'People say that we are already dead much as we can still walk': a qualitative investigation of community and couples' understanding of HIV serodiscordance in rural Uganda.
Stable, co-habiting HIV serodiscordant couples are a key population in terms of heterosexual transmission in sub-Saharan Africa. Despite the wide availability of antiretroviral treatment and HIV educational programs, heterosexual transmission continues to drive the HIV epidemic in Africa. To investigate some of the factors involved in transmission or maintenance of serodiscordant status, we designed a study to examine participants' understanding of HIV serodiscordance and the implications this posed for their HIV prevention practices.



In-depth interviews were conducted with 28 serodiscordant couples enrolled in a treatment-as-prevention study in Jinja, Uganda. Participants were asked questions regarding sexual behaviour, beliefs in treatment and prevention, participants' and communities' understanding and context around HIV serodiscordance. Qualitative framework analysis capturing several main themes was carried out by a team of four members, and was cross-checked for consistency.



It was found that most couples had difficulty explaining the phenomenon of serodiscordance and tended to be confused regarding prevention. Many individuals still held beliefs in pseudoscientific explanations for HIV susceptibility such as blood type and blood "strength". The participants' trust of treatment and medical services were well established. However, the communities' views of both serodiscordance and treatment were more pessimistic and wrought with mistrust. Stigmatization of serodiscordance and HIV-positive status were reported frequently.



The results indicate that despite years of treatment and prevention methods being available, stigmatization and mistrust persist in the communities of HIV-affected individuals and may directly contribute to new cases and seroconversion. We suggest that to optimize the effects of HIV treatment and prevention, clear education and support of such methods are sorely needed in sub-Saharan African communities.
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Jiho
J
Kim
The AIDS Support Organization, Jinja, Uganda.
Mastula
M
Nanfuka
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
David
D
Moore
The AIDS Support Organization, Jinja, Uganda.
Murisho
M
Shafic
The AIDS Support Organization, Jinja, Uganda.
Maureen
M
Nyonyitono
The AIDS Support Organization, Jinja, Uganda.
Josephine
J
Birungi
The AIDS Support Organization, Jinja, Uganda.
Florence
F
Galenda
Global Health Sciences, University of California San Francisco, San Francisco, California, USA. Rach@vtx.ch.
Rachel
R
King
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001294:Attitude to Health; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity; D020010:Heterosexuality / Q000523:psychology; D006801:Humans; D008297:Male; D012423:Rural Health; D012424:Rural Population; D021841:Safe Sex; D012725:Sexual Behavior; D012747:Sexual Partners; D014454:Uganda
D019380:Anti-HIV Agents
Africa; HIV; Serodiscordance; Sexual health; Uganda