a reciprocal relationship between ART and relationships such that couple ART use may enhance relationship quality. Primary partners are important pillars of support for ART adherence, especially in contexts of high unemployment and poverty. Future interventions that encourage and leverage these supportive relationships could improve ART adherence among heterosexual couples in similar settings.

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The Influence of Relationship Power Dynamics on HIV Testing in Rural Malawi

Cited by 26 publications

References 57 publications

Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi

Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi

A method for measuring spatial effects on socioeconomic inequalities using the concentration index

‘I told her this is your life’: relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples

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