Abstract
Poor marital satisfaction is associated with high-risk sexual behavior and HIV transmission. We tested whether a counselor-led couple education and counseling intervention dubbed Waya (paternal aunt) would improve marital satisfaction and reduce HIV risk behavior among married couples in Kisumu County, western Kenya. In a pre–post design, we enrolled 60 heterosexual married couples at high risk for HIV to undergo five 1-h couple education and counseling sessions over 56 days. We collected self-reported data on marital satisfaction, the number of sex partners, and condom use with extramarital partners at pre- and post-intervention visits. We used Wilcoxon and McNemar tests to examine the association of our intervention with marital relationship satisfaction and reduction in HIV risk sexual behavior. The intervention was associated with marital relationship satisfaction score improvement from a median of 5 (interquartile range [IQR], 4–5) to 6 (IQR, 6–7) among men and 4 (IQR, 3–5) to 6 (IQR, 5–6) among women (p < .01). The intervention was also associated with reducing HIV risk sexual behaviors depicted by a reduction in the number of sex partners in the past one month and an increase in consistent extramarital condom use. The number of sex partners reduced from a median of 2 (IQR, 1–2) to 1 (IQR, 1–2) and consistent extramarital condom use increased from 4% at baseline to 56% among men. Our intervention was associated with improvements in marital relationship satisfaction and reductions in HIV high-risk behaviors necessary for achieving epidemic control in HIV hotspots such as fishing communities in western Kenya.
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Data Availability
All datasets used for this manuscript are available from the corresponding author on reasonable request.
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Acknowledgements
We wish to acknowledge the following for their support and leadership that enabled the study to be conducted: (a) Director General, Kenya Medical Research (Nairobi) and; (b) Director, Centre for Microbiology Research (Nairobi). We thank the officials of all Beach Management Units that we worked with for their support. We would also like to acknowledge the hard work of Sexual Concurrency Study staff: David Ang’awa, Paul Ochieng, Mercy Ogolla, and Bernard Dago as well as our sister projects under Research Care and Training Program. In a special way, we thank all married couples from fishing communities in Kisumu County who took the risk and volunteered to participate in our study.
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Funding support this study was obtained from University of Washington’s Center for AIDS Research Mentored International Investigator Award (Grant#P30 AI027757).
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ZK wrote the first draft of the manuscript and modified subsequent drafts based on other authors’ comments and was also involved in the analysis and interpretation the results. CD, CF, and CM were involved in data analysis, interpretation, and review of the manuscript. JT provided technical assistance during the analysis, interpretation, and writing of the manuscript. EB and JB reviewed the manuscript for intellectual content and scientific integrity. All authors have read and approved this manuscript for publication.
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This study was reviewed and approved for implementation by Kenya Medical Research Institute’s Scientific and Ethics Review Unit (SSC#2877) and University of Washington Human Subjects Division (#CR00001149). All participants provided informed consent to participate in the study. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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Kwena, Z.A., Bukusi, E.A., Turan, J.M. et al. Effects of the Waya Intervention on Marital Satisfaction and HIV Risk Behaviors in Western Kenya: A Pre–Post Study Design. Arch Sex Behav 51, 3689–3701 (2022). https://doi.org/10.1007/s10508-021-02180-9
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DOI: https://doi.org/10.1007/s10508-021-02180-9