title: 'I told her this is your life': relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples.
abstract: Despite the important role of social relationships for health and wellbeing, little is known about how primary partners affect adherence to HIV care and treatment. We qualitatively explored how relationship dynamics and partner support influence adherence among couples from KwaZulu-Natal, South Africa. Twenty-four heterosexual couples with at least one HIV-positive partner completed semi-structured interviews on topics including relationship dynamics (intimacy or emotional closeness, communication, violence), experiences with HIV care and treatment and HIV-related social support. The majority of couples were seroconcordant HIV-positive (92%) and both on antiretroviral therapy (ART) (63%). Participants described how primary partners both interfered with and supported adherence. Negative forms of influence included relationship conflict, which resulted in forgetfulness to take pills, and men's attempt to control use of ART. However, participants were more likely to highlight positive forms of influence on adherence, which included social support (instrumental, informational and emotional), intimacy and commitment. The findings also suggest a reciprocal relationship between ART and relationships such that couple ART use may enhance relationship quality. Primary partners are important pillars of support for ART adherence, especially in contexts of high unemployment and poverty. Future interventions that encourage and leverage these supportive relationships could improve ART adherence among heterosexual couples in similar settings.
authors.affiliation: a Center for AIDS Prevention Studies , University of California , San Francisco , USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Conroy
authors.affiliation: b Department of Health, Behavior and Society , John Hopkins University , Baltimore , USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Leddy
authors.affiliation: a Center for AIDS Prevention Studies , University of California , San Francisco , USA.
authors.forename: Mallory
authors.initials: M
authors.lastname: Johnson
authors.affiliation: c Human and Social Development Program , Human Sciences Research Council , Msunduzi , South Africa.
authors.forename: Thulani
authors.initials: T
authors.lastname: Ngubane
authors.affiliation: d Human and Social Development , Human Sciences Research Council , Overport , South Africa.
authors.forename: Heidi
authors.initials: H
authors.lastname: van Rooyen
authors.affiliation: e Department of Health Behavior and Biological Sciences , University of Michigan , Ann Arbor , USA.
authors.forename: Lynae
authors.initials: L
authors.lastname: Darbes
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D044383:Black People / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D012747:Sexual Partners / Q000523:psychology*; D012944:Social Support; D013019:South Africa; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents
keywords: Relationship dynamics; South Africa; antiretroviral therapy; couples; social support