AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #193 - Zooming in and out: Explorations of HIV risk, responsibility, intimacy and love in rural South Africa (NIMH Project Accept-HPTN 043)
Authors: Presenting Author: Dr Heidi van Rooyen - HSRC
Additional Authors:
Aim: Several studies in the United Kingdom and the United States have explored risk management in HIV prevention amongst gay men. The aim of this paper is to explore how a group of rural, heterosexual South African women, living in the midst of spiraling HIV infection, negotiate issues of HIV risk and responsibility in the context of their intimate love relationships.
Method / Issue: Drawing on qualitative data collected as part of Project Accept, a randomized controlled trial to determine the effectiveness of a community mobilization, community-based voluntary counseling and testing (CBVCT) intervention, the approach to the analysis will be two-fold. First, we explore the themes of risk, responsibility, intimacy and love across a sample of longitudinal cohort interviews collected over a two year period from women at baseline (N=64), 6 months (N=47) and 15 month (N=38) in the study. Next, we switch perspective and zoom in on a single woman’s story over these 3 time-points, and explore how she negotiates HIV risk and responsibilities in the context of her relationships.
Results / Comments: Women showed a realistic appraisal of relationship risks in this high prevalence setting. Trust and faithfulness were delicately negotiated as women sought to maintain healthy relationships, and assumed different meanings depending on the nature, length and duration of relationship. In a context of viral dangers sexual safety was often rejected in long term relationships, particularly where other relationship needs and values took precedence. In these partnerships, unprotected sex appeared to be less a case of ignoring viral dangers as an acceptance that danger is part of love and life.
Discussion: Risk management continues to be framed as the product of rational decision making. Our HIV prevention efforts have discounted the irrationality of emotion, and how meanings attached to love, relationship and intimacy impact risk management. Love and intimacy are critical to relationship survival and are complicated under the threat of HIV transmission and illness. To successfully address risk management, these “softer” issues need to be addressed.
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