title: Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis.
abstract: HIV infection is frequently transmitted within stable couple partnerships. In order to prevent HIV acquisition in HIV-negative couples, as well as improve coping in couples with an HIV-positive diagnosis, it has been suggested that interventions be aimed at strengthening couple relationships, in addition to addressing individual behaviours. However, little is known about factors that influence relationships to impact joint decision-making related to HIV.
  
  
  
  We conducted qualitative in-depth interviews with 40 pregnant women and 40 male partners in southwestern Kenya, an area of high HIV prevalence. Drawing from the interdependence model of communal coping and health behaviour change, we employed thematic analysis methods to analyze interview transcripts in Dedoose software with the aim of identifying key relationship factors that could contribute to the development of a couples-based intervention to improve health outcomes for pregnant women and their male partners.
  
  
  
  In accordance with the interdependence model, we found that couples with greater relationship-centred motivations described jointly engaging in more health-enhancing behaviours, such as couples HIV testing, disclosure of HIV status, and cooperation to improve medication and clinic appointment adherence. These couples often had predisposing factors such as stronger communication skills and shared children, and were less likely to face potential challenges such as polygamous marriages, wife inheritance, living separately, or financial difficulties. For HIV-negative couples, joint decision-making helped them face the health threat of acquiring HIV together. For couples with an HIV-positive diagnosis, communal coping helped reduce risk of interspousal transmission and improve long-term health prospects. Conversely, participants felt that self-centred motivations led to more concurrent sexual partnerships, reduced relationship satisfaction, and mistrust. Couples who lacked interdependence were more likely to mention experiencing violence or relationship dissolution, or having difficulty coping with HIV-related stigma.
  
  
  
  We found that interdependence theory may provide key insights into health-related attitudes and behaviours adopted by pregnant couples. Interventions that invest in strengthening relationships, such as couple counselling during pregnancy, may improve adoption of beneficial HIV-related health behaviours. Future research should explore adaptation of existing evidence-based couple counselling interventions to local contexts, in order to address modifiable relationship characteristics that can increase interdependence and improve HIV-related health outcomes.
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; rogersaj@uab.edu.
authors.forename: Anna Joy
authors.initials: AJ
authors.lastname: Rogers
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Lillian
authors.initials: L
authors.lastname: Achiro
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.|Department of Obstetrics and Gynaecology, University of Washington, Seattle, WA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Division of HIV/AIDS, Department of Medicine, University of California, San Francisco (UCSF), San Franscisco, CA, USA.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Hatcher
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kwena
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Musoke
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Elly
authors.initials: E
authors.lastname: Weke
authors.affiliation: Center for Sexuality and Health Disparities, Department of Health Behaviour and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.
authors.forename: Lynae A
authors.initials: LA
authors.lastname: Darbes
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods; D030881:Disclosure; D005069:Evaluation Studies as Topic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D007398:Interpersonal Relations; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D012306:Risk; D012747:Sexual Partners / Q000523:psychology; D057545:Social Stigma; D018454:Spouses; D055815:Young Adult
keywords: Africa; HIV; couples interventions; health behaviour; pregnancy; qualitative