Couple Decision Making Regarding Couple HIV Testing and Counselling (CHTC) in Rural Lilongwe, Malawi

Purpose:In Malawi, about 80% of new HIV infections occur among partners in stable relationships.The large number of new HIV infections occurring in couples, pose a great challenge to public health and justifies the need to go beyond individual-level models of HIV prevention to couple-level models. The purpose of this qualitative study was to understand and describe the couple’s decision making processes and experiences with couple HIV testing and counselling during the prenatal period. Method:This study took place in a rural antenatal clinic of Lilongwe district, Malawi. A qualitative grounded theory approach was used, with simultaneous data collection and analysis. Individual in-depth interviews were conducted with 20 couples presenting for HIV testing, resulting in 40 participant interviews. Results:We identified two distinct patterns of decision making for couples who attend antenatal clinics:decided and undecided couples. The deciders (16 couples) signifycouples who considered their decision to test for HIV at home prior to attending the antenatal clinic while the undecided couples (3 couples) signify couples who did not consider HIV testing at home before attending the clinic. The two decision patterns are categorized in three main steps: initiating a conversation, deliberating and reaching an agreement. Fears, responsibility for male partner, intimacy and policy acted as motivation for couples to consider HIV testing. On couple’s experiences, thirteen couples described positive feelings with group HIV pretest counselling while seven couples identified challenges to the group model. Most couples described their experiences as beneficial and informative, giving them knowledge that instilled confidence and encouraged them to go ahead with HIV testing decisions. However, some couples felt that their right to privacy was violated; some sessions were rushed through giving inadequate information to couples; and that group members paid less attention to some issues in a group setting. Implications:Couple decision making regarding HIV testing in antenatal clinics is informed by the diverse needs of couples. This calls for more community outreach programs to raise awareness of the existing services. Group pretest counseling for couples contemplating HIV testing needs to be more sensitive to privacy needs for some couples.