Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care

Lynn T. Matthews, Bridget F. Burns, Francis Bajunirwe, Jerome Kabakyenga, Mwebesa Bwana, Courtney Ng, Jasmine Kastner, Annet Kembabazi, Naomi Sanyu, Adrine Kusasira, Jessica E. Haberer, David Bangsberg, Angela Kaida

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. Methods: We recruited HIV-positive men and women on antiretroviral therapy (ART) (‘index’) from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner (‘partner’), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. Results: 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner’s HIV status. Similarly, the partner’s HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner’s desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. Conclusions: Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.

Original languageEnglish (US)
Article numbere0183131
JournalPLoS One
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

communication (human)
Communication
HIV
Risk perception
animal communication
Disclosure
Uganda
Decision making
RNA
therapeutics
risk perception
insemination
decision making
interviews
disease control
methodology
Male Circumcision
uptake mechanisms
Insemination
Condoms

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Matthews, L. T., Burns, B. F., Bajunirwe, F., Kabakyenga, J., Bwana, M., Ng, C., ... Kaida, A. (2017). Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care. PLoS One, 12(9), [e0183131]. https://doi.org/10.1371/journal.pone.0183131

Beyond HIV-serodiscordance : Partnership communication dynamics that affect engagement in safer conception care. / Matthews, Lynn T.; Burns, Bridget F.; Bajunirwe, Francis; Kabakyenga, Jerome; Bwana, Mwebesa; Ng, Courtney; Kastner, Jasmine; Kembabazi, Annet; Sanyu, Naomi; Kusasira, Adrine; Haberer, Jessica E.; Bangsberg, David; Kaida, Angela.

In: PLoS One, Vol. 12, No. 9, e0183131, 01.09.2017.

Research output: Contribution to journalArticle

Matthews, LT, Burns, BF, Bajunirwe, F, Kabakyenga, J, Bwana, M, Ng, C, Kastner, J, Kembabazi, A, Sanyu, N, Kusasira, A, Haberer, JE, Bangsberg, D & Kaida, A 2017, 'Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care', PLoS One, vol. 12, no. 9, e0183131. https://doi.org/10.1371/journal.pone.0183131
Matthews, Lynn T. ; Burns, Bridget F. ; Bajunirwe, Francis ; Kabakyenga, Jerome ; Bwana, Mwebesa ; Ng, Courtney ; Kastner, Jasmine ; Kembabazi, Annet ; Sanyu, Naomi ; Kusasira, Adrine ; Haberer, Jessica E. ; Bangsberg, David ; Kaida, Angela. / Beyond HIV-serodiscordance : Partnership communication dynamics that affect engagement in safer conception care. In: PLoS One. 2017 ; Vol. 12, No. 9.
@article{bcc0d3d220da4499b84e8de29a28bb06,
title = "Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care",
abstract = "Introduction: We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. Methods: We recruited HIV-positive men and women on antiretroviral therapy (ART) (‘index’) from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner (‘partner’), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. Results: 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80{\%} had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner’s HIV status. Similarly, the partner’s HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner’s desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. Conclusions: Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.",
author = "Matthews, {Lynn T.} and Burns, {Bridget F.} and Francis Bajunirwe and Jerome Kabakyenga and Mwebesa Bwana and Courtney Ng and Jasmine Kastner and Annet Kembabazi and Naomi Sanyu and Adrine Kusasira and Haberer, {Jessica E.} and David Bangsberg and Angela Kaida",
year = "2017",
month = "9",
day = "1",
doi = "10.1371/journal.pone.0183131",
language = "English (US)",
volume = "12",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "9",

}

TY - JOUR

T1 - Beyond HIV-serodiscordance

T2 - Partnership communication dynamics that affect engagement in safer conception care

AU - Matthews, Lynn T.

AU - Burns, Bridget F.

AU - Bajunirwe, Francis

AU - Kabakyenga, Jerome

AU - Bwana, Mwebesa

AU - Ng, Courtney

AU - Kastner, Jasmine

AU - Kembabazi, Annet

AU - Sanyu, Naomi

AU - Kusasira, Adrine

AU - Haberer, Jessica E.

AU - Bangsberg, David

AU - Kaida, Angela

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Introduction: We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. Methods: We recruited HIV-positive men and women on antiretroviral therapy (ART) (‘index’) from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner (‘partner’), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. Results: 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner’s HIV status. Similarly, the partner’s HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner’s desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. Conclusions: Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.

AB - Introduction: We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. Methods: We recruited HIV-positive men and women on antiretroviral therapy (ART) (‘index’) from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner (‘partner’), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. Results: 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner’s HIV status. Similarly, the partner’s HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner’s desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. Conclusions: Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.

UR - http://www.scopus.com/inward/record.url?scp=85028970928&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028970928&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0183131

DO - 10.1371/journal.pone.0183131

M3 - Article

C2 - 28880892

AN - SCOPUS:85028970928

VL - 12

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 9

M1 - e0183131

ER -