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Am J Public Health. 2014 Apr;104(4):612-20. doi: 10.2105/AJPH.2013.301670. Epub 2014 Feb 13.

Importance of relationship context in HIV transmission: results from a qualitative case-control study in Rakai, Uganda.

Author information

At the time of data collection and analysis, Jenny A. Higgins, Sanyukta Mathur, Elizabeth Eckel, Laura Kelly, and John S. Santelli were with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY. At the time of article preparation, Jenny A. Higgins was with the Department of Gender and Women's Studies, University of Wisconsin-Madison. Neema Nakyanjo, Richard Sekamwa, Josephine Namatovu, William Ddaaki, Rosette Nakubulwa, and Sylvia Namakula are with the Qualitative Research Section, Rakai Health Sciences Program, Kalisizo, Uganda. Fred Nalugoda is with the Kalisizo Field Station, Rakai Health Sciences Program, Kalisizo, Uganda.

Erratum in

  • Am J Public Health. 2014 Aug;104(8):e6. Kelly, Laura [corrected to Kelley, Laura].
  • Erratum. [Am J Public Health. 2016]


We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health.

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