Couples Counseling Key to HIV Prevention and Maternal Care

“I’ve done a lot of couples-based interventions to focus on improving relationship quality and things like communication skills,” noted Lynae Darbes, PhD, professor, School of Nursing, University of Michigan, and a clinical psychologist by training, “in the thinking that this can then ultimately influence and improve health related behaviors.”

Darbes, whose work primarily focuses on HIV prevention and treatment in South Africa and Kenya, presented “Efficacy of Home Visits for Pregnant Couples to Promote Couple HIV Testing and Family Health,” at the 2025 Conference on Retroviruses and Opportunistic Infections.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What are key takeaways from your research into couples interventions for HIV prevention and maternal health?

There’s been a lot of work over the years on antenatal care and how to improve it, especially in contexts like Kenya, and there's been a lot of improvement in terms of the HIV field and antenatal care for women living with HIV. But there still remains some areas of challenge.

One of the aspects, given what I said about working with couples, is that people have been saying, how do we involve men? Having men involved often results in improved outcomes for women, for lots of reasons. Men have a lot of influence in family decision-making, in supporting women to be able to do things like make it to their antenatal care appointments, things like that. Wanting them involved is one thing, but getting them involved is another, so that's often been shown to be a challenge.

We wanted to focus on couples-based testing for HIV, because that has been demonstrated over years to be very effective. Because when couples participate in testing for HIV together, mutual disclosure happens, so both partners know their HIV serostatus. But also what happens is the counseling is tailored based on those results—so if the couple is found out to be both living with HIV, they can get tailored guidance around treatment strategies. If the couple is found to be a serodiscordant couple, where one partner is living with HIV and the other is not, they can get tailored communication and guidance around how to keep the partner who's not living with HIV to not be infected, as well as to get the person living with HIV into treatment, etc.

It's a really effective strategy, but the problem is, uptake remains low, and when we talk to people about couples testing, one of the things we hear is that, “Yes, we think it's important,” but it's kind of scary for people; they don't want to perhaps disclose their status because of perceived or adverse consequences from disclosing them living with HIV. Then we also hear things from especially male partners, about, “I want to be involved. I want to talk about HIV. HIV is very important, but I don't know how to talk about it.” There's been some work over recent years about how we can get couples to engage in couples testing even though it's a bit of a challenge.

The original idea for this project actually came from a Kenyan colleague of ours. His name was George Owino, and he was a long time HIV counselor in this area of Kenya and in Nyanza province, and he really wanted to get male partners involved. He said we should do a study where we work with couples. He had been working in this area for a long time, and so he was actually the inspiration. He thought that a couples-based approach could engage men. He was actually the first project director on this on this project, and sadly, he passed away a few years ago. So those of us who are continuing to work on this project really are honoring him.