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<h5 class="section-title" id="d478061e179">Rationale:</h5>
<p id="P1">Despite the importance of primary partners for health, little is known
about factors
that constrain the ability of couples to work collaboratively towards HIV care and
treatment (dyadic coordination). This study examined the interplay of marital infidelity,
food insecurity, and couple instability on dyadic coordination and adherence to antiretroviral
therapy (ART) in Malawi.
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<h5 class="section-title" id="d478061e184">Methods:</h5>
<p id="P2">In 2016, we conducted 80 in-depth interviews with 25 couples with at least
one partner
on ART. Couples were recruited at two HIV clinics in the Zomba district when attending
clinic appointments. Participants were asked about their relationship history, relationship
dynamics (love, trust, conflict), experiences with HIV care and treatment, and how
partners were involved. Using an innovative analysis approach, we analyzed the data
at the couple-level by examining patterns within and between couples.
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<h5 class="section-title" id="d478061e189">Results:</h5>
<p id="P3">Three patterns emerged. For some couples, ART led to positive changes in
their relationships
after men terminated their extramarital partnerships in exchange for love and support.
For other couples with power imbalances and ongoing conflict, men’s infidelity continued
after ART and negatively affected dyadic coordination. Finally, some couples agreed
to remain “faithful”, but could not overcome stressors related to food insecurity,
which directly impacted their adherence.
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<h5 class="section-title" id="d478061e194">Conclusions:</h5>
<p id="P4">Couples-based interventions targeting ART adherence should improve relationship
quality,
while also addressing interpersonal stressors such as marital infidelity and food
insecurity. Multi-level interventions that address both dyadic and structural levels
may be necessary for couples with severe food insecurity.
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