Understanding the relationship between couple dynamics and engagement with HIV care services: insights from a qualitative study in Eastern and Southern Africa
Understanding the relationship between couple dynamics and engagement with HIV care services: insights from a qualitative study in Eastern and Southern Africa
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DOI：
10.1136/sextrans-2016-052976
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发表时间：
2017-07-01
影响因子：
3.6
通讯作者：
Wringe, Alison
中科院分区：
文献类型：
--
作者：
Wamoyi, Joyce;Renju, Jenny;Wringe, Alison
目的在坦桑尼亚、马拉维和南非三个人口健康监测点，探讨夫妻动态与艾滋病病毒感染者(PLHIV)参与HIV护理和治疗服务之间的相互作用。方法对107名有HIV护理和治疗病史的PLHIV患者进行深入访谈，包括目前使用HIV诊所的人和未参加HIV护理的人。访谈探讨了与艾滋病毒携带者生活的经历以及他们如何以及为什么选择参与或不参与艾滋病毒服务。结果在坦桑尼亚、马拉维和南非，我们发现夫妻动态与HIV护理和寻求治疗行为之间存在相互作用。处于一种关系中会以多种方式影响与艾滋病毒服务的接触程度和类型。在某些情况下，艾滋病毒携带者夫妇相互支持，提高了他们对护理的参与度，加强了他们的关系。满足社会期望并吸引新伴侣，或与新伴侣生孩子，或获得情感或经济支持的愿望，加强了对艾滋病毒护理和治疗的持续参与。然而，对指责、遗弃或虐待的恐惧导致不愿透露，并经常导致夫妇之间的纠纷或不和。几乎没有证据表明夫妻内部理解彼此感染艾滋病毒的经历，我们发现夫妇很少与正式的卫生系统一起互动。结论夫妇动态通过无数途径影响双方对艾滋病毒检测、护理和治疗的参与。需要对夫妇友好的艾滋病毒护理和治疗方法，超越个性化护理，承认伴侣在艾滋病毒护理参与中的作用。
Objective To explore the interplay between couple dynamics and the engagement of people living with HIV (PLHIV) with HIV care and treatment services in three health and demographic surveillance sites in Tanzania, Malawi and South Africa.Methods A qualitative study was conducted involving 107 in-depth interviews with PLHIV with a range of HIV care and treatment histories, including current users of HIV clinics, and people not enrolled in HIV care. Interviews explored experiences of living with HIV and how and why they chose to engage or not with HIV services. Thematic analysis was conducted with the aid of NVivo 10.Results We found an interplay between couple dynamics and HIV care and treatment-seeking behaviour in Tanzania, Malawi and South Africa. Being in a relationship impacted on the level and type of engagement with HIV services in multiple ways. In some instances, couples living with HIV supported each other which improved their engagement with care and strengthened their relationships. The desire to fulfil societal expectations and attract a new partner, or have a baby with a new partner, or to receive emotional or financial support, strengthened on-going engagement with HIV care and treatment. However, fear of blame, abandonment or abuse resulted in unwillingness to disclose and often led to disputes or discord between couples. There was little evidence of intracouple understanding of each other's lived experiences with HIV, and we found that couples rarely interacted with the formal health system together.Conclusions Couple dynamics influenced engagement with HIV testing, care and treatment for both partners through a myriad of pathways. Couple-friendly approaches to HIV care and treatment are needed that move beyond individualised care and which recognise partner roles in HIV care engagement.