264695 Contexts of HIV transmission among young adults in Rakai, Uganda: The importance of relationship dynamics

Wednesday, October 31, 2012 : 8:30 AM - 8:50 AM

Jenny Higgins, PhD, MPH , Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI
Sanyukta Mathur, MHS , Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, Long Island City, NY
Neema Nakyanjo , Qualitative Research Department, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Elizabeth I. Eckel , Population and Family Health, Columbia University, New York City, NY
Laura Kelley, MPH , Mailman & Clinton Health Access Initiative, Mailman School of Public Health, Leawood, KS
Richard Sekamwa , Qualitative Research Department, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Josephine Namatovu , Qualitative Research Department, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Fred Nalugoda, S Stat, MHS , Director of Kalisizo Field Station, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
John S. Santelli, MD , Department of Population and Family Health, Columbia University, New York, NY
Background: Continuing HIV transmission among youth in sub-Saharan Africa demands greater awareness of the contextual variables influencing HIV transmission. Few qualitative studies have been able to use HIV data from recently infected youth or to compare newly positive and negative peers. Methods: This analysis draws from 60 in-depth life history interviews with young women and men (15-24 years) drawn from an ongoing Rakai Community Cohort Study in Rakai, Uganda. An innovative "ethnographic case-control" study design matched newly infected HIV+ cases with HIV- controls by gender, marital status, and community. Interviews explored a range of developmental and behavioral factors, including relationship history, family history, and aspirations for education, employment, and childbearing. Results: Relationship dynamics, both within respondents' primary relationships and outside partnerships, emerged as the most salient theme explaining differences in HIV-status. Compared to those who became HIV infected in the last year, respondents who remained HIV-negative were more likely to report communication with their main partner about HIV, knowledge of their partner's HIV testing history and results, awareness of their partners' other partners and condom use with other partners. Although condom use was infrequent in most primary partnerships, men's refusal to wear them was more common among relationships of HIV-positive respondents. Conclusions: Results highlight the importance of dyadic approaches to HIV -- namely, that relationship dynamics significantly influence HIV-related communication, testing, and prevention practices. Interventions that emphasize couple-based testing and/or communication skills appear justified. Finally, using matched-pairs as the unit of analysis greatly helped clarify the primary factors explaining HIV.

Learning Areas:
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research
Social and behavioral sciences

Learning Objectives:
At the conclusion of this session, attendees should be able to: - Identify the utility of contextual studies to explain HIV transmission among youth; - Articulate the methods and benefits of the investigators' "ethnographic case-control" study design; - Explain the ways in which relationship dynamics differed between HIV-positive and negative respondents, both in primary and outside partnerships.

Keywords: HIV/AIDS, Youth

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted research on sexual health for over 10 years, and I participated directly in the research highlighted by this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.