An exploratory study of psychosocial implications of HIV serodiscordance in married heterosexual couples.

Abstract

There is limited knowledge on the psychosocial implications of HIV/AIDS in serodiscordant heterosexual couples in sub-Saharan Africa. Several studies have indicated that there is an increase in the number of such couples on the African continent, yet there are minimal or no services offered to support such couples. The aim of the study was to explore the psychosocial challenges faced by heterosexual serodiscordant couples who were married. Ecosystems and biopsychosocial approaches were used as a framework to guide the study. A qualitative study was conducted in Durban, South Africa. Purposive sampling was used, comprising of four married couples and two individuals who were married but participated individually and not as a couple. Semi-structured interviews were undertaken. Both inductive and deductive approaches were carried out to analyse interview transcripts. None of the participants had received satisfactory explanations of their serodiscordant results. The discovery of serodiscordance resulted in difficulties with disclosure to families and children, maintaining safer sex, achieving intimacy due to lack of communication and bearing children due to fears associated with infection. Serodiscordance resulted in positive partners constantly fearing that their negative partners would leave them. Participants in discordant relationships had difficulties dealing with the changes that discordance brought into their lives. This resulted in enormous stress in their relationships including feelings of isolation, confusion and despair. Acceptance of serodiscordant status and support from family members were positive coping mechanisms used by discordant couples to alleviate stress. Avoidance was a negative coping mechanism used by some couples in dealing with the challenges of discordance. Factors contributing to the negative participants remaining in the relationship included love and companionship, children, commitment to the relationship and acknowledgement of the existence of HIV. The findings also indicated that none of the participants received on-going counseling and there were no programs catering for serodiscordant couples. This study supports the view of other researchers who believe that there is a dire need for service provision for serodiscordant couples. Based on the findings of this study, micro, mezzo and macro intervention strategies are recommended.