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The University of Southampton
University of Southampton Global Health Research InstituteResearch

Relationship dynamics and health in South Africa

Our Wellcome Trust funded research explores sexual behaviour and relationship dynamics in the era of HIV treatment and tests couples-based interventions to reduce HIV transmission.

Partners have a significant influence on each other’s health, and similarities in health behaviours increases with union duration, potentially making couple-focused interventions for health behaviour change more effective than individual interventions. Nuala McGrath conducts dyadic analyses of couples data from Africa and the UK, has conducted a systematic review of interventions of health behaviour change for couples, and examined the protective effect against mortality of being in a couple for men and women in South Africa.

Exploring sexual behaviour and relationship dynamics in the era of antiretroviral treatment (ART) rollout in South Africa
Exploring sexual behaviour and relationship dynamics in the era of antiretroviral treatment (ART) rollout in South Africa

How sexual behaviour has changