The total number of participants that volunteered to be interviewed was ten but the tenth participants interview was terminated prematurely because his consent was wavering due to suspicion of being recorded. Data collected from this participant was therefore treated as void and was not used in this study. Shona was the dominant language used during data collection; all chose to speak in Shona. The average age for the participants was 39. All the relationships where monogamous however 33 percent were in their second marriages. One (11 percent) was about to enter into her second marriage. A further 44 percent were in their first marriages and only one (11 percent) was never married. 22 percent were cohabitating whilst the rest were married. Majority of participants had achieved General Level certificate of education ('O' Levels) whilst one had done 'A' Levels and another one only had little primary education. Most worked as casual workers whilst a couple were unemployed and one was a teacher. The average number of children per serodiscordant couples was 3 with the largest family having 5 and the smallest having none. Average duration of marriage for the participants was 14 years. The longest married couple had been married for 31 years whilst two were cohabitating for a year or less. Participants showed that they had been infected for an average of 4.5 years, the longest participated had known about her status for 25.5 years with only having known within the last month. Appendix 6 shows the socio demographic characteristic of participants. Table 1 below shows the specific socio demographic characteristic of participants.
Table : Socio demographic characteristics of participants
Female
Male
Total
Age of Respondent
18 to 30 yrs
2
0
2
31 to 40 yrs
0
1
1
41 to 50 yrs
3
2
5
51 to 60 yrs
1
0
1
Religion
Traditional church
4
2
6
Pentecostal
0
3
3
Educational level
< than O Level
1
0
1
O Level
4
3
7
> Than O level
1
0
1
Duration since 1st diagnosis
0 to 5 yrs
5
3
8
6 to 15 yrs
0
0
0
15 to 30 yrs
1
0
1
Duration of union
0 to 5 yrs
2
0
2
6 to 15 yrs
1
2
3
15 to 30 yrs
3
1
4
Specific demographic characteristic of participants
Participant
A
B
C
D
E
Age
42
41
45
26
56
Gender
Female
Male
Female
Female
Female
Duration leaving together
12 years
19years
20 years
6 months
23 years
HIV Status
Pos
Pos
Neg
Pos
Pos
Number of children
3
5
3
2
4
Duration of 1st diagnosis
5 years
1 month
1 year & 5 months
1 year & 6 months
25 years & 6 months
Religion
Apostolic St peters
AFM
Church of England
Christian
Methodist
Education
"O" level
"O" level
"O" level
"A" Level
F2
Participant
F
G
H
I
J
Age
33
42
22
48
Void
Gender
Male
Male
Female
Female
Male
Duration leaving together
8 years
11years
1 year
31 years
Void
HIV Status
Pos
Pos
Pos
Pos
Void
Number of children
2
4
0
4
Void
Duration of 1st diagnosis
1 year & 1 month
2years
3 years
1 year
Void
Religion
Pentecostal
Forward
In faith
Catholic
Apostolic
Void
Education
O level
"O" level
"o" level
Primary school
Void
Main findings
From analysis of individual interviews and across all interviews that explored the life experiences of HIV serodiscordant heterosexual couples in this study several recurrent themes emerged. Connections were made among the emergent themes that were streamlined the themes and the results are presented in terms of the discrete but interrelated main themes: 1. Psychological issues: impact of HIV, fear and guilt feelings; 2. Socio-cultural issues: communication/disclosure, behaviour changes (sexual abstinence, condom use, religion) and stigma; 3. Illness and Treatment:
4.3.1 Theme 1: Psychological Impact
Impact of HIV status
All participants reported some form of psychological distress following the HIV diagnosis. Some participants had assumed that they were negative because their spouses had tested negative therefore they too would automatically be negative and were reluctant to be tested. When they eventually got tested and found to be positive they found it hard to copy and accept.
"The shock comes when you are told that you are positive when in actual fact you were thinking I am negative...It was hard to accept but knowing my past ... I could possibly have been infected before I even got married" (Participant F).
"I was devastated by the news... I did not know how to inform my husband but I had to gather the courage to tell him" (Participant I).
Participant G reported being sent back home three times in one of Harare's testing clinic because there was no one to deliver counselling when he wanted to be tested whilst participant E who was diagnosed in 1987 reported that the counselling she got was unhelpful and nothing positive came out of the counselling. The participant was told that she would die within 5 years and was no longer to have children or sleep with man without condoms.
"I went there three times and all the time I was told that they had no counsellors until I decided to go to a private doctor I had started experiencing heat in my legs and initially I had thought it was due to standing for long hours" (Participant G).
"The counselling I was given then was only to ask how many children I had and whether I was married. I was advised not to have any more children. I was told that if I sleep with anyone without protection I would pass the virus to them. I was also told I had only 5 years live from the date of my diagnosis. I went home; I had no one to talk to about this. I already had pressure from my family because of the two children I had out of wedlock, so there were now three issues as far as my family were concerned.
