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“Him Leaving Me – That is My Fear Now”: A Mixed Methods Analysis of Relationship Dissolution Between Ugandan Pregnant and Postpartum Women Living with HIV and Their Male Partners

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Abstract

High rates of relationship dissolution among pregnant women living with HIV (PWLHIV) and their male partners might increase mothers’ and children’s vulnerability to financial hardship and poor health outcomes. This mixed methods analysis identified factors associated with separation between PWLHIV and their male partners. We utilized data from a randomized controlled trial (www.ClinicalTrials.gov NCT03484533) of 500 PWLHIV attending antenatal care in Uganda and 237 male partners between 2018 and 2020 and followed until 12 months postpartum. Multivariate regression models estimated the impact of relationship factors on the adjusted relative risk of separation during follow up, and we conducted in-depth interviews with 45 women and 45 men enrolled in the trial. Overall, 23% of PWLHIV reported separation during the study period. HIV serodifferent status, financial burdens and gender expectations were sources of relationship conflict. Significant factors associated with separation included unmarried, non-cohabitating, shorter, polygamous relationships, as well as HIV non-disclosure and verbal abuse. Participants discussed potential positive and negative consequences of separation, including impact on their mental health, treatment continuation, financial security, and safety. Addressing relationship dynamics is essential to improve counseling messaging and support PWLHIV who are experiencing relationship conflict.

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Data Availability

Quantitative and qualitative data may be made available by authors CC and NW, upon reasonable request.

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Acknowledgements

We would like to thank the study team and the study participants. We acknowledge Dr. Karusa Kiragu, the Country Director of The Joint United Nations AIDS Program (UNAIDS) in Uganda, for providing her insight and expertise.

Funding

This work was supported by the US National Institutes of Health [NIMH R01 MH113434; awarded to CC]. The funders had no role in study design, data collection, analysis, writing of the report, nor the decision to submit for publication.

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Authors and Affiliations

  1. Department of Global Health, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA

    Michelle A. Bulterys, Andrew Mujugira, Monisha Sharma, Jade Boyer & Connie L. Celum

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Michelle A. Bulterys

  3. Infectious Diseases Institute, Makerere University, Kampala, Uganda

    Andrew Mujugira, Agnes Nakyanzi, Brenda Kamusiime, Vicent Kasiita, Grace Nalukwago Kakoola, Alisaati Nalumansi, Collins Twesigye & Faith Naddunga

  4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Monique A. Wyatt & Norma C. Ware

  5. Harvard Global, Cambridge, MA, USA

    Monique A. Wyatt & Emily E. Pisarski

  6. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Norma C. Ware

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Contributions

Authors MAB, AM, CC, and NW conceptualized the research question. CC, AM, AN, FN, MS, and JB led the quantitative research, and NCW, MAW and EEP led the qualitative research and supervised data collection and analysis. BK, VK, GNK, AN, and CCT collected the qualitative data. MAB analyzed the quantitative and qualitative data under guidance by CC, NW, and AM. MAB and CC drafted the manuscript with substantial input from NW, AM, MS, and EEP. All authors approved the final version.

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Correspondence to Michelle A. Bulterys.

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Dr. Celum has served as a scientific advisor to Gilead Sciences and Merck. The authors declare no conflicts of interest.

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Bulterys, M.A., Mujugira, A., Nakyanzi, A. et al. “Him Leaving Me – That is My Fear Now”: A Mixed Methods Analysis of Relationship Dissolution Between Ugandan Pregnant and Postpartum Women Living with HIV and Their Male Partners. AIDS Behav 27, 1776–1792 (2023). https://doi.org/10.1007/s10461-022-03910-3

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