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What the better half is thinking: A comparison of men’s and women’s responses and agreement between spouses regarding reported sexual and reproductive behaviors in Rwanda

Kathy M Hageman1, Etienne Karita2, Kayitesi Kayitenkore2, Roger Bayingana2, Ariane van der Straten3, Rob Stephenson4, Martha Conkling5, Amanda Tichacek1, Lawrence Mwananyanda5, William Kilembe5, Alan Haworth6, Elwyn Chomba6, Susan A Allen1
1Rwanda Zambia HIV Research Group, Emory University, Atlanta, Georgia, USA; 2Projet San Francisco, Kigali, Rwanda; 3Women’s Global Health Imperative, RTI International, San Francisco, USA; 4Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; 5Zambia Emory HIV Research Project, Lusaka, Zambia; 6University Teaching Hospital, Lusaka, Zambia

Objective: To compare responses to a sexual behavioral survey of spouses in cohabiting heterosexual relationships in Kigali, Rwanda.

Design: Cross-sectional survey.

Methods: Husbands and wives in 779 cohabiting couples were interviewed separately with parallel questionnaires. Participants were recruited from a three-year old cohort of 1458 antenatal clinic attendees enrolled in a prospective study in 1988. Analyses compared responses at the gender- and couple-level for agreement and disagreement.

Results: Couples were in disagreement more than agreement. Women reported occasionally refusing sex, suggesting condom use, and believing married men were unfaithful. Men reported being in a faithful relationship, greater condom use, and being understanding when his wife refused sex. Agreement included relationship characteristics, safety of condoms, and whether condoms had ever been used in the relationship. Disagreement included the preferred timing of next pregnancy, desire for more children, and whether a birth control method was currently used and type of method.

Conclusions: Rwandan husbands and wives differed in sexual behavior and reproductiverelated topics. Couple-level reporting provides the most reliable measure for relationship aspects as couples’ agreement cannot be assumed among cohabiting partnerships. Furthermore, HIV prevention programs for couples should incorporate communication skills to encourage couple agreement of HIV-related issues.

Keywords: HIV, couples, counseling and testing, agreement and disagreement, sexual behavior, condom use, and pregnancy

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