Uthando Lwethu: Why did we do this study?

Uthando Lwethu feedback for Department of Health

Why did we do this study?
•    HIV is an important issue for couples. Most HIV infections in sub-Saharan Africa occur within couple relationships.
•    We know that even when people get tested for HIV, often they do not disclose their status to their partner.
•    We know that women access HIV testing and services more than men.
•    Couples HIV testing and counseling (CHTC) is a way to address these observations. It is a service in which both partners can get tested together and find out each other’s HIV status.
o    CHTC has been found to reduce sexual risk behavior and help HIV-positive people get into treatment (take ARVs/medication for HIV).

However, CHTC is hard for people to do. Even where CHTC is available most couples don’t access the service.  We wanted to help people access this service so we interviewed couples and asked them about CHTC. We asked what would make it easier or harder to get CHTC with their partner.

They told us things like:
o    They like services for couples
o    Talking about HIV with their partner is hard, but it is important to do. They want to talk to their partners about HIV, but don’t know how.
o    They thought it was important to do with someone who they were serious about , or wanted to have a baby with.
o    Mostly, people talked about wanting to have good relationships with their partners, and know how to keep themselves and their partner healthy—even if one of them had HIV.

So, we developed a program for couples to help them talk about HIV: Uthando Lwethu.  This was a program that was for couples to help with their relationships. Some of the program was delivered to groups of couples, and others to individual couples with a counselor. We included topics that are important to couples, like family planning, gender issues, intimate partner violence. We provided health information about issues such as TB and alcohol use. When couples met with a counselor, they chose a topic having to do with HIV to discuss with their counselor. The counselor also helped them work on communication skills so they could talk to their partner about things that might be hard to talk about or sensitive topics. But they also talked about what they liked about their partner and their relationship, and what they appreciated about their partner and relationships.

After we had our topics, we also consulted with local leaders from churches, health care workers, and chiefs to get their thoughts and feedback about whether this program would be a good thing for the community.

Our goal was to provide information but also to help couples to improve their relationship and their ability to talk about HIV together. We used mobile caravans to conduct our study activities. This way, we could come to the communities so that couples did not have to travel to clinics or health centers. We conducted counseling and HIV testing in our caravans.

We offered the opportunity to get CHTC with their partner. This was the goal or the outcome of our study . CHTC can help people stay HIV-negative,  and help couples learn how to prevent giving HIV to their partner, if they are HIV-positive. The counseling is based on the HIV results of the couple and the counselor works with the couple to make goals for their future.

In order to determine whether our program was successful in helping couples to get tested, we had to compare it to something. So, half of the couples participated in group sessions and couples counseling sessions right away. The other half of the couples participated in one group session, and had the option to receive couples counseling sessions after their final follow-up.

We followed both couples for 9 months to see how their relationships and behavior changed over time.