Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

16 March 2012

PrEP trial helps some couples work through relationship disharmony

Original content from the Mapping Pathways blog team

In an interesting development, many of the couples involved in a pre-exposure prophylaxis (PrEP) trial in Kenya and Uganda saw the trial as a way for them to save their strained relationships.

The trial was the Partners PrEP study and the couples involved were serodiscordant couples (heterosexual couples in which one partner was HIV negative and the other was HIV positive). The objective of the study is to see whether having this medication in the bloodstream prevents the HIV uninfected partner from getting HIV. According to researchers, a whopping 99 percent of the prescribed doses were taken, as opposed to other new prevention technology trials where the level of adherence has been significantly lower. .

The reason behind this became obvious once the researchers did a little digging. It was often found that when the HIV-negative individual first found out that their partner was HIV positive, it tended to create a crisis in the relationship with the HIV-negative partner having doubts about his/her own safety as well as the faithfulness of the HIV-positive partner. Many couples saw condoms as expensive and uncomfortable and, as a result, their physical intimacy reduced to a minimum.

The couples struggling with this situation saw the PrEP trial as a means to resolve the crisis in their relationship. They understood that though PrEP was unproven, it might still offer a ray of hope for them: protection for the partner who was HIV negative and an option that could help potentially restore intimacy.

Suddenly, rebounding from the hostility that had begun to characterize their relationship, trial investigators observed that the couples became very keen to keep follow-up appointments and replenish their pill supplies. Study participants received adherence and relationship counseling and the couples cited the counselors as a crucial source of support. Partners reminded one another to take their pills on time, and even the children got involved at times, asking their parent to take their doses according to schedule. The couples started to use mobile phone alarms to time their doses and made sure that, despite hectic workloads, the dosage schedules were adhered to.

Of course, not all couples found harmony in their relationships during the PrEP trial. For some, the discord did not end: some quarreled and accused the other partner of perceived infidelities and some partners accused the others of indifference and opposition to the treatment. However, these cases were overshadowed by the ones that saw PrEP as a new beginning for their relationships.

Said one participant “My husband reminds me to take my drugs the moment the time is up. Even before the radio mentions the time, he quickly reminds me that I need to swallow my drugs. If he knows I am travelling somewhere, he tells me to carry my drugs. He doesn’t want me to leave my drugs behind.”

The main takeaway for researchers was that partnered relationships provided strong support for PrEP adherence. One partner knowing the HIV status of the other and supporting him/her through the trial enhanced the quality of findings of the trial and, more importantly, helped in some cases to sustain the relationship through a rocky period.

Read more about this study here.  And for a first-hand example of how love can play an important part in HIV prevention and treatment, read about an Indian couple’s Modern Day HIV Love Story

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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