COUPLE COMMUNICATION, SEXUAL COERCION AND HIV RISK REDUCTION IN KIGALI, RWANDA

Objectives: To describe sexual interaction and HIV-related communicati on in Rwandan couples and to examine their relationship to HIV testing and condom use.Study design: Cross-sectional survey of a longitudinal cohort. Methods: In 1988, women recruited for an epidemiological stud y of HIV, and interested male partners, received confidential HIV test ing and counseling. Two years after enrollment, 876 women reporting on e steady partner in the past year completed a questionnaire addressing sexual and HIV-related communication, sexual motivation and violence in the partnership. Results: Men control sexual decision making, and c oercive sex and violence between partners is not uncommon. HIV-positiv e women were more likely to report coercive sex and less likely to hav e discussed their test results with their partner. Women with HIV-posi tive partners were more likely to report being physically abused. Cond om use was more common if the man had been previously tested, and if w omen reported discussing or negotiating condom use. HIV-negative women with untested or seronegative partners were the least likely to use c ondoms or to discuss or attempt to negotiate condom use. Conclusions: Participation of the male partner is crucial for successful HIV risk r eduction in couples. HIV testing and counseling of couples has benefic ial long term effects on condom use and HIV-related communication. Cou ple communication is associated with condom use, but only when the dis cussion is specific (sexually transmitted disease risks and using cond oms). Seronegative women with untested partners are at increased risk for HIV as they are the least likely to discuss or attempt to negotiat e condom use.