Why do marital partners of people living with HIV not test for HIV? A qualitative study in Lusaka, Zambia

Maurice Musheke, Sonja Merten and Virginia Bond

Background

Knowledge of HIV status is crucial for HIV prevention and management in marital relationships. Yet some marital partners of people living with HIV decline HIV testing despite knowing the HIV-positive status of their partners. To date, little research has explored the reasons for this.

Methods

An exploratory qualitative study was undertaken in Lusaka, Zambia, between March 2010 and September 2011, nested within a larger ethnographic study. In-depth interviews were held with individuals who knew the HIV-positive status of their marital partners but never sought HIV testing (n = 30) and HIV service providers of a public sector clinic (n = 10). A focus group discussion was also conducted with eight (8) lay HIV counsellors. Data was transcribed, coded and managed using ATLAS.ti and analysed using latent content analysis.

Results

The overarching barrier to uptake of HIV testing was study participants’ perception of their physical health, reinforced by uptake of herbal remedies and conventional non-HIV medication to mitigate perceived HIV-related symptoms. They indicated willingness to test for HIV if they noticed a decline in physical health and other alternative forms of care became ineffective. Also, some study participants viewed themselves as already infected with HIV on account of the HIV-positive status of their marital partners, with some opting for faith healing to get ‘cured’. Other barriers were the perceived psychological burden of living with HIV, modulated by lay belief that knowledge of HIV-positive status led to rapid physical deterioration of health. Perceived inability to sustain uptake of life-long treatment – influenced by a negative attitude towards treatment – further undermined uptake of HIV testing. Self-stigma, which manifested itself through fear of blame and a need to maintain moral credibility in marital relationships, also undermined uptake of HIV testing.

Conclusions

Improving uptake of HIV testing requires a multi-pronged approach that addresses self-stigma, lay risk perceptions, negative treatment and health beliefs and the perceived psychological burden of living with HIV. Strengthening couple HIV testing services, including addressing conflict and addressing gendered power relationships are also warranted to facilitate joint knowledge, acceptance and management of HIV status in marital relationships.

September 6, 2016
Year of publication
2016
Countries
Tags
HIV status, married couples, HIV testing, HIV testing and counseling (HTC), HIV testing uptake, uptake of HIV testing, Zambia

Similar Resources

The epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example.

This case study documents how the Jane Goodall Institute (JGI) is effectively mainstreaming HIV/AIDS and broader health issues into their  natural resource management and economic growth activities in Western Tanzania.

Latest PEPFAR program results fact sheet, issued November 2011.

Despite scale-up of HIV testing and counseling (HTC) interventions mostly involving voluntary counseling and testing (VCT) or client-initiated testing and counseling sites, HTC uptake and individual knowledge of HIV status in many countries remains low.

The Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC) supports SADC's efforts as a Principal Recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and as a facilitator of a coordinated response to HIV prevention in the Southern…

This report presents the preliminary findings from an ongoing project undertaken by 4Children that seeks to identify key opportunities to incorporate violence prevention and response interventions within priority PEPFAR Program Areas at clinical and community levels.

AVAC’s Research Literacy Database contains educational materials and tools from across the entire HIV prevention research field—everything from simple fact sheets to basic PowerPoint presentations to online learning courses.

The largest HIV epidemics in Sub-Saharan Africa have either stabilized or are showing signs of decline. Between 2000 and 2008, 22 Sub-Saharan Africa countries experienced declines in new HIV infections of 25% or more among young people aged 15-24 years.

Prompted by a growing knowledge of the complexity of HIV transmission, many countries are reassessing the nature of their HIV epidemics.