Abstract
Despite evidence that a greater focus on couples could strengthen HIV prevention efforts, little health-related research has explored relationship functioning and relationship quality among couples in Africa. Using data from 162 couples (324 individuals) resident in a peri-urban Ugandan community, we assessed actor and partner effects of sexual risk behaviors on relationship quality, using psychometric measures of dyadic adjustment, sexual satisfaction, commitment, intimacy, and communication. For women and men, poor relationship quality was associated with having concurrent sexual partners and suspecting that one’s partner had concurrent sexual partners (actor effects). Women’s poor relationship quality was also associated with men’s sexual risk behaviors (partner effects), although the inverse partner effect was not observed. These findings suggest that relationship quality is linked to HIV risk, particularly through the pathway of concurrent sexual partnerships, and that positive relationship attributes such as sexual satisfaction, intimacy, and constructive communication can help couples to avoid risk.
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Jiwatram-Negrón T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: advantages, gaps, and future directions. AIDS Behav. 2014;18(10):1864–87.
Kwena Z, Mwanzo I, Shisanya C, Camlin C, Turan J, Achiro L, et al. Predictors of extra-marital partnerships among women married to fishermen along Lake Victoria in Kisumu County, Kenya. PLoS ONE. 2014;9(4):e95298.
Leddy A, Chakravarty D, Dladla S, de Bruyn G, Darbes L. Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa. AIDS Care. 2016;28(2):228–33.
Vamos S, Cook R, Chitalu N, Mumbi M, Weiss SM, Jones D. Quality of relationship and sexual risk behaviors among HIV couples in Lusaka, Zambia. AIDS Care. 2013;25(9):1102–8.
Conroy AA, McGrath N, van Rooyen H, Hosegood V, Johnson MO, Fritz K, et al. Power and the association with relationship quality in South African couples: implications for HIV/AIDS interventions. Soc Sci Med. 2016;153:1–11.
Wabwire-Mangen F, Odiit M, Kirungi W, Kisitu DK, Wanyama JO. Uganda HIV prevention response and modes of transmission analysis. Kampala: Uganda AIDS Commission; 2009.
Ministry of Health. Uganda AIDS indicator survey 2011. Kampala: Ministry of Health and ICF International; 2012.
Green EC, Halperin DT, Nantulya V, Nantulya V, Hogle JA. Uganda’s HIV prevention success: the role of sexual behavior change and the national response. AIDS Behav. 2006;10(4):335–46.
Low-Beer D, Stoneburner R. Uganda and the challenge of HIV/AIDS. In: Poku NK, Whiteside A, editors. The political economy of AIDS in Africa. Farnham: Ashgate; 2010. p. 165–90.
Green EC. Rethinking AIDS prevention: learning from successes in developing countries. Westport: Praeger; 2003.
Slutkin G, Okware S, Naamara W, Sutherland D, Flanagan D, Caraël M, et al. How Uganda reversed its HIV epidemic. AIDS Behav. 2006;10(4):351–60.
Stoneburner RL, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004;304(5671):714–8.
Kirby D. Changes in sexual behaviour leading to the decline in the prevalence of HIV in Uganda: confirmation from multiple sources of evidence. Sex Transm Infect. 2008;84(Suppl 2):35–41.
Opio A, Mishra V, Hong R, Musinguzi J, Kirungi W, Cross A, et al. Trends in HIV-related behaviors and knowledge in Uganda, 1989–2005: evidence of a shift toward more risk-taking behaviors. J AIDS. 2008;49(3):320–6.
Kajubi P, Green EC, Hudes ES, Kamya MR, Ruark A, Hearst N. Multiple sexual partnerships among poor urban dwellers in Kampala, Uganda. J AIDS. 2011;57(2):153–6. doi:10.1097/QAI.0b013e318211b466.
Hearst N, Kajubi P, Hudes ES, Maganda AK, Green EC. Prevention messages and AIDS risk behavior in Kampala, Uganda. AIDS Care. 2012;24(1):87–90. doi:10.1080/09540121.2011.582478.
Green EC, Kajubi P, Ruark A, Kamya S, D’Errico N, Hearst N. The need to reemphasize behavior change for HIV prevention in Uganda: a qualitative study. Stud Fam Plann. 2013;44(1):25–43.
Higgins JA, Mathur S, Eckel E, Kelly L, Nakyanjo N, Sekamwa R, et al. Importance of relationship context in HIV transmission: results from a qualitative case-control study in Rakai, Uganda. Am J Public Health. 2014;104(4):612–20.
Larsson EC, Thorson A, Nsabagasani X, Namusoko S, Popenoe R, Ekström AM. Mistrust in marriage- reasons why men do not accept couple HIV testing during antenatal care—a qualitative study in eastern Uganda. BMC Public Health. 2010;10:769.
Agol D, Bukenya D, Seeley J, Kabunga E, Katahoire A. Marriage, intimacy and risk of HIV infection in South West Uganda: original research article. Afr J Reprod Health. 2014;18(4):86.
