Making the case for joint decision-making: the influence of partner preferences on future dual prevention product use

BACKGROUND: Research on novel HIV prevention methods in sub-Saharan Africa has often focused on women due to their increased risk of HIV. However, relationship considerations, such as lack of male partner support, may be important barriers to women's product uptake and adherence.
METHODS: The MTN-045/CUPID study assessed preferences for future dual-purpose HIV and pregnancy prevention (DPP) products among 400 heterosexual couples in Uganda and Zimbabwe, to inform the product development process. A purposive sub-sample of couples (female partners aged 18-40 and HIV-negative) completed in-depth interviews (IDIs). Couples represented a range of relationship durations and communication patterns (evaluated by trained observers). IDIs explored relationship dynamics, preferences for DPP products, and partner influences on preferences. Key themes were documented in debriefing reports and analyzed using the Framework Method, stratified by individual (a comparison of separate male and female partner reports) or joint interview mode and communication patterns.
RESULTS: Among 39 couples, 20 male and female partners were interviewed individually and 19 jointly, with 13 classified as male-dominated, 12 female-dominated, and 14 equal communicators. The average relationship length was five years. Regardless of observed communication pattern, the majority of couples described a process of joint decision-making with greater emphasis on women's attribute preferences. 'Male-dominated' couples interviewed individually frequently expressed contradictions in how decisions were made and whose influence dominated. A desire to have positive communication, as well as greater satisfaction in their ultimate choice of products and attribute characteristics, was cited by most female-dominated and equal contribution couples interviewed jointly, as rationales for shared decision-making. Women held more sway when product characteristics would impact their body (e.g., side effects), while men's preferences held more importance when attributes (such as impact on menses) may also affect the couples' sexual experience.
CONCLUSIONS: The inclusion of couples in DPP preference studies is novel and offers an opportunity to understand how relationship dynamics impact prevention choices and decision-making. Most men supported their female partner's decisions regardless of the couple's communication style. Therefore, engaging men in DPP decision-making offers an opportunity to create a dynamic whereby men can support women's product preferences without dominating their decisions.