Phases of Adjustment of Couples Living with Human Immunodeficiency Virus Serodiscordance and the Role of Seronegative Partner: A Qualitative Study in Parakou, Benin

Introduction: HIV serodiscordance remains largely unknown to both the general public and healthcare professionals not directly involved in HIV response efforts. Three out of four infected couples are affected by this issue. This study aims to explore the adaptation process of serodiscordant couples, identifying the key stages of their journey and highlighting the central role of the seronegative partner in this dynamic. The objective of this study is to describe the adaptation process of these couples to their discordant status by outlining the stages of this adaptation and the role of the partner in this process. Study Setting and Methods: This study was conducted at HIV care sites in the city of Parakou, located in northeastern Benin. It was an exploratory qualitative study involving three target groups: people living with HIV (PLHIV) engaged in serodiscordant relationships, their seronegative partners, and resource persons involved in the care and support of serodiscordant couples. Through semi-structured face-to-face interviews, data were collected from fifteen participants (10 PLHIV and their partners, and 5 resource persons) in order to construct an adaptation model. This model was then tested on other participants (PLHIV and their partners) for refinement until saturation was reached, which occurred after 25 interviews. Results: The key stages of adaptation for couples in HIV serodiscordant relationships include: emotional reactions to the discovery of the couple’s discordant status, questioning, redefining the terms of the union, and reaching a bilateral agreement. These stages are preceded by the sharing of respective serological statuses, which marks the entry into serodiscordance. As for the pivotal role of the seronegative partner in the adaptation process, it is crucial. The seronegative partner alone bears the responsibility for initiating and guiding the adaptation process. Conclusion: A successful adaptation of couples to their discordant status ensures the stability of the relationship, better adherence to antiretroviral therapy (ART) by the infected partner, and improvement in their health and well-being. This process needs to be better supported, with the systematic involvement of a psychologist, particularly emphasizing the seronegative partner, who bears almost sole responsibility for the adaptation process.