Conroy AA, Tsai AC, Clark GM, Boum Y, Hatcher AM, Kawuma A, et al. Relationship power and sexual violence among HIV-positive women in rural Uganda. AIDS Behav. 2016;20(9):2045–53.
Mah TL, Shelton JD. Concurrency revisited: increasing and compelling epidemiological evidence. J Int AIDS Soc. 2011;14:33.
Kajubi P, Kamya MR, Kamya S, Chen S, McFarland W, Hearst N. Increasing condom use without reducing HIV risk: results of a controlled community trial in Uganda. J AIDS. 2005;40(1):77–82.
Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38(1):15–28.
Hudson WW, Harrison DF, Crosscup PC. A short-form scale to measure sexual discord in dyadic relationships. J Sex Res. 1981;17(2):157–74.
Sternberg RJ. Construct validation of a triangular love scale. Eur J Soc Psychol. 1997;27(3):313–35.
Heavey CL, Larson BM, Zumtobel DC, Christensen A. The communication patterns questionnaire: the reliability and validity of a constructive communication subscale. J Marriage Fam. 1996;58(3):796–800.
Kenny DA, Kashy DA, Cook WL. Dyadic data analysis. New York: Guilford Press; 2006.
Kenyon CR, Kirungi W, Kaharuza F, Buyze J, Bunnell R. Who knows their partner’s HIV status? results from a nationally representative survey in Uganda. J AIDS. 2015;69:92–7.
Uganda AIDS Commission. HIV and AIDS Uganda country progress report 2014. Kampala: Uganda AIDS Commission; 2015.
Kabwama SN, Ndyanabangi S, Mutungi G, Wesonga R, Bahendeka SK, Guwatudde D. Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey. Glob Health Action. 2016;9:1945.
Zablotska IB, Gray RH, Koenig MA, Serwadda D, Nalugoda F, Kigozi G, et al. Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15–24 in Rakai, Uganda. AIDS Behav. 2009;13(2):225–33.
Seeley J, Nakiyingi-Miiro J, Kamali A, Mpendo J, Asiki G, Abaasa A, et al. High HIV incidence and socio-behavioral risk patterns in fishing communities on the shores of Lake Victoria, Uganda. Sex Transm Dis. 2012;39(6):433–9.
Wagner GJ, Holloway I, Ghosh-Dastidar B, Ryan G, Kityo C, Mugyenyi P. Factors associated with condom use among HIV clients in stable relationships with partners at varying risk for HIV in Uganda. AIDS Behav. 2010;14:1055.
Parikh SA. The political economy of marriage and HIV: the ABC approach, “safe” infidelity, and managing moral risk in Uganda. Am J Public Health. 2007;97(7):1198–208.
Biraro S, Ruzagira E, Kamali A, Whitworth J, Grosskurth H, Weiss HA. HIV-1 transmission within marriage in rural Uganda: a longitudinal study. PLoS ONE. 2013;8(2):e55060–9.
Gray R, Ssempiija V, Shelton J, Serwadda D, Nalugoda F, Kagaayi J, et al. The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda. AIDS. 2011;25(6):863–5.
Ruzagira E, Wandiembe S, Abaasa A, Levin J, Bwanika A, Bahemuka U, et al. Prevalence and incidence of HIV in a rural community-based HIV vaccine preparedness cohort in Masaka, Uganda. PLoS ONE. 2011;6(6):e20684.
Acknowledgements
This research was supported by a grant from the New Paradigm Fund, which supported A. Ruark, P. Kajubi and S. Ruteikara in designing and implementing the study. A. Ruark was supported in analysis of data and preparation of the manuscript by a post-doctoral fellowship through the National Institute on Drug Abuse (Grant Number T32DA13911). We thank the Ugandan facilitators and research assistants who participated in the intervention and research: Jamillah Naamala, Dativa Ssozi, Francis Ssozi, Marvin Katerega, Catherine Kiyenje, Josephine Nabukera, Ritah Nassaka, and Claire Seremba. Our sincere thanks to the participants and community leaders in Tebuyoleka Zone who made the research possible.
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A. Ruark serves on the Advisory Board of the New Paradigm Fund (NPF) and received funding from NPF and from the National Institute on Drug Abuse (Grant Number T32DA13911). P. Kajubi and S. Ruteikara received funding from NPF. E. C. Green is President and Director of NPF. N. Hearst serves on the Board of Directors of NPF.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Ruark, A., Kajubi, P., Ruteikara, S. et al. Couple Relationship Functioning as a Source or Mitigator of HIV Risk: Associations Between Relationship Quality and Sexual Risk Behavior in Peri-urban Uganda. AIDS Behav 22, 1273–1287 (2018). https://doi.org/10.1007/s10461-017-1937-9
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DOI: https://doi.org/10.1007/s10461-017-1937-9