Online Program

Relationship trajectories, trust, and couples HIV counseling and testing in rural Tanzania: Qualitative findings from NIMH project accept (HPTN 043)

Monday, November 4, 2013

Marta Mulawa, PhD, Duke Global Health Institute, Duke, Durham, NC
Suzanne Maman, PhD, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
Jacob Ntogwisangu, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Michael Sweat, PhD, Psychiatry and Behavioral Sciences, Medical University of South Caroline, Charleston, SC
Couples HIV Counseling and Testing (CHCT) has shown promise as an effective HIV prevention tool, yet rates of CHCT remain low throughout sub-Saharan Africa. To better understand low uptake of CHCT, we analyzed longitudinal qualitative data from the Tanzania site of NIMH Project Accept (HPTN 043), a multi-site community-randomized trial assessing the effectiveness of a community-based HIV prevention intervention. This analysis was restricted to women in intervention communities in relationships at baseline. We systematically coded interview transcripts with topical codes and then developed narrative summaries of the relationship trajectories and attitudes and experiences with HIV testing for each woman spanning the baseline, 15-month and 30-month interviews. Next, we developed matrices to compare the relationship and testing narratives for the participants over time. Fifteen women were identified that met our criteria and the most common patterns are represented by three illustrative cases. The cases represent 1) women who discussed their HIV results with their partners and could not convince their partners to get tested, 2) women who described “sequential” testing for HIV, where she tested first and was followed by her partner testing individually, and 3) women who originally described “concurrent” CHCT with partners as ideal within trusting relationships and later emphasized the benefits of concurrent testing within strained relationships. Our findings highlight a wide range of attitudes towards CHCT that were shaped by relationship trajectories. Strategies to increase CHCT in sub-Saharan Africa should focus on maximizing benefits of sequential CHCT and encouraging concurrent CHCT in a wide range of relationships.

Learning Areas:

Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Describe how attitudes towards and experiences of HIV testing among women in rural communities in Tanzania are influenced by the nature of their relationships over time. Identify three patterns of relationships and HIV testing experiences. Discuss implications of the research for strategies to increase CHCT testing in sub-Saharan Africa.

Keyword(s): HIV Interventions, Women and HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a Master of Health Science degree in International Health and was based in Tanzania as the Research Coordinator for this study for two years. I led the analysis of this data and drafted the abstract and manuscript. I am currently a PhD Student in Health Behavior.
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.