Magister Public Health - MPH / The HIV prevalence rate in Zimbabwe has been estimated at 15% (15 years old and above), which is one of the highest in the world, and HIV/AIDS remains a significant public health problem. The focus of HIV prevention strategies has been on heterosexual transmission since this is the primary driver of the HIV epidemic in Zimbabwe. Heterosexual serodiscordant couples represent an important subpopulation for HIV prevention but are not well studied in Zimbabwe. In Harare almost all serodiscordant couples participating in the HPTN 052 study reported correct and consistent condom use. However, rates of STIs and pregnancies showed that couples in the study continued to have unprotected sex, in-spite of intensive couples’ counselling, quarterly follow up visits and provision of condoms. The aim of this qualitative study was to explore barriers to condom use by these serodiscordant couples in which one partner was on ART in Harare, Zimbabwe. It used a two stage qualitative approach with semi-structured interviews being the primary method of data collection. These interviews were conducted on a sample of five study staff, 15 serodiscordant couples and individuals enrolled in the HPTN 052 study in Harare, Zimbabwe after consent was obtained. Thematic analysis was used to analyse data collected.The study findings showed that partners were in a fairly large age range (30 to 50+ years) with males being slightly older than females. Seven males and five females were HIV positive. Couples had a wide variation in the length of their relationships, from one month to over 15 years as a couple. The study findings also showed that individuals in serodiscordant relationships understood serodiscordance. Problems unique to these couples were identified and broadly categorized as dealing with an HIV positive result, accepting serodiscordance, and difficulty of disclosing serodiscordance to family. Couples also showed understanding of the importance of condom use in a discordant relationship. The most common reason for using condoms was to prevent transmission of HIV to the uninfected partner. The main barriers to condom use were the strong desire to have children, male partner reluctance to use condoms and the influence of the negative partner in determining condom use. Based on these findings, a nuanced approach to prevention strategies, such as condom use and couples counselling and testing, is required. The aim should be to increase understanding of serodiscordance, risk and condom use at all sessions or contacts with couples.

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HIV/AIDS is severely affecting the armed forces in South Africa. Combating HIV/AIDS demands a high level of commitment from the Ministry of Defence and all the Divisions and Services at all levels in the Department of Defence. Prevention practice for HIV/ AIDS is a challenged because the nature and full extent of the impact on the forces, and in particular on serodiscordant couples, are not known. This research study explored the experiences of serodiscordant couples regarding the impact of serodiscordancy on their marriages. The Infectious Disease Clinic engages serodiscordant couples as active participants in dealing with their HIV status. The researcher explored the impact of HIV serodiscordancy on married couples attending the Infectious Disease Clinic at 1 Military Hospital with the intended outcome of informing intervention and prevention strategies and programmes for serodiscordant couples. The study utilised a qualitative research approach and the research design was an instrumental case study. The population for the study was all the married serodiscordant couples in the Infectious Disease Clinic at 1 Military Hospital. The sample consisted of 20 serodiscordant couples attending the Infectious Disease Clinic for at least the past two years. The data was collected through semi-structured interviews. The study concluded that empowerment programmes on HIV/AIDS should include knowledge of, as well as coping skills and guidance for couples dealing with serodiscordancy, including disclosure and discrimination; marital and parenting roles; health management, building of trust; facilitating open and positive communication; and financial management. Based on the conclusions of the study, the main recommendation is that prevention strategies and empowerment programmes for serodiscordant couples should be based on a holistic, well-integrated intervention plan which contextualises strategies and programmes for prevention, treatment, counselling, empowerment and continuous support of the employee, their spouse and their family, including home visits, as required by the serodiscordant couple. Furthermore, it should clearly conceptualise the role of each team member at both the Infectious Disease Clinic and the relevant units of the SANDF, in particular the role of the social worker. / Dissertation (MSW)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted