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Relationship dynamics and challenges of safer sex in an HIV serodiscordant couple in India: A case review from the positive Jeevan Saathi study

ABSTRACT Currently, no counseling guidelines exist for HIV serodiscordant couples in India. One-on-one interviews were conducted with married, serodiscordant couples in Western India, from which one couple was selected to explicate the factors that elevated HIV risk, using an intrinsic case study approach. This case study describes the factors that contribute to HIV risk in a married serodiscordant couple, including shifts in spousal roles, history of child sexual abuse, unfulfilled sexual desire, unprotected sex with extramarital relations, intimate partner violence, and inconsistent condom use with marital partner. Although there were improvements in the couple’s relationship after HIV entered their lives, shifts in relationship dynamics and behaviors exacerbated HIV risk. Early and ongoing counseling interventions with couples are key, as relationship dynamics and behaviors can change over time. HIV service providers must be trained appropriately to address the spectrum of risk that may lie in HIV serodiscordant couples.