Men are always scared to test with their partners . . . it is like taking them to the Police’’: Motivations for and barriers to couples’ HIV counselling and testing in Rakai, Uganda
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of the International AIDS Society
Abstract
Uptake of couples’ HIV counselling and testing (couples’ HCT) can positively influence sexual risk behaviours and
improve linkage to HIV care among HIV-positive couples. However, less than 30% of married couples have ever tested for HIV
together with their partners. We explored the motivations for and barriers to couples’ HCT among married couples in Rakai,
Uganda.
Methods: This was a qualitative study conducted among married individuals and selected key informants between August
and October 2013. Married individuals were categorized by prior HCT status as: 1) both partners never tested; 2) only one or
both partners ever tested separately; and 3) both partners ever tested together. Data were collected on the motivations for and
barriers to couples’ HCT, decision-making processes from tested couples and suggestions for improving couples’ HCT uptake.
Eighteen focus group discussions with married individuals, nine key informant interviews with selected key informants and six indepth
interviews with married individuals that had ever tested together were conducted. All interviews were audio-recorded,
translated and transcribed verbatim and analyzed using Nvivo (version 9), following a thematic framework approach.
Results: Motivations for couples’ HCT included the need to know each other’s HIV status, to get a treatment companion or seek
HIV treatment together if one or both partners were HIV-positive and to reduce mistrust between partners. Barriers to
couples’ HCT included fears of the negative consequences associated with couples’ HCT (e.g. fear of marital dissolution), mistrust
between partners and conflicting work schedules. Couples’ HCT was negotiated through a process that started off with one of
the partners testing alone initially and then convincing the other partner to test together. Suggestions for improving couples’
HCT uptake included the need for couple- and male-partner-specific sensitization, and the use of testimonies from tested
couples.
Conclusions: Couples’ HCT is largely driven by individual and relationship-based factors while fear of the negative consequences
associated with couples’ HCT appears to be the main barrier to couples’ HCT uptake in this setting. Interventions to increase
the uptake of couples’ HCT should build on the motivations for couples’ HCT while dealing with the negative consequences
associated with couples’ HCT.
Description
Keywords
Motivations, Barriers couples, Counselling, Testing, Rakai, Uganda
Citation
Matovu, J. K., Wanyenze, R. K., Wabwire‐Mangen, F., Nakubulwa, R., Sekamwa, R., Masika, A., ... & Serwadda, D. (2014). “Men are always scared to test with their partners… it is like taking them to the Police”: motivations for and barriers to couples’ HIV counselling and testing in Rakai, Uganda: a qualitative study. Journal of the International AIDS Society, 17(1), 19160. http://dx.doi.org/10.7448/IAS.17.1.19160