Serodiscordant Relationships Examined in Doctoral Research

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UKZN part time Psychiatry Lecturer Dr Sibongile Mashaphu’s research focuses on the psychological impact of living in an HIV serodiscordant relationship – where one partner is HIV positive and the other is negative.

Mashaphu’s research forms part of her PhD study titled: “Serodiscordant Couples”.

Her interest in HIV and Mental Health dates back to her registrar days at Townhill Hospital in Pietermaritzburg, during which time she completed her Master’s degree. Her research then focused on the prevalence of HIV in patients who were admitted at the hospital for the first time, discovering in her study that people with mental illnesses were more affected by HIV than the general population.

In 2006, Mashaphu joined Prince Mshiyeni Memorial Hospital as Clinical Head of Department of Psychiatry, leaving in 2010 to pursue a private practice on a full time basis where her interest in research and academia grew stronger.

She re-joined the Department on a part-time basis as Lecturer and consultant, with HIV and Mental Health as her major areas of focus and expertise.

In private practice, Mashaphu dealt with serodiscordant couples battling with depression and anxiety.

‘This couple type is a challenge both for the couple as well as the health care providers because these relationships are often riddled with stress, anxiety, fear and concern,’ she said.

She said some of the most disturbing challenges of existing in a mixed status relationship were physical violence, sexual abuse, emotional abuse, fear of contracting or transmitting the virus, concerns about child bearing, and caring for the infected partner and anticipated grief.

Mashaphu said at some point people who were HIV negative were going to make a choice to enter into a relationship with someone already living with HIV. According to Mashaphu, these couples should be offered the right sort of counselling to promote a healthy relationship.

She said the focus had now shifted from HIV as a death sentence to a positive outlook of a chronic condition which can be successfully managed by a combination of health interventions.

‘My concern with most HIV related counselling interventions is that they focus more on the individual at risk but sexual transmission of HIV frequently occurs in the context of a primary relationship between two partners. So my approach would be to focus on the couple as a unit of change.’

In September last year, Mashaphu was awarded a scholarship to spend three months at UCLA in the United States studying a specific programme on how to conduct group and couple therapy for people living in serodiscordant unions.

‘This intervention has been used successfully in HIV heterosexual African-American couples in two geographic areas of Los Angeles that have a high prevalence of HIV infection to reduce the transmission of HIV and to improve physical and psychological wellbeing,’ she said.

She has been using the experience that she gained from that programme to help address some of the unique psychological, physical and other health needs of the HIV serodiscordant heterosexual couples she treats in her practice.

‘I believe this type of intervention should be made available to all couples both in the private and public sectors. In addition to the psychological benefits of this intervention, it has also been shown to reduce high risk behavior and the transmission of HIV within these couples, which is a desirable outcome.’

She has submitted a research protocol to the UCLA Review Board to study the implementation, effectiveness and the feasibility of this intervention within the South African context and is awaiting full approval.

‘According to my literature search, this type of study is novel in South Africa,’ added Mashaphu.

Nombuso Dlamini