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LETTER TO EDITOR
Year : 2022  |  Volume : 27  |  Issue : 1  |  Page : 82

Sharing medical adherence responsibilities together: An approach for promoting responsibility and solidarity in human immunodeficiency virus serodiscordant couples


1 Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Midwifery, School of Nursing and Midwifery; Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Submission02-Feb-2021
Date of Decision26-Apr-2021
Date of Acceptance04-Oct-2021
Date of Web Publication25-Jan-2022

Correspondence Address:
Prof. Robab Latifnejad Roudsari
Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnmr.ijnmr_19_21

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How to cite this article:
ML, Roudsari RL. Sharing medical adherence responsibilities together: An approach for promoting responsibility and solidarity in human immunodeficiency virus serodiscordant couples. Iranian J Nursing Midwifery Res 2022;27:82

How to cite this URL:
ML, Roudsari RL. Sharing medical adherence responsibilities together: An approach for promoting responsibility and solidarity in human immunodeficiency virus serodiscordant couples. Iranian J Nursing Midwifery Res [serial online] 2022 [cited 2022 Dec 7];27:82. Available from: https://www.ijnmrjournal.net/text.asp?2022/27/1/82/336433



Dear Editor,

The Human Immunodeficiency Virus (HIV) serodiscordant relationship refers to mixed-status and condition in which one of the partners is HIV positive, while the other is HIV negative. It is anticipated that 75% and 37% of serodiscordant couples are living in countries with low and high HIV prevalence, respectively. They play a significant role in preserving the global HIV epidemic through sexual contacts.[1] There is a strong tendency towards conducting studies on HIV prevention that address couples as a unit for changing behaviors and interventions.[2],[3] There are two general strategies of service delivery in serodiscordant couples, including biobehavioral and biomedical categories, with emphasis on couple-based strategies.[3] SMART Couples, which stands for Sharing Medical Adherence Responsibilities Together, is a biobehavioral and couple-based approach for discordant couples with inadequate medication adherence in the HIV-positive partner. This approach educates couples about the significance of compliance to reduce viral resistance. The intervention involves cognitive-behavioral elements to identify barriers, promote healthy behaviors, and employing problem-solving techniques to identify and address adherence barriers.[4] Training on the importance of adherence to prevent viral resistance, health maintenance, recognition of non-adherence patterns, and increasing mutual social support for good health outcomes are core components of it. SMART Couples sessions for partners are better provided by a certified social worker or therapist, HIV case manager, health educator, or a nurse with experience of dealing with a dyad couple.[4],[5]

The couple-based approaches in the service delivery process that emphasize healthy lifestyles, behavioral changes, and mutual supports can have positive consequences for the individual, newborn, family, and community. These approaches provide a context for couples to recognize their mutual responsibility to protect each other from transmitting HIV and to maintain each other's health. It also creates a safe environment to discuss sensitive issues such as sexual relationships using negotiation skills. It should be noted that for the effective implementation of couple-based approaches in real-world contexts, a cultural shift from focusing on individuals to dyad couples is needed, as well as the emphasis on addressing existing organizational and financial barriers.

Financial Support and Sponsorship

Research Deputy, Mashhad University of Medical Sciences, Mashhad, Iran

Conflicts of Interest

Nothing to declare.



 
  References Top

1.
Larki M, Bahri N, Moghri J, Latifnejad Roudsari R. Living with discordance: A qualitative description of the challenges faced by HIV negative married women. Int J Community Based Nurs Midwifery 2020;8:103-15.  Back to cited text no. 1
    
2.
El-Bassel N, Wechsberg WM. Couple-based behavioral HIV interventions: Placing HIV risk-reduction responsibility and agency on the female and male dyad. Couple Family Psychol 2012;1:94.  Back to cited text no. 2
    
3.
Jiwatram-Negrón T, El-Bassel N. Systematic review of couple-based HIV intervention and prevention studies: Advantages, gaps, and future directions. AIDS Behav 2014;18:1864-87.  Back to cited text no. 3
    
4.
CDC. Sharing Medical Adherence Responsibilities Together. 2020. Available from: https://www.cdc.gov/hiv/pdf/research/interventionresearch/compendium/ma/cdc-hiv-smartcouples_ma_good.pdf. [Last accessed on 2020 Nov].  Back to cited text no. 4
    
5.
Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, et al. Couple-focused support to improve HIV medication adherence: A randomized controlled trial. Aids 2005;19:807-14.  Back to cited text no. 5
    




 

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