Doctoral thesis
As treatment and health care related to HIV/AIDS improve, infected partners now have a chance to live longer than before, thus, HIV concordancy and discordancy have become quite common among partners in union. The infected partners, however, increasingly face emotional and psychosocial challenges associated with HIV infection. These challenges expose them to the risk of developing depression symptoms, declined intimacy and dysfunctional relationships, with considerable variations among concordant and discordant partners. This has resulted into marital separations and divorce, with negative implications on the partners' wellbeing and that of the family at large. The quantitative part of this study, sought to investigate the magnitude of HIV sero-discordancy and concordancy in the Southern Highlands Zone of Tanzania, and the influence that the two conditions have on infected couples’ emotional patterns, particularly, depression symptoms, intimate bond and relationship functioning. The qualitative part served to explore the dynamics and experiences of living in a discordant relationship, partners’ awareness and perceptions regarding protected sex. Using the mixed approach, 623 participants were recruited, among which, 537 respondents’ questionnaires were complete and admissible. Out of the 537, about 84 respondents were either no longer in union, or had no disclosure of serostatus with spouses: data from these were, thus, excluded in analyses of scaled measures. Finally, a sample of 343, including 153 male and 190 female partners was obtained and used in the quantitative research phase. In addition, 58 were randomly picked from those identified as being discordant and were enlisted in the qualitative research phase. Findings in this study revealed that 237 (69%) of the infected partners in union were HIV concordant, while 106 (31%) were discordant. Concordant female partners were 137 (72%), whereas, concordant male partners were 100 (65%). Severe depression was observed among 38 (16%) concordant and 22 (20.8%) discordant partners. Regarding sex, 20 (13.1%) of the males and 40 (21.1%) of the females experienced severe depression. Depression was significantly associated with sex (Wald χ2=6.551, p=0.011), age (Wald χ2=4.478, p=0.034), geographical area (Wald χ2=3.733, p=0.053), number of dependants/children (Wald χ2=6.136, p=0.013) and spouse's education (Wald χ2=5.348, p=0.021). Results also showed that intimate caring was significantly associated with the respondents' sex (Wald χ2 =4.171, p=0.041) and serodifference (Wald χ2=7.982, p=0.005). Relationship functioning among the partners was significantly associated with sex (Wald χ2=4.352, p=0.037) and serodifference (Wald χ2=7.175, p=0.007). The qualitative findings showed that financial dependence, serodifference, disclosure and counselling had a great influence on the partners' depressive feelings, perceptions of intimacy particularly among the females, and the partners' consistence in protected sex. It was therefore concluded that the infected partners' relationship functioning was partly influenced by emotional challenges, self-efficacy and access to both psychosocial and physical resources and serodifference. This calls for a broader HIV prevention framework that incorporates physical, psychosocial, emotional and financial aspects of couples in union, particularly, those who are in discordant relationships.