Approval Sheet Understanding HIV Transmission Risk in Married HIV Serodiscordant Couples in Gujarat, India: The Positive Jeevan Saathi Study Public
Patel, Shilpa Narendra (2012)
Published
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
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