Duration: 4 min
KHOPOTSO: It reminds me of those invitations where the card reads, almost menacingly: ‘Strictly couples.’ Not anyone can walk into the Tshwarisanang Centre for Couples’ Counselling and ask for an HIV test. You have to be accompanied by your partner. This is a new exploratory programme aimed at encouraging people to know their status. But what is the thinking behind the concept of couples’ counselling? Gavin Robertson is a psychologist at the Tshwarisanang Centre.
GAVIN ROBERTSON: Most of transmissions, especially now in Africa, are happening between couples and particularly in stable relationships, because people are not aware sometimes, that one partner is HIV positive; or they assume that because they are HIV positive that the partner is also HIV positive; or they assume that because they’re negative the partner is negative or vice versa. So, discordancy ‘ having one person negative and one positive in a long-term stable relationship seems like a mystery to most people. And it is, because we don’t actually have an explanation for how this happens. Essentially, what we’re trying to do is help protect both partners and protect the relationship.
KHOPOTSO: Yes, there is no explanation as to why one person can be infected and the other uninfected in a relationship. But then of course, there are theories around that. What are these theories that actually go around?
GAVIN ROBERTSON: Well, there’s a lot of different theories. And a lot of them are also myths because some people feel that because they are positive and their partner is negative, perhaps the negative partner is somehow immune or cannot contract the disease, which is not exactly true because they can contract it at a later date. So, we need to be able to protect that partner. Just because they haven’t become infected up to this point does not mean that they necessarily will stay uninfected. We have to be very careful about those kinds of myths.
KHOPOTSO: Studies have been conducted among sex workers in Uganda, which suggest that some communities are not susceptible to HIV, regardless of their high-risk profile. But still, there is no conclusive evidence to support the suggestion. Since it opened doors two months ago at the beginning of June, the Tshwarisanang Centre for Couples’ Counselling, a project of Wits University’s Peri-natal HIV Research Unit at Chris Hani Baragwanath Hospital in Soweto, has seen 75 couples to date. Numbers are expected to increase over time. Naka Sibeko is one of three counsellors at the centre.
NAKA SIBEKO: There are dynamics when dealing with couples’¦ It really goes beyond just doing pre and post-counselling. It is very much important to emphasise risk reduction to your clients, to say: ‘This is the situation. You are both HIV positive.’ Most of the people believe that if they are both HIV positive there is no need for them to use a condom, because ‘hey, why do we have to do that because already we are HIV positive?’ – not knowing that if they are not going to use a condom they will be re-infecting themselves.
For people who are both HIV negative, because people think if you have tested negative, you are going to stay negative. They will start sleeping around and everything. For people who are discordant, it is very much important for you again to emphasise the issue of risk reduction for the other one to remain HIV negative’¦ and positive living, accepting the situation.
KHOPOTSO: Acceptance of the situation by couples, says psychologist Gavin Robertson, is one of the main focal points of the project.
GAVIN ROBERTSON: What we try and do is reduce any blame that happens in a situation to an absolute minimum because as soon as one person in the relationship starts blaming the other that blame leads to a decrease of their own power because they no longer feel that they can do something about the situation’¦ Our whole focus is on what to do about the situation now because you don’t know where it came from; and you don’t know when that person became infected ‘ in a previous relationship, or whatever the case is. We can’t work that out now. What we need to deal with is how best to work this relationship at this moment and protect both people in the relationship. So, we avoid any blame and deal with a focus on responsibility in the relationship.
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