"I never thought that it would happen … " Experiences of HIV seroconverters among HIV-discordant partnerships in a prospective HIV prevention study in Kenya.
In spite of access to behavioral and biomedical HIV prevention strategies, HIV transmission occurs. For HIV-serodiscordant couples, prevention programs can be tailored to address individual and couples' needs to preserve their relationship while minimizing HIV risk. Programs for serodiscordant couples may benefit from learning from experiences of couples who transmit HIV. We conducted 20 individual in-depth interviews with 10 initially HIV-serodiscordant couples who transmitted HIV during prospective follow-up at a peri-urban research site in Thika, Kenya. Data were analyzed inductively to identify situations that led to prevention failure and coping mechanisms. Inconsistent condom use driven by low HIV risk perception and alcohol use often preceded seroconversion while persistent blame frequently hindered couples' communication soon after seroconversion. In this emerging era of antiretroviral-based HIV prevention, couples' counseling can capitalize on opportunities to foster a supportive environment to discuss initiation and adherence to time-limited pre-exposure prophylaxis and lifelong antiretroviral therapy, in addition to strategies to reduce alcohol use, diffuse blame, and use condoms.
a School of Public Health , Jomo Kenyatta University of Agriculture and Technology , Juja , Kenya.|b Department of Global Health , University of Washington , Seattle , WA , USA.
Kenneth
K
Ngure
c Partners in Health Research and Development , Nairobi , Kenya.
Sophie
S
Vusha
b Department of Global Health , University of Washington , Seattle , WA , USA.|d Center for Clinical Research , Kenya Medical Research Institute , Nairobi , Kenya.
Nelly
N
Mugo
b Department of Global Health , University of Washington , Seattle , WA , USA.
Mira
M
Emmanuel-Fabula
c Partners in Health Research and Development , Nairobi , Kenya.
Mariah
M
Ngutu
b Department of Global Health , University of Washington , Seattle , WA , USA.|e Department of Epidemiology , University of Washington , Seattle , WA , USA.|f Department of Medicine , University of Washington , Seattle , WA , USA.
Connie
C
Celum
b Department of Global Health , University of Washington , Seattle , WA , USA.|e Department of Epidemiology , University of Washington , Seattle , WA , USA.|f Department of Medicine , University of Washington , Seattle , WA , USA.
Jared M
JM
Baeten
b Department of Global Health , University of Washington , Seattle , WA , USA.|c Partners in Health Research and Development , Nairobi , Kenya.
Renee
R
Heffron
D000328:Adult; D000428:Alcohol Drinking; D003142:Communication; D017280:Condoms; D003376:Counseling; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis; D011446:Prospective Studies; D012747:Sexual Partners / Q000523:psychology*; D047568:Unsafe Sex
HIV; Kenya; couples; prevention; seroconversion