IN SICKNESS and in HEALTH Supporting couples to support each other
t seems to be common sense that in relationships, the health of one partner is linked to the health of the other. But couples struggle to get access to reproductive health and HIV/AIDS services together, ZIPHO PHAKATHI, HEIDI VAN ROYEN, NUALA MCGRATH and VICKY HOSEGOOD found during a pilot study conducted in Vulindlela, KwaZulu-Natal.
Given that the health of couples are intricately linked, it is reasonable that partners should be concerned and actively involved in ensuring the health of the other as it will also eventually translate to their own wellbeing. Relationships, after all, are associated with enjoying togetherness and companionship, caring and love, and being there for each other.
So why do couples struggle to access services of reproductive health, HIV/AIDS and also relationship support services together?
The Couples Pilot Study was conducted as a sub-study of the larger Project Accept in Vulindlela, KwaZulu-Natal. Project Accept is an ongoing trial testing the efficacy of a community-based voluntary counselling and testing (CBVCT) intervention.
Interestingly, both men and women regarded family planning as a service for women only.
The Couples Pilot Study described the engagement of couples with existing services and investigated the feasibility and acceptability of enhanced couples focused services for male and female partners. We conducted interviews with each partner separately, followed by an interview with the couple jointly. Couples were asked about their use of family planning, reproductive health and HIV/AIDS services individually and as a couple.
The study shows that couples were seeking family planning and HIV/AIDS services at primary healthcare centres, such as hospitals and clinics. Interestingly, both men and women regarded family planning as a service for women only.
Importantly, the findings show that men rely on their women to access the services of reproductive health and family planning, rather than accompanying their women when they consult these services.
Couples and family planning
Several reasons were provided for why men did not accompany their partners to access reproductive health and family planning services, including lack of time because of work commitments; the perception that current health facilities are women-centred/-focused; and the fact that couples are not living together in this community, making it difficult to go to services together. Importantly, the findings show that men rely on their women to access the services of reproductive health and family planning, rather than accompanying their women when they consult these services.
In addition, most couples reported that they have never discussed reproductive health and family planning related issues in their relationships, or doing so very cursorily. They reported that these discussions only occurred in times of ill health, but not when thinking through and planning for the relationship.
Couples and HIV
Similarly, people do not go as a couple for HIV testing and other HIV-related services; they prefer to do it individually. Both men and women added that females are the ones who are taking the lead in getting HIV testing and education, because they make more use of clinics and hospitals.
This finding is also supported by the view from the community stakeholders who expressed that ‘men have a big problem of not wanting to hear about HIV/AIDS issues’. Men rather suggested that the focus of HIV prevention services should be women because they were familiar with the healthcare services and could then educate their male partners.
As a result, it was suggested by both men and women that community-based services operating outside formal health institutions were needed in order to reach couples with HIV/AIDS and reproductive health related services. This also confirms the notion that men use women as their means of accessing services for the couple as a whole.
This finding is also supported by the view from the community stakeholders who expressed that ‘men have a big problem of not wanting to hear about HIV/AIDS issues’.
Of great concern, given that it had been established that couples need to access health services together, we identified no programmes currently ongoing in the community which were specifically assisting couples with their reproductive health, family planning and HIV prevention needs. The few couples who sought to access services together were reliant on the clinic based and hospital-centred services, which are perceived to be women-centred and present various challenges for men to access them.
In summary, this current health-seeking pattern among couples is problematic because, amongst other reasons: women tend to be blamed for HIV disease if their status is positive, and this results in gender violence; sexual reproductive health is dependent on both partners’ behaviours; and men need to acknowledge their own risk and take responsibility in health matters.
Community-based, integrated services
There is a strong belief that if these services can be centred in the community as a community-based, couples-focused programme, it would facilitate both women and men in couples to access services.
In addition, most couples felt that services for couples would be best delivered and received if they were integrated, including services for reproductive health, family planning, HIV prevention, HIV education, and HIV treatment. Interestingly, there is a view that integrating these services would in turn increase people’s access to a range of information and services that affect HIV outcomes. Integrating services can benefit couples by: more people getting tested for HIV; reducing stigma and discrimination; increasing access to and use of services; and by contributing to reduce unintended pregnancy and perinatal transmission, as well as mortality from HIV/AIDS.
Integrated services would be ideal for attracting men in the community as they would be offered at convenient times; have a welcoming atmosphere (unlike clinics and hospitals which are women-centred); and would contribute in changing men’s minds about using women as proxies to access the services of a couple, and thereby support couples to improve their communication generally and their health specifically.
Zipho Phakathi; Heidi van Rooyen, chief research manager, HSRC; Victoria Hosegood, department of population studies, London School of Hygiene & Tropical Medicine and visiting academic, HSRC; Nuala McGrath, department of infectious disease epidemiology, London School of Hygiene & Tropical Medicine, honorary fellow with the HIV/AIDS, STIs and TB research programme, HSRC.