The burden of HIV in stable relationships places emotional, economic and physical stresses on families. We compared the influence of HIV notification on marital partnerships in northern Thailand among a cohort of HIV discordant couples, and identified factors associated with marital disruption. Data were collected using in-depth interviews with both members of six separated or divorced couples and 13 couples whose relationship remained intact. Five factors influenced marital stability following HIV notification: longer duration of relationship; economic constraints, extended family members' opinions, especially parents; the existence of children from the marriage; and fear of stigmatization by community members. Social influences, both overt and perceived, are important in shaping marital behaviour and decision-making in HIV epidemic areas. HIV counselling needs to be extended beyond the individual seeking testing to include stable partners (and perhaps further, to include the extended family), although it is recognized that this is not the norm for most HIV testing centres.
PIP: This study investigates the factors influencing marital stability among HIV discordant couples in northern Thailand. The influence of HIV notification on marital partnerships was compared between 6 separated or divorced couples and 13 couples whose relationship remained intact after positive HIV diagnosis of the husband through in-depth interviews. An ethnographic field guide was used in the interview, which addressed premarital background, marital relationships, and changes in the spousal relationship following notification of the husband's HIV test results. The results indicated that 5 factors influenced marital stability following HIV notification: 1) a longer duration of relationship; 2) economic constraints; 3) opinions of extended family; 4) presence of children; and 5) fear of stigmatization by community members. Separation and divorce usually occurred in short-duration, childless marriages and among high-income women. The findings suggest the need for culturally fitting HIV prevention and counseling programs with both the infected individual and his partner.