Approval Sheet Understanding HIV Transmission Risk in Married HIV Serodiscordant Couples in Gujarat, India: The Positive Jeevan Saathi Study Open Access

Abstract

Background: Few studies have examined the factors that contribute to HIV transmission
risk among HIV-negative wives in married serodiscordant relationships in India. No
study addresses this issue in Gujarat, a state with one of the largest numbers of new cases
of HIV in India.
Methods: This study employed a mixed-methods study design. First, in-depth
interviews with 23 HIV serodiscordant couples were conducted in either Gujarati or
Hindi with HIV-negative wives and their HIV-positive husbands. Interviews focused
on marital sex as well as the factors that protect against and put HIV-negative wives at
risk for HIV. Data were analyzed using Grounded Theory in Maxqda. Second, one
couple was selected as a case study to illustrate how specific factors amplify HIV
transmission risk. Lastly, surveys were administered to 185 HIV-positive husbands and
their HIV-negative wives to describe their individual, interpersonal, and behavioral
characteristics, as well as the factors associated with inconsistent condom use and
male-dominated sexual decision-making, using SPSS 18.0.
Results: Based on the qualitative data, fear of HIV, positive sex communication, the
wife's assertiveness to protect herself, mutual respect regarding sexual desire, and the
husband's desire to protect his HIV-negative wife, promoted safer sex or no sex. Factors
that placed wives at risk for HIV included husband's alcohol use, intimate partner
violence (IPV), and displeasure with condoms. In addition, unfulfilled sexual desire and
refusal of sex contributed to extramarital relations. Survey data showed a high proportion
of husbands and wives reported joint sexual decision-making and consistent condom use
in the past three months. Wives who reported any communication about sex with their
husbands were less likely to report inconsistent condom use or male-dominated decision-
making regarding condom use. About 20% of wives reported IPV; wives who reported
male-dominated sexual decision-making were more likely to report IPV.
Conclusions: While a high proportion of HIV-positive husbands and their HIV-negative
wives reported consistent condom use, several factors created challenges in maintaining
such behavior. Addressing topics such as sexual fulfillment, safer sex methods, and sex
communication; as well as IPV and alcohol use may be important in preventing risk to
HIV-negative wives in HIV serodiscordant relationships.

Table of Contents

Table of Contents
CHAPTER 1:

Literature review







Overview of Problem
1
HIV Prevention among Heterosexual Serodiscordant Couples 3
Individual-level Determinants of HIV Risk 4
Interpersonal-level and Socio-cultural determinants of HIV risk 6
Significance of Study Site





10
Study Significance and Implications



11
Conceptual Framework



12
Overview of Research and Subsequent Chapters 12
References






14

CHAPTER 2: Influences on Sexual Risk among HIV Serodiscordant Couples in
Gujarat, India: Results from the Positive Jeevan Sathi Study
Abstract






23
Introduction







25
Background







25
Methods







29
Results







33
Discussion






42
Conclusions 46
References







47

CHAPTER 3: He Said, She Said: A Case Study on the Relationship Dynamics and
Challenges of Safer Sex among a HIV Serodiscordant Couple in Gujarat, India

Abstract






53
Introduction 54
Background







55
Methods






56
Results







58

Discussion & Recommendations




63
Conclusions 66
References







67

CHAPTER 4: Individual, Interpersonal, and Behavioral factors that Influence
Male-dominated Sexual Decision-Making and Inconsistent Condom Use among
Married HIV Serodiscordant Couples in Gujarat, India
Abstract







69
Introduction







71
Background



72
Methods






75
Results







83
Discussion


86

Conclusions






91
References







93

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV prevention HIV serodiscordant couples HIV prevention India
Committee Chair / Thesis Advisor	Wingood, Gina M, Emory University
Committee Members	Windle, Michael, Emory University Yount, Kathryn, Emory University Hennink, Monique, Emory University Mccarty, Frances A., Emory University

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