is associated with lower HIV stigma in couples from Malawi Session on Stigma Interventions Amy A Conroy PhD MPH University of California San Francisco Center for AIDS Prevention Studies I have no relevant financial relationships with ineligible companies to disclose ID: 1044610
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1. Partner support and sexual satisfaction is associated with lower HIV stigma in couples from MalawiSession on Stigma InterventionsAmy A. Conroy, PhD MPHUniversity of California, San FranciscoCenter for AIDS Prevention Studies
2. I have no relevant financial relationships with ineligible companies to disclose.Disclosures
3. Major obstacle to global AIDS targetsBarrier to HIV testing, care, and treatmentLimits access to resourcesNegatively impacts quality of life and mental healthEnding AIDS requires reducing stigmaNyblade, Mingkwan, & Stockton, Lancet HIV, 2021Stigma reduction must occur at multiple levels
4. Why target couples and HIV stigma?Couples and families are social units; goes beyond individual Working with couples can target both people who experience and perpetrate stigma Can address fundamental cause of stigma: power and oppression Leverage the couple as source of resilience
5. Are couple relationships increasing or decreasing HIV stigma?Is stigma negatively or positively affecting relationships?Couple Relationships and HIV StigmaCouple relationshipsHIV StigmaSocial support can decrease effects of stigmaStigma from a partner can increase self-stigmatizationIncrease instability, conflict, low sexual satisfactionShared experience of stigma can foster closeness
6. Focus has been on HIV risk versus HIV treatment engagementMost studies have been qualitative by designDearth of quantitative studies on HIV stigma and couple relationships Evidence needed to support stigma interventions with couples and familiesGaps in knowledge on couples and HIV stigma
7. Do individuals in higher quality relationships experience less HIV stigma?And does this vary by couple serostatus?Research Questions
8. A dyadic investigation of relationship dynamics and engagement in HIV care in Malawian couples Umodzi M’Banja (Unity in the Family)
9. Two recruitment sites in Zomba district:An urban clinic at a district hospital (7000+ patients)A rural clinic at a private hospital (4000+ patients)Index patients were recruited in waiting rooms when attending appointmentsSeparate, private interviews (single visit)Study Procedures
10. Both partners were asked the same questions on:Relationship dynamics (e.g., intimacy, sexual satisfaction)Partner support (general and HIV-treatment specific)Couple communication patternsAnticipated HIV stigma (Earnshaw et al., 2013)Linear regression to test for associations between relationship factors and HIV stigmaMeasures and Analysis
11. Couple CharacteristicsmeanAge40.5meanRelationship Duration (years)12.5meanTime on ART (years)4.8466.8%N=352
12. Results: Relationship Dynamics Predicting HIV Stigma (N=345)*Models controlled for socio-demographics and couple characteristicsPredictor VariableBeta coefficient ( )95% CIP-valueIntimacy-0.13-0.31, 0.530.166Trust-0.01-0.03, 0.010.252Equality-0.01-0.03, 0.010.186“We-ness”/unity-0.05-0.18, 0.070.378Sexual satisfaction-0.22 -0.41, -0.03 0.020Commitment-0.11-0.37, 0.150.421
13. Results: Support and Communication Predicting StigmaPredictor VariableBeta coefficient ()95% CIP-valuePartner support (general)-0.02-0.04, -0.01 0.006Partner support (HIV treatment-specific)-0.17-0.04, 0.000.053Communication style Withdrawal0.130.04, 0.21 0.003 Demanding0.170.09, 0.24 <0.001 Avoidant0.260.13, 0.39 <0.001*Models controlled for socio-demographics and couple characteristics
14. Do associations vary by couple serostatus?Are couples similar in experiences of HIV stigma?No significant interaction terms for key variablesSmall correlation (r=0.28)Is stigma greater in discordant vs. concordant couples?Higher scores in discordant couples, but not statistically significant
15. Practical skills like communication and support matter more than relationship dynamics, with exception of sexual qualityRole of couple serostatus may be less important for HIV stigma within long-term relationships Longitudinal investigations are needed to establish directionality and causalityConclusions
16. HIV stigma interventions are lacking for couples in sub-Saharan AfricaHIV stigma is a couple-level issue, requiring couple-level solutionsInterventions needed to build resiliency in couples and strengthen couple relationshipsStigma Interventions for Couples
17. AcknowledgementsCo-investigators and staffLynae Darbes, PhDTorsten Neilands, PhDMonica Gandhi, MDAllison Ruark, PhDJames Mkandawire, MPHSylvia Jebiwott, MPHNancy Mulauzi, MBAFunding sourcesP30-AI027763K01-MH107331Invest in Knowledge Staff in MalawiOur research participants and people living with HIV in Malawi