Encouraging wider counselling uptake: urged by additional risk factors associated with HIV infection

Recently, in HIV/AIDS – Research and Palliative Care, Arishaba et al. (2022) have published original research demonstrating the additional, perhaps unknown, risks linked to HIV infection beyond individual medical symptoms1. This cross-sectional, qualitative study was able to suggest that HIV infection in Uganda could be linked to negative relational experiences, whether physical, sexual or emotional, creating further distress and harm as a result. These concerning findings can lead to one pressing question: how can this risk be mitigated?

As explained, many factors have been identified by previous studies as increasing the risk of poor relational experiences. These may be closely related to their HIV status, including being seen to actively treat their condition with retroviral therapy, disclosing their positive status to a significant other or requesting the use of contraception during intimacy. Furthermore, past research has determined additional risk factors outside of health behaviors may also put them at risk of negative experiences, such as their educational level and marital status.

Uganda has introduced formal services aiming to assist individuals in harmful and negative relationships. However, external factors, such as community attitudes, can influence the uptake of these services. Communities may hold certain attitudes about HIV status, relationship behaviors and an individual’s autonomy that stigmatize seeking support and therefore discourage others from participating in the available services.

Unfortunately, the harmful outcomes associated with the risk factors of a positive HIV status may mean an individual’s condition could deteriorate further. Examples of outcomes suggested by the authors include rejecting the support available to reduce HIV transmission, poor adherence to antiretroviral therapy and a smaller likelihood of achieving viral load suppression.

In this influential study, Arishaba et al. (2022) continually enrolled women seeking HIV treatment at two centers. The researchers went on to investigate the demographic factors, relationships and previous counselling experience of participants.

Out of the sample collected, 60.7% women sought help from specialized services for their relationship, 53.5% from family or friends, 40.8% from multiple support networks, both professional and informal. These numbers are not representative of individuals dissuaded from seeking any type of support for HIV or relationships due to negative relational experiences, as previously mentioned and explained by the study authors.

Therefore, the task of encouraging more individuals to seek support for negative relational experiences requires further investigation. The findings of this study reported that knowledge about support services and counsellor availability were significantly associated to seeking help. These factors can illuminate a roadmap for addressing the earlier question of mitigating the apparent risk of harm. For example, increasing the widespread knowledge of support services may encourage more individuals to uptake services local to them.

However, this is dependent on the availability of services within a given locality, which is not always guaranteed. Secondary to this, counsellors may be occupied providing services to other individuals and therefore cannot support everyone. These issues imply that reducing risk involves additional factors related to the services themselves, including funding, ease of access, staffing resources and more. Thus, resource allocation should become a consideration in mitigating the risk of negative relational experience for individuals living with a positive HIV status.

When understanding the impact of this publication, the answer is relatively clear. Increasing knowledge and availability of support has the potential to normalize seeking support when experiencing negative relational experiences. Given that such experience has the potential to lead to further harm regarding individual HIV status, ensuring the risk is mitigated as much as possible is urgent. The researchers conclude that this vital intervention could start with familiarity about services, and well-resourced formal support.

You can read the full article referred to in this blog post on the Dovepress website at this link.

¹ Arishaba A, Kiduuma W, Night G, Arinaitwe I, Niyonzima V, Mubangizi V. Predictors and factors associated with counseling seeking behavior against intimate partner violence among HIV-positive women in southwestern Uganda. HIV AIDS (Auckl). 2022;14:275—283.

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