“It will be everyone’s secret; he won’t tell, and I won’t tell” : the impact of HIV diagnosis on serodiscordant couples

Anti-retroviral therapy (ART) and oral pre-exposure (PrEP) have proven effective in the prevention of HIV. As Tanzania begins a nationwide scale-up of pre-exposure prophylaxis (PrEP) with a focus on key populations including couples with different HIV status, described as serodiscordant, we seek to understand the perceived effects of PrEP and early ART on facets of serodiscordant relationships. Additionally, given the gender disparities that contribute to women’s increased risk of HIV infection, this paper will also examine female partners’ decision-making related to HIV testing and partner dynamics post-testing. Using a social constructivist grounded theory paradigm, 44 in-depth interviews conducted during the Dyadic-based Diagnosis, Care and Prevention (DDCP) study in Kisarawe, Tanzania were analysed. Content analysis was employed alongside metaphor analysis and case study analysis to create a contextual, animated yet distinctive, and holistic understanding of the experiences of serodiscordant couples. The findings of the study reveal that when there is disclosure of HIV status to the partner, there is a general feeling of closeness by both partners; however, most participants indicated being more comfortable disclosing to specific family members than partners. Analyses also found that participants were interested in PrEP as a substitute for condom use; some having expressed that PrEP will return their sexual interactions to a semblance of normality. Case study analysis showed that most female participants, regardless of their HIV status, would get tested alone if their partner refused to get tested together. There was also a general consensus on the unfaithfulness of male partners, and for some female participants this led to the breakdown of the relationship whilst others chose to live in peace. The study shows that couples testing is a crucial intervention that may promote better quality of serodiscordant relationships. Including family members and communities in conversations about HIV testing, care and treatment, can engender a more informed support network that promote early ART/PrEP adherence and more stable serodiscordant relationships. Better guidelines that are informed by and accommodate the interests and experiences of serodiscordant couples need to be developed to improve and inform patient-centred care.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat