A Struggle To Maintain Relationship - Sexual Life And Fertility Desire In Long-term Hiv Sero-discordant Couples A Grounded Theory Study

Introduction: Even though remarkable progress has been achieved, AIDS continues to be a major global health priority. HIV discordant relationship is one of the emerging issues concerning HIV prevention. In Ethiopia, very little is known about HIV-serodiscordant couples particularly how they manage their sexual relationship.rnObjective: This study was conducted with the aim to exploring and conceptualizing the sexual life, concerns and fertility desire, in the context of long-term HIV discordant (mixed HIV status) relationships in Addis Ababa, Ethiopia.rnMethodology: The study was carried out at different health facilities (3hospitals, 1health center) & 1NGO in Addis Ababa from December 2010 – April 2011. An exploratory qualitative design was applied using an in-depth interview method. Data were collected using in-depth interviews guide with both 28 clients from discordant relationship and 8 key informants (health care providers). People in serodiscordant relationship & key informants were recruited using purposive and theoretical sampling. Data collection and analysis were undertaken simultaneously using a constant comparison Grounded Theory approach and for the data analysis OpenCode software were used.rnIn order to make sure the appropriateness of assigned cods and consistencies in coding there was debriefing with public health post graduate candidates & reviewing the coding of the text. Finally conceptualization and generalization to wider context of meaning units was made. All ethical issues and data quality management were maintained.rnFindings: A Grounded Theory pertaining to sexual life, concern & desire to have a child among HIV discordant couples emerged with maintaining the relationship as its core category. Couples pass through a social process of struggle to maintain their relationship. The causal conditionsrnviirnfor couples to enter into the process of struggle to maintaining their relationship were collectively categorized as “Entering in to a transition” (knowing HIV serostatus) and include mismatch desire on having a child, controversy: Safe sex Vs desire to have a child and undeniable change in sexual desire & practice through time.rnThe action/ interaction strategies were collectively named as Dealing with Discordancy and it includes Accepting the Fact – Normalizing, Selective Disclosure and Entertaining Partner’s Interests – Sacrifice of one self interest. Their action/ interaction strategies were resulted with some consequence which is named as “Ups & Downs: Passing through difficulties” and includes A Double Burden, Shifting of Interest and Less Undesirable social Pressure from people around them.rnThe context named “Our Cosmo”: Couple’s Living Circumstances that includes Defining the relationship, Spending Long time Together, Being in Different HIV Serostatus than Partner, Being Parents of common children, Ageing and Gender and an intervening conditions “Shared Life – Living with Community”- consists of Relatives’ Influence, People’s Judgments – A Concern & Information Influences were shaping couple’s actions/interactions strategies in the process of maintaining their relationship.rnConclusions & Recommendations: HIV discordant relationship is filled with struggle to maintain relationship versus fear of infection. The findings suggest the need to view discordant couple’s actions in the process of maintaining their relationship. Further work should be done with HIV discordant couples to assess the fit of the current model in a different set up and population. In addition, work could begin to test the hypotheses proposed in this study.rnKey words: HIV, Discordant couples, Relationship, Grounded theory, Addis Ababa, Ethiopia

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