1. I had children out of wedlock
2. All my siblings were intelligent and high fliers and had done well for themselves, whereas I was an average student and was graded at school so I was put in F2 where you could not proceed to do 'o' levels. I was looked down on by every one
3. I was now HIV positive" (Participant E)
The unpreparedness and inadequate pre-counselling led to participants having suicidal ideations, feeling isolated and resorting to unhelpful coping strategies. Three participants reported feeling suicidal. One reported resorting to unhelpful coping mechanisms such as substance misuse which was short lived as participant reported having the same suicidal feelings after the drugs had worn off. He stopped abusing alcohol and cannabis when his family intervened and counselled him.
"I thought life was not worth living. I was just seeing death ahead of me. First counselling is very short ... its 30 minutes of general talk and because you are not expecting it...it is very different (the counselling) from when you are commenced on treatment. ...life was not worth living. I took it that dying today was the same as dying later. I felt suicidal. I started drinking alcohol and taking cannabis and coming home late. Once the drink and drugs wore off I would start to experience the suicidal thoughts, my mind would be racing and I would feel very distressed. It took me 3-4 months to come to terms with the diagnosis. I was physically fit but just mentally fragile. My wife and family helped. I think this had an effect on my first CD4 count which was 354...." (Participant F)
The other two participants who felt suicidal also reported that swift support and counselling from their families had a positive effect on their acceptance of living with the virus and subsequently relief. Almost half the participants reported isolating crying, and loss of appetite or just not eating soon after they learnt of their positive status.
"It was difficult to process and hard to accept...when I was told that I was positive I was not expecting it because I was in good health and I had not lost any weight... I thought the side pain I had at the time was TB. I thought of committing suicide because I didn't know how people would perceive me given that I had once lived abroad... " (Participant D)
The participant who had just known for one month about his status was still struggling to accept and come to terms with living with the HIV virus. Participants that with longer diagnosis period generally accepted their status than those with shorter diagnosis. This may be due to the fact that time heals all wounds hence they may have come to accept the predicament they found themselves in. However, the participant who had had her first diagnosis in 1987 found it hard to accept at first and choose to disregard the negative information she had received on testing and to have faith in God.
"I cried for a while, then I binned [meaning disregard] all the information I was given about my HIV status started to counsel myself that the information I had been given by the doctor was based on what the doctor had learnt through her education but was not from God, or delivered by God. I said to myself I am not going to die within the next 5 years, because both the doctor and I are God's creation. I also told myself that my children will not be orphans. I assumed a stance that the doctor may be wrong and I started living positively" (Participant E).
Participant H who was born with the virus reported that she was too sick to care as at the time of her diagnosis she was very unwell even to participant in any counselling which was then given to her family members who were caring for her at the time.
"When I improved I started to asking..why me? I went back to the nurses seek explanations as I was still a virgin. I was told that I got it from my mother. The nurse examined my skin and told me that the skin rash that I had was consistent with mother-to-baby transmission so I had to accept it." (Participant H)
Similarly the participant C who was HIV negative reported that as her spouse immediately became very unwell soon after his diagnosis she did not time have to process anything as she adopted the caring role and was only concerned with getting her husband treated so she just accepted the diagnosis. However, she became distressed because her husband accused her of bewitching him and also his mother accused her of wanting to kill him so she could inherit matrimonial property.
Feelings of guilt and shame
Three participants reported feeling guilty of having brought the virus into their households. One participant reported that he even tolerated physical abuse from his wife because of the guilty feelings.
"My wife was very angry with me and she started being physically aggressive towards me and whenever she thought of it she would cane me with a stick even in the middle of the night until her anger subsided. I did not retaliate because I knew I was in the wrong" (Participant G)
"I felt guilty. After 1999, there was more awareness of the HIV virus and AIDS so I encouraged my husband to go get tested but he declined. I was in good health from the time of my diagnosis up until after my last two children were born. My husband remained open-minded and reaffirmed that he will remain in the marriage regardless of what the outcome of the HIV test. I continued to feel guilty and at the same time I feared being rejected. The subject of getting tested is one I used to bring up regularly with my husband- during the times I was pregnant but we never got round to doing it. My husband used to refuse saying if you go and you are found to be positive then it will automatically mean that I will be positive too" (Participant E)
Participants acknowledged various changes in their way of living after HIV diagnosis which psychologically affected their behaviour towards their spouse or partner.
