Partner social support and sexual satisfaction is associated with lower anticipated HIV stigma in Malawian couples living with HIV

BACKGROUND: Fear of HIV stigma can lead to non-disclosure of HIV status to partners and negative impacts on couple relationships; at the same time, partner support has the potential to reduce the harms of HIV stigma on health. Little research has focused on couples who have disclosed their HIV status and whether a supportive relationship could protect against anticipated experiences of HIV stigma outside the partnership. We investigated the association between HIV stigma and relationships dynamics in couples living with HIV to identify dyadic targets for intervention.
METHODS: Married couples (N=211) with at least one partner on antiretroviral therapy were recruited from HIV clinic waiting rooms in Zomba, Malawi. Partners completed separate surveys on anticipated HIV stigma outside of the relationship and relationship dynamics (e.g., intimacy, trust, sexual satisfaction, general social support from the partner, and couple communication patterns). Linear mixed models tested for associations between relationship dynamics and anticipated stigma, and whether this association varied by gender, after controlling for socio-demographics and relationship characteristics.
RESULTS: Couples were together for 12.5 years, on average, and two-thirds were sero-concordant positive. In multivariable models, higher sexual satisfaction (b=-0.22, 95%CI= -0.41; -0.03, p=0.020) and partner social support (b=-0.02, 95%CI=-0.04; -0.01, p=0.006) were associated with less stigma, while negative communication styles such as withdrawal (b=0.13, 95%CI=0.04; 0.21, p=0.003), demanding (b=0.17, 95%CI=0.09; 0.24, p<0.001), and avoidant communication (b=0.26, 95%CI=0.13; 0.39, p<0.001) were associated with higher stigma. Associations did not vary by gender.
CONCLUSIONS: Couple-based interventions that promote constructive forms of couple communication, strengthen emotional and practical support within couples, and improve sexual satisfaction could reduce extra-dyadic HIV stigma and its negative impacts on the health of couples living with HIV in sub-Saharan Africa. Relationship dynamics such as sexual satisfaction and social support may be of equal importance for both men and women in efforts to reduce anticipated HIV stigma.