Relationship dynamics and HIV testing behavior: A couples study from southern Malawi

Background: HIV testing is often promoted as the key to prevention in sub-Saharan Africa. While testing decisions are frequently made within the context of a dyad, little research has examined how relationship factors can inhibit or promote HIV testing behavior. This study identifies the gendered patterns of HIV testing and disclosure at the individual and relationship levels using a sample of young couples (n=932) from Malawi. Methods: The data come from Tsogolo la Thanzi, a longitudinal study on sexual behavior and AIDS in southern Malawi. Structural equation models were used to test for associations between a two-factor measure of relationship power (containing “unity” and “dominance” subscales), socio-demographics, perceived risk of infection, and two testing outcomes: ever tested and disclosure of test results to a primary partner. Results: HIV testing patterns varied by gender. After controlling for covariates, women who experienced less dominance by a partner had a lower odds of ever having an HIV test (OR=0.54, p<0.05). For men, unity (OR=0.28, p<0.05) and dominance (OR=0.67, p<0.05) were significant predictors of ever having an HIV test. Unity was a significant predictor of disclosure among women to their male partners (OR=1.91, p<0.05). Conclusions: Although individuals in loving relationships with open communication were more likely to disclose test results to each other, they were less likely to get tested for HIV. HIV testing may be incompatible with intimate relationships. HIV organizations working in sub-Saharan Africa to promote testing might consider targeting more serious partnerships in order to increase rates of couples testing.