"Most of the times my wife reassures me. Sometimes when I complain of abdominal pains my wife will reassure me that I will get better, then I will think to myself whether she is forgetting that I have HIV virus, does she think this is normal abdominal pain [small laugh] ... there is a difference between living with and living without HIV.... I tell my wife to be upfront with me and to inform me if she starts finding me repulsive....at first when I first started taking tablets it was difficult and she did not make it easy....when getting ready for sexual intercourse she verbalised that 'ah your penis seems to have shrunk' and I would say to her there was no difference and explain that tablets or HIV does not affect my penis size but it can affect my weight and that my sexual performance is still the same as before" (Participant G)
"The way I used to enjoy sex without protection before the diagnosis and now my performance eh its very different eh... I'm now living a different life... sometimes I participate in sexual intercourse to please my wife. She too is no longer enjoying the sex as my performance is no longer the same. I tried to use some tablets from the pharmacies called sildenafil to boost libido hah.. It's now all about inducing it otherwise naturally I no longer have that drive" (Participant F).
Most participants acknowledged that once they came to terms with their status their psychological well being improved except for one participant who was still coming to terms with his recent ( a month ago) diagnosis at the time of the interview.
Fear
All participants that were HIV positive experienced fear of rejection and this led to selected disclosure with some participants. Other forms of fear the participants experienced included fear of infecting partner, fear of stigma, fear of being judged by the outside world, fear of being exposed and fear of both dying and leaving children orphaned and fear of having more children.
Participants reported being fearful and anxious of being rejected by their families hence acceptance gave them reassurance.
Stigma
4.3.2 Theme 2: Socio-cultural issues
Communication and Disclosure of HIV status.
All participants expect one were HIV positive. All their spouses except one knew of their HIV status from the onset. Participants generally reported that they communicated freely about the HIV virus except for the one HIV negative participant who indicated her spouse was unwilling to talk about issues regarding his positive status.
The duration of knowing their HIV status was variable with the shorter duration being one month and the longest being 25 and half years. However, the partner for the participant who had known about her status for 25 and half years only disclosed her status when she was re-tested in 2006. The participant reported that instead of receiving post test counselling, the participant was humiliated in front of others patients by health care professional
"the doctor said look at this woman, she is HIV positive and I am about to test her baby too" (Participant E).
Furthermore the same doctor told the respondent that she just had 5 years to live. The other factor that could have influenced her behaviour in risking having children is the cultural expectation of Zimbabwean custom that expects marriage to be solemnised by having children as supported by literature (Runganga 2001). HIV was highly stigmatised at the time even by health care professionals who themselves did not have much understanding and were also scared by the virus.
Six participants (67 percent) had mainly grown up children. Of these six, twenty two percent had not told their children of their status. One of the two participants stated that her children talked negatively about HIV and she feared that once they know they would tell other people therefore the participant and her husband agreed not to disclose to them. The participants below 40 either had young children or did not have any. One participant in this group reported that they had told their 8 year old twins and found disclosure helpful as the children become very supportive.
Sexual intimacy and condom use
All participants accept the two youngest participants who cohabitated reported changes in sexual intimacy and reduced sexual contact with their spouses and attributed this to having lost interest in sex, fatigue and also fear of infecting spouse.
"It is hard, eh on behalf of my wife maybe she finds it hard to have sex with me eh because when we came for counselling we were told to use condoms to prevent her from getting infected... [pause] so when I suggest that we use condoms of course she can agree, but on the other hand the condom can break and then she gets the virus eh so I suggested to her that is was better to abstain from having sex altogether, so I protect her life in case I die early then she can continue to live and look after the children..... Yes it is hard but one has to face reality of the situation----- Yes we have been given education on this but knowing that you partner is negative you become fearful (Participant B who was still coming to terms with living with HIV having been diagnosed a month ago.)
The notion that condom worsens sexual dysfunction and makes sex less pleasurable was expressed by two participants whilst one reported loss of libido.
Family Support
The impact of family support is important for curbing situations where a person has suicidal tendencies, finding it hard to cope and where there is physical health deterioration as mentioned above in 4.3.2. Most respondents reported valuing their spouses support except the one respondent who was HIV negative who felt that his spouses did not show appreciation for the support and care she gives;
"I haven't really seen or heard him say anything about appreciation; maybe he says it to other people .... my husband does not want other people to know but I told my sister and she is very supportive because her own son is living with HIV". (Participant C)
Most of respondents took the position that they were automatically of the same HIV status as their tested spouse and needed encouragement to be tested.
Three participants who had either been pre-counselled by relatives living with the virus or had the experience with someone living with HIV/AIDS found it easy to accept their HIV.
Participant E reported that after she disclosed her status to her siblings again selectively; her elder sister became very supportive.
