Sexual life and fertility desire in long-term HIV serodiscordant couples in Addis Ababa, Ethiopia: a grounded theory study

BACKGROUND Even though remarkable progress has been achieved, HIV/AIDS continues to be a major global health priority. HIV discordant relationship is one of the emerging issues in HIV prevention endeavour. In Ethiopia, very little is known about HIV-serodiscordant couples particularly how they manage their sexual relationship and fertility desire. Therefore, we conduct this study with the aim of exploring the experiences of HIV discordant couples about their sexual life, and fertility desire in the context of long-term relationships in Addis Ababa, Ethiopia. METHODS A grounded theory approach was employed using in-depth interviews among 36 informants in ART/PMTCT centers of three public hospitals, a health center and one PLHIV association in Addis Ababa. Theoretical sampling was used to recruit 28 clients who lived in a discordant relationship and eight health care providers as key informants. Data collection and analysis were undertaken simultaneously using a constant comparison. The analysis was facilitated using OpenCode software. RESULTS A grounded theory pertaining to sexual life and desire to have a child among HIV discordant couples emerged as "maintaining the relationship" as a core category. Couples pass through a social process of struggle to maintain their relationship. The causal conditions for couples to enter into the process of struggle to maintain their relationship were collectively categorized as "Entering in-to a transition" (knowing HIV serostatus) and this includes mismatch of desire to have a child, controversy on safe sex versus desire to have a child, and undeniable change in sexual desire and practice through time were the features in entering into-transition. Then after the transition, couples engaged in certain actions/strategies that are categorized as "dealing with discordancy" such as entertaining partner's interest by scarifying once self interest to maintain their relationship. CONCLUSIONS HIV discordant couples' relationship is filled with controversies of maintaining relationship versus fear of getting infected. The findings of this study have suggested the need to view discordant couple's actions as a process of maintaining their relationship in the context of eminent risks. Further study should be done among HIV discordant couples to assess the fitness of the current model in different setups and population. In addition, a study could begin to test the hypotheses proposed in this study.