title: A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings.
abstract: BACKGROUND
  While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs.
  
  
  METHODS
  Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework.
  
  
  RESULTS
  Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples.
  
  
  CONCLUSIONS
  Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. joshua.mendelsohn@utoronto.ca.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Mendelsohn
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. liviana.calzavara@utoronto.ca.
authors.forename: Liviana
authors.initials: L
authors.lastname: Calzavara
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. ad2254@columbia.edu.|Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu Natal, Durban, South Africa. ad2254@columbia.edu.
authors.forename: Amrita
authors.initials: A
authors.lastname: Daftary
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. sanjana.mitra@utoronto.ca.
authors.forename: Sanjana
authors.initials: S
authors.lastname: Mitra
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. joel.pidutti@mail.utoronto.ca.
authors.forename: Joel
authors.initials: J
authors.lastname: Pidutti
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. dan.allman@utoronto.ca.
authors.forename: Dan
authors.initials: D
authors.lastname: Allman
authors.affiliation: Sigma Research Group, London School of Hygiene and Tropical Medicine, London, UK. adam.bourne@lshtm.ac.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Bourne
authors.affiliation: Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada. mona.loutfy@wchospital.ca.
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. ted.myers@utoronto.ca.
authors.forename: Ted
authors.initials: T
authors.lastname: Myers
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D035841:Behavioral Research; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D020010:Heterosexuality; D006801:Humans; D007182:Income; D008297:Male; D055118:Medication Adherence; D043762:Reproductive Behavior; D012306:Risk; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology*; D012944:Social Support
chemical_list: D044966:Anti-Retroviral Agents