"Speaking truthfully my older sister is very supportive..... When I had my operation for hysterectomy, I told my elder sister that I was going into theatre, if I die during the operation don't give my husband grief because I am HIV positive.... I did not tell my young sister.... she thinks she is untouchable even up to now she is not enlightened, she does not believe that she can be infected with the HIV, yet her husband is very promiscuous, she still uses stigmatising language such as that money for bus fare..." (Participant E)
"I locked myself in my bedroom for the first two days and I did not eat anything until my parents counselled me and reassured me that I had done the right thing of getting tested before I became ill. They encouraged me to be positive so I could live longer and look after my children....." (Participant D)
Behaviour Changes
In regards to spouse knowing of their HIV status participants generally reported that their partners were supportive. However, one reported both physical and verbal aggression.
Most males did not like using condoms as a way of protection with one participant who had had the virus the longest reporting they never used condoms because her husband does not like them and he goes for regular tests and he remains negative to date. Most participants reported fearing infecting their partners or their partners feared being infected by them hence altering their sexual behaviour. About 50 percent of the participants reported themselves or their spouse being docile as a result of the guilt and/or shame of having brought the virus into the family.
As a result communication was improved for others where others reported their spouses being unresponsive. In Zimbabwean culture man are known to be the dominant hence their communication with their wives is that of authoritarian and suppression. Being positive in a serodiscordant relationship means men can easily become submissive even to the extent their wife can become abusive as with the participant who reported being beaten by his wife and not retaliating as he felt he was responsible for bringing the virus. The same participant had told his wife assertively that she was free to go before he went for HIV testing. However after testing positive his tolerance of abuse changed and stated that he wanted her anger to naturally subside.
"I had never had extramarital affairs.....At that time I felt guilt... What I have done (sleeping with the sex worker) I have sinned before God and before my wife....when my wife returned home I told her the truth that I had cheated on her and it could be that I contracted the HIV virus so can we start using condoms before we go for test but she argued and refused.... she asked who the person was and I did not divulge because the woman I had slept with was known to my wife.... I eventually told her who it was and she became very irate.... I gave her the choice of divorce if she was struggling to cope with what I did." (Participant G)
All male participants except one reported difficulties in adapting condoms usage. The reasons given for the difficulties were that it did not feel right as condom usage is associated with use outside marital homes with prostitutes, reduction in sexual pleasure and exacerbating sexual dysfunction. Some participants reported fear of losing their spouses following the diagnosis. Male participant reported that having the virus made them inferior and inadequate in the home even though their spouses were supportive.
"I'm troubled in my mind, my wife would want sex and I refuse.. I am stressed because we are now using condoms during sexual intercourse.. eh so you start to think whether this is still a marriage... eh..." (Partcipant F).
Most participants adopted a caring role of caring attitude towards others living with HIV or those showing symptoms of the virus.
"I cared for sick relatives that were HIV positive whole heartedly because at the back of my mind I knew that one day I will need similar support. I looked after my sister- in - law(brother's wife). I used to carry on my back as she was too ill to mobilise. I cared for HIV infected relatives that were ill both my side of the family and my husband's side. I saw caring for others as being helpful to my understanding of the HIV virus". (Participant E)
Children
The participants that reported having children in their marriages were 89% and this constituted eight participants and only (11 percent) one participant did not have any children. Six of the participants all above 40 years old indicated that they had had enough children and did not wish to have more whilst one 33 year old participant would have wanted more children and to try for a boy as he currently have two young daughters but he said he had to alter their lifestyle because of the virus. He cited that he is now fearful of infecting his wife and/or passing the virus to the baby during pregnancy.
"the child we had would be the last one because I don't see us having another child, we have two girls and we were thinking of trying for a boy but I don't see it happening now... most of it is coming from me seeing that my wife is negative, if we try to have another child maybe she will catch the HIV virus and pass it to the baby eh.. this is killing the entire family" (Partcipant F)
One participant felt that it would be wrong for one to have children once you have been found to be HIV positive.
The two youngest participants reported that they certainly would want to have children after they are married. Both of them highlighted the signification of cultural expectation to justify their need for children.
"I have been told that my CD4 count needs to be above 400 and ideally 520" (Participant H)
Participant D's belief was that children bring stability to a marriage even when she had twins from her previous marriage whilst her partner also has twins from his previous relationship she still wanted children once she got married again. However, on one she was indicating this on the other hand she feared having the children.
"I want my relationship to be stable. When someone is married what do they expect (meaning family)? You are a woman!" (Participant D)
In the study none of respondents reported their children to have HIV infection. The oldest participant who had two children when HIV/AIDS was still new reported that both these children later in their adult lives had tests; one was tested when she was got into a relationship and the last one was tested because she needed to go Ukraine to study medicine and was required to test for HIV. Participant reported she experienced extreme relief and joy that she had diarrhoea from a mixture of happiness and anxiety she had when she was given the results by her last two daughters. By this time both children knew that there was a possibility of them having been born with the virus.
