The Importance of Relationship Dynamics in Explaining HIV Transmission: Results from a Qualitative Case-Control Study in Rakai, Uganda

Jenny A. Higgins, University of Wisconsin-Madison
Sanyukta Mathur, Columbia University
Neema Nakyanjo, Rakai Health Sciences Program
Elizabeth Eckel, Columbia University
Richard Sekamwa, Rakai Health Sciences Program
Josephine Namatovu, Rakai Health Sciences Program
Fred Nalugoda, Rakai Health Sciences Program
John Santelli, Columbia University

Continuing HIV transmission among youth in sub-Saharan Africa demands greater awareness of the contextual variables influencing HIV transmission, but few studies have compared newly HIV positive and negative peers. We present results from 60 in-depth interviews with 15-24 year-old women and men from Southern Uganda. An innovative ethnographic case-control design matched newly infected HIV-positive cases with HIV-negative "controls." The most salient themes explaining HIV differences were relationship dynamics, type, and quality. Respondents who had remained HIV-negative were more likely than their newly infected peers to report communication with their partners about HIV and pregnancy, knowledge of partners’ HIV testing history, and greater trust in and connectedness with their partner; they also reported fewer partners and smaller sexual networks. Relationship dynamics appear strongly correlated with HIV prevention practices. Interventions emphasizing couple-based testing and/or communication may be justified. Finally, using HIV-matched pairs can shed important light on the factors influencing HIV infection.