UvA-DARE ( Digital Academic Repository ) HIV and dyadic intervention : an interdependence and communal coping analysis

Background: The most common form of HIV transmission in sub-Saharan Africa is heterosexual sex between two partners. While most HIV prevention interventions are aimed at the individual, there is mounting evidence of the feasibility, acceptability, and efficacy of dyadic interventions. However, the mechanisms through which dyadic-level interventions achieve success remain little explored. We address this gap by using Lewis et al’s interdependence model of couple communal coping and behaviour change to analyse data from partners participating in an HIV prevention trial in Uganda and Zambia. Methods and Findings: We conducted a comparative qualitative study using in-depth interviews. Thirty-three interviews were conducted in total; ten with couples and twenty-three with staff members at the two sites. The Ugandan site recruited a sero-discordant couple cohort and the Zambian site recruited women alone. Spouses’ transformation of motivation is strong where couples are recruited and both partners stand to gain considerably by participating in the research; it is weaker where this is not the case. As such, coping mechanisms differ in the two sites; among sero-discordant couples in Uganda, communal coping is evidenced through joint consent to participate, regular couple counselling and workshops, sharing of HIV test results, and strong spousal support for adherence and retention. By contrast, coping at the Zambian site is predominantly left to the individual woman and occurs against a backdrop of mutual mistrust and male disenfranchisement. We discuss these findings in light of practical and ethical considerations of recruiting couples to HIV research. Conclusions: We argue for the need to consider the broader context within which behaviour change occurs and propose that future dyadic research be situated within the framework of the ‘risk environment’. Citation: Montgomery CM, Watts C, Pool R (2012) HIV and Dyadic Intervention: An Interdependence and Communal Coping Analysis. PLoS ONE 7(7): e40661. doi:10.1371/journal.pone. 0040661 Editor: Elvin Hsing Geng, University of California, San Francisco, United States of America Received January 30, 2012; Accepted June 11, 2012; Published July 12, 2012 Copyright: 2012 Montgomery et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: Fieldwork for this research was supported by a small grant from the Microbicides Development Programme administered through Imperial College, London, and the London School of Hygiene & Tropical Medicine. The Microbicides Development Programme (MDP) is a partnership of African, UK and Spanish academic government/institutions and commercial organisations. MDP was funded by the British Government Department for International Development (DIFD) and the UK Medical Research Council. Analysis and manuscript writing was supported by the UK Economic and Social Research Council [Grant Ref. PTA-026-272714]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: catherine.montgomery@insis.ox. ac.uk