"Every day I had homework regarding the status of these two children that were born after my diagnosis; I used to regularly pray to God to keep my children and husband safe from HIV" (Participant E)
Partcipant A who was pregnant when she tested positive expressed worry over her unborn child but was reassured that the baby could be negative if she took her prescribed medication. To date the baby is having regular HIV tests and the outcomes so far show that she is negative.
Religion
All participants reported that they were Christians and Participant had back slided but returned to Christianity once he was diagnosed with the HIV virus. Participant E reported that she went to different churches before she settled in Methodist.
"I pray for a cure and for God to intervene because we can talk as much but if God has not intervened nothing can be done" (Participant F)
4.3.3 Illness and treatment issues
Positive people stop knowingly spreading the virus (F, E)
More education/ awareness programmes
Go for HIV Test before falling ill
Adhere to Medication regimes
4.20 Summary
This chapter presented findings of the study and considered whether they support the research objectives. The following chapter presents discussion of the findings.
Chapter 5: discussion of results
Introduction
This chapter presents a brief summary of the study findings followed by a discussion of the study findings in relation to literature. The chapter also considered the implications of the findings on HIV policies and treatment and also highlights the limitations of the study.
The study sought to explore the life experiences of heterosexual couples living to with HIV virus where only one of them was positive. This study offered the participants in serodiscordant relationship an opportunity to talk freely, possibly for the first time, about the experiences of living with either with HIV positive status whilst their spouse was not. This was the first research of this type at this centre and some participants shared experiences that they had not shared with anyone before. The results from the interpretive phenomenology analysis suggested that participants manage to adapt and to accept challenges of living with HIV. In particular three main themes we identified focusing on psychological issues, socio-cultural issues and illness and treatment issues. As these themes were interrelated the discussion will not be in any particular order.
The study indicated that there is likelihood of people that were diagnosed when HIV/AIDS was new did not disclose their status due to stigma and this could explain the prevalence of the virus in the late 80s and early 90s. The participant whose initial testing was done in 1987 did not disclose her status to anyone. In 1987 when she was initially tested, the virus was just emerging in the world and there was little or no information at all about the virus hence managing or treating the virus was difficult. At this time stigmatization was high as the virus was labelled a death sentence affecting sex workers and gay people. The participant's decision not discloses her status raised a lot of ethical dilemmas; she knew her status before she got married but she choose to engage in risk behaviour with full awareness of her status and went on to have children. This means she was knowingly putting her husband and children at risk. Here in the UK this behaviour constitutes a criminal offence of grievous bodily harm (GBH) and attracts a prison sentence of 8 years. This may be attributed to the fact that counselling structures were poor at the time. In those days HIV was very stigmatised and even today it is still a stigmatised virus that should be hidden away from others despite a lot of advancement towards treatment, health education and awareness programmes. One participant stated that in Zimbabwe if HIV was advertised the same way that politics is advertised in local media: television, radio and newspapers then its spread would be going down and it would be more acceptable. He went further to say a small child can talk to you about the country's politics and the same child will have little or no awareness of HIV virus.
Most of respondents in the study took the position that they were automatically of the same HIV status as their tested spouse and needed encouragement to be tested. WHO estimates that only 40% of those with living with HIV globally are aware of their status, and that up to half of HIV positive individuals in primary relationships have HIV negative partners/spouse (WHO 2012). The challenge here is to get couples to be jointly tested. The study highlighted that some participants initially refused to go for HIV testing after their spouses/partners had been tested as they assumed that their status would be the same as the tested partner. They needed a lot of persuasion for them to be tested.
When facing societal discrimination and other hardships related to HIV/AIDS, a strong and supportive family is crucial to psychological, emotional and general wellbeing ( ). Most respondents only disclosed and discussed their status within their nuclear families. However those that had told significant others found it helpful and those that did not feared stigma and rejection. The decision not to disclose to close family members was a result of how the family viewed HIV and how negative they were towards those affected by the HIV. The findings of this study in regards to stigma are consistent with the findings of literature reviewed in chapter 2 (Holzenar et al 2007). The fear of rejection is strongly supported by literature where marriages breakdown as a result of HIV positive status (Stevens & Galvao 2007).
Children born with the disease will want children of their own and possibly will most likely enter into serodiscordant relationships. Firstly for this group of people there are two issues; that of disclosure and that of having the children. In the study the participant H who was born with the HIV virus had two relationships were she tried to conceal her status but when the people she was dating became aware the relationships ended. When she eventually disclosed her status again her relationships ended without explanations. (Supporting lit)
Most participants recommended early testing and diagnosis so that treatment can be commenced early enough. This is very important as evidence support that ART improves health hence HIV virus is no longer viewed as a death sentence. Furthermore ART reduces the likelihood of transmitting to partners (Donnell et al 2010). WHO currently recommends that HIV positive partners in serodiscordant couples ought to receive ART for prevention despite their CD4 T-cell count (WHO 2012). Currently in Zimbabwe treatment is commenced when CD4 count is at 350. In the study some participants indicated that since their diagnosis their physical health had not changed whilst others indicated that they experienced various health problems for example TB, candida,
Loose of identity as a men and a father in the house through use of condoms then thru submission due to guiltness - abuse. Women take advantage to abuse their husbands. Cite more than two 1. physical abuse. 2. -ve woman, 3. Acceptance difficulties from -ve partner murume wekumayard.
Belief in change of physical attribute making manhood smaller. Impact of a man being told this by a woman especially in a culture where such can be a taboo even between married couples. Because the man wil ask the woman whose else have u seen or who are you comparing me with.
Man do not like using condoms because they are not part and parcel of family sexual life. They are only accepted for use with sexworkers.
Years of non-condom use but still managed not to contract it- maybe diet, maybe the unexplained.
Role of caring - used an excuse where of infedility was not .
Precounselling and post counselling play an important role in building or breaking family after diagnosis. Use drugs as a copying mechanism in the discussion earlier importance of family role was highlighted as significant.
Issue of sex. Once hiv the likelihood of change in sexual behaviour is high with all men in the study pointing out reduced activity. Although the participants in the study perceived use of condom to reduce libido it has been contended that erectile dysfunction and low sexual desire has been associated with being HIV-positive (Asboe et al 2007) and also with men taking HIV medication (Lamba et al 2004).
The study showed that HIV related stigma was constantly present in the communities where the participants lived, particularly as most of the participants linked HIV with promiscuity.
Limitations of the study
All respondents preferred to be interviewed in vernacular language, Shona hence some information might have been lost in translation.
All data was not transcribed soon after the interviews due to lack of public utilities (electricity), however, all the interviews recordings were replayed soon after the interviews.
Time constraints led to some willing participants withdrawing their participation whilst some of those that took part only if did so because they had other business at the centre.
The participants were chosen on a first come first serve depending on their availability hence the sample was a convenient one.
Chapter 6: Conclusion
3.10 Anticipated Implications for Policy/Practice
The information gained from this research will facilitate understanding of how current practice can be changed to meet serodiscordant couples' needs and it is hoped that it will present a more in-depth picture of a phenomenon that has previously not been reported in the context of Zimbabwean population. It is also hoped that this study will influence policy formulation on testing married and or cohabitating couples and help achieve the world vision of world's new vision on HIV/AIDS zero new infections, zero discrimination and zero death in Zimbabwe.
3.11 Dissemination of results
This research project is the property of Brunel University and will be submitted for marking as part of fulfilment of MSc award. If participants are interested in having a copy of the findings the researcher will seek permission to facilitate this from the University and this also applies to MRCZ and City of Harare which might want to circulate the research paper to users under their umbrella. The findings will also be made available to other professionals in peer review meetings. The paper maybe submitted for publication to interested journals with Brunel University's approval.
3.12 Justification and Contribution Of Research:
Addressing issues of serodiscordancy would help achieve the worlds new vision on 'HIV/AIDS zero new infections, zero discrimination and zero death' (UNAIDS 2010) in Zimbabwe. Even though this is a small scale study it can highlight issues as well as contribute towards this vision in Zimbabwe. It will also highlight other HIV/AIDS issues in relation to meeting United Nations (UN Millennium Development Goal (MDG) number 6 set out in the year 2000 which is concerned with halting the prevalence of HIV/AIDS by 2015 and achieving access to treatment of HIV/AIDS for those that need treatment by 2010 respectively.
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APPENDICES
Brunel University - West London
Appendix 1
Information Sheet/Gwaro reziviso (adapted from Reynolds, 2004)
Exploring the Life Experiences of Serodiscordant HIV/AIDS couples/ Kuongorora magariro evarume nevakadzi kana mumwe aine hutachiwona hweHIV/AIDS mumwe asina.
My name is Phillomina Mabiza. I am a student of Health Promotion and Public Health at Brunel University, UK and I am carrying out a study on exploring the life experience of serodiscordant HIV/AIDS couples.
Ndinonzi Phillomina Mabiza. Ndiri mudzidzi we zvekukuridzira hutano kubatanidza nezvese zvehutano hwevanhu paBrunel University kuUnited Kingdom. Mufundo yangu ndirikuda kunzwisisa nezvemagariro evarume nevakadzi kana mumwe aine hutachiwona hweHIV/AIDS.
Purpose of the Study/Chinangwa chefundo
For this study, I wish to interview married or cohabitating individuals where only one partner is HIV positive.
The study aims to explore the following issues
1) Your experience of living with HIV/AIDS or caring for your partner with the virus
2) The current challenges that you face
3) The support that you would like to receive
Padzidzo iyi ndinoda kutaura nevanhu vanemuchato kana kuti vanogara vese mumwe wavo aine chirwere kana hutachiona hweHIV/AIDS.
Fundo iyi yakatarisira kuongoora zvinhu zvinotevera:
Magariro ako nehutachiona hweHIV/AIDS kana kuti machengetero emumwe
wako anehutachiwona hwacho kana iwewe usina.
Miyedzo yaunosangana nayo.
Rubatsiro rwaunotarisira kuti ungawane.
What does the Study Involve?/Fundo iyi inomirirei?
The study involves an interview that will take place at Wilkins Infectious Diseases Hospital. With your permission the interview will be tape recorded, and will be informal and relaxed. The interview will last 60-90 minutes.
Fundo iyi ichaitwa pachipatara chinonzi Wilkins Infectious Diseases Hospital apo muchabvunzwa nezvemagariro enyu nehutachiona uhu. Kana muchitendera zvichataurwa zvinenge zvichitapwa. Bvunzo iyi ichatora nguva inokwana awa imwe uye inogona kudarika awa zvishoma.
What will the Information be Used For?/Fundo iyi ichashandiswa sei?
The information given by you will remain confidential and your name and personal details will not be given to anyone else. Quotations from your interview may be used in the report, but your identity will not be disclosed. The data from the interview will be kept securely.
Zvese zvamuchataura pamusoro pemagariro enyu pamwe nemazita enyu, zvichachengetedzwa panzvimbo yazvisingagone kushandiswa nevanhu vasina mvumo. Zvamunenge mataura zvinogona kushandiswa mugwaro richanyorwa zvisingadudze mazita enyu.
The Benefits of Joining the Study/Zvinokubatsireyi kuti munge muri mufundo iyi?
You and your partner may not benefit directly from participation in the study. However, I hope that the research will be useful to other serodiscordant couples and health professionals in future.
Fundo iyi inogona kutadza kukubatsirayi imimi pachenyu asi inotarisirwa kuti ichabatsira vamwe vachapinda pachidanho chakafanana nechamuri iko zvino nevashandi vezvehutano.
The Risks of Joining the Study/Zvinogona kusakufadzai mufundo iyi?
I hope that your participation in this study will be positive, but there is a risk that the interview may touch upon a sensitive or upsetting experience. If this occurs, you will have a choice of either continuing with the interview or ending it at that point. I will be available afterwards if you want to discuss these issues further.
Ndinodaira kuti kuvepo kwenyu mufundo iyi chichave chinhu chakanaka asi panogona kubvunzwa zvinhu zvinorwadza mwoyo kana kusakufadzayi. Izvi zvikaitika makasununguka kuregera kuenderera mberi nefundo iyi. Ndichange ndiripo kana muchida kuzoenderera mberi nefundo iyi kuti mutsanangure zvinenge zvakukanganisai kana kusakufadzayi.
Your Confidentiality/Kuchengetedzwa kwemashoko amuchataura
You will not be referred to by name in any report concerning the study. Your anonymity will be maintained throughout as the transcripts will be coded for identification instead of using your name. However, should you disclose harm or public interest issues for example child protection issues, knowingly spreading the HIV virus or bad professional practice, confidentiality will be overridden by this and relevant authorities will be notified.
Mufundo iyi mazita eyu haashandiswe uyezwe manyorerwo anoitwa anovanza zita renyu. Mhinduro dzese dzinochengetedzwa asi pakaita nyaya dzinogona kutyora mitemo yenyika yeZimbabwe, takasungirwa kuzivisa vezvemitemo.
Your Participation/Kuvapo kwenyu mufundo iyi
Your participation in this study is entirely voluntary. You have the right not to answer any questions in the interview and you can withdraw from the study at any time without explanation. Should you decide to withdraw from participation, please note that this will not in any way affect the treatment or services that you are currently receiving.
No financial reimbursement will be offered for participation in the study.
Kuvapo kwenyu mufundo iyi kunotorwa serubatsiro kana tsiye nyoro dzengu. Hamusungirwe kupindura mibvunzo yese kana ichikuremerai. Munogona kuregera pamunenge musisade kuenderera mberi musingape chikonzero. Kuregedza kwenyu hakuzokanganise marapirwo amuri kuitwa kana amuchaitwa.
Hapana mari kana mubayiro uchapiwa avo vachange vari mufundo iyi.
Compensation for Harm/Kuripwa kana pane chinenge chakanganiswa
Brunel University provides the relevant insurance and indemnity, participants will be covered for any negligence on the part of the University, however, this will not be anticipated due to a rigorous Ethical Approval process.
Brunel University inoripa kana pane zvinenge zvakanganisika zvakanangana nefundo iyi. Izvi hazvo hazvitarisirwe kuitika nekuda kwekuti fundo iyi yakaongororwa ikabvumirwa nemabatoanoona nezveutano(Ethics Committee) yeBrunel University uyezwe neveMedical Research Council yemuZimbabwe(MRCZ) uyezwe neCity of Harare IRB.
Complaints Procedures/Kumhangara
Should you wish to make complaints please contact either MRCZ or the School Research Ethics Committee Chair, David Anderson-Ford on the following addresses respectively:
Medical Research Council of Zimbawe 2. School of Health Sciences Josiah Tongogara/ Mazoe Street and Social Care
P.O.Box CY 573 Brunel University
Causeway Uxbridge
Harare Middlesex, UB8 3PH
Tel: (04) 791792/791193 Tel: 00 44 01895 268731
Email: [email protected] Email: [email protected]
Kuti paine zvamusina kufadzwa nazvo zvakanangana nefundo iyi munotaura nemutungamiri anoongorora nezvemaverengerwo nemabatirwo evanhu kuBrunel University anonzi David Anderson-Ford pakero iri pamusoro apo.
Research Ethics Approval/Mvumiro yefundo iyi.
Research Ethics Approval has been obtained for this study from the School of Heath Sciences and Social Care Research Ethics Committee, Brunel University as well as from MRCZ and City of Harare IRB.
Fundo iyi yakatendeterwa neSchool of Health and Social Care Research Ethics Committee, Brunel University neveMedical Research Council yemuZimbabwe uyezwe neCity of Harare IRB.
Further Information/Zvimwe Zvamungade kunzwisisa.
Please contact me by e-mail: [email protected] or by phone on __________ (this phone is solely for the purpose of the research only and will only be live until 18/8/2012). Alternatively you can contact my supervisor, Dr Amir Takian by email: [email protected] if you require further information about this study. The physical contact details are the same as for the researcher given below.
Kana paine zvamungade kunzwisisa maererano nefundo iyi ndinowanikwa pakero yeemail inoti [email protected] kana supervisor wangu, Dr Amir Takian pakero inoti [email protected] .
Please sign the attached consent form if you are agreeable to participating in the study.
Mungaise runyoro rwenyu pafomu rekubvuma kuvapo kwenyu mufundo iyi.
Thank-you for your assistance.
Tinotenda nerubatsiro rwenyu.
PHILLOMINA MABIZA
Brunel University
Kingstone Lane
Uxbridge
Middlesex
UB8 3PH 
Brunel University - West London
Appendix 2
Participant Consent Form/Fomu Remvumo yenyu
Exploring the Life-Experiences of Serodiscordant couples living with HIV/AIDS.
The participant should complete the whole of this sheet him/herself
Fomu iri rinosungirwa kunyorwa nemunhu ari kubvuma kuva mufundo iyi.
Please initial the appropriate box
Pindurai hongu kana kwete pakafanira
YES / Hongu
NO/ Kwete
Have you read the Research Participant Information Sheet?
Maverenga here gwaro rinotaura nezvekubatsira kwenyu mufundo iyi?
Have you had an opportunity to ask questions and discuss this study?
Mawana mukana yekubvunza nezvefundo iyi?
Have you received satisfactory answers to all your questions?
Mapiwa mhinduro dzakafanira here panezvamabvunza?
Who have you spoken to?
Mataura nani?
Do you understand that you will not be referred to by name in any report concerning the study?
Manzwisisa here kuti zita renyu harisikuzoshandiswa mufundo iyi?
Do you understand that you are free to withdraw from the study at any time.
Manzwisisa here kuti munogona kuregera kupindura mibvunzo kana maona kuti hamuchakwanisa?
without having to give a reason for withdrawing
musingasungirwe kupa chikonzero
without affecting any services/care you are currently receiving or may receive in the future
izvi hazvizokanganisa marapirwo kana kubatsirwa kwamuri kuitwa parizvino neramangwana
I agree to my interview being audio recorded
Ndinopa mvumo yekuti mutape mazwi angu padzidzo iyi
I agree that the words I say may be used as anonymous quotations when the study is written or published.
Ndinopa mvumo kuti mhinduro dzandichapa dzishandiswe mukunyora fundo iyi kana kutsikiswa zvisina zitarangu mukati
Do you agree to take part in this study?
Munopa mvumo here yekuve mufundo iyi
Signature of Research Participant:
Date:
Name in Capitals:
Name of researcher:
Signature of researcher:
Witness Statement:
I am satisfied that the above named has given informed consent.
Witnessed by:
Date:
Name in Capitals:
Brunel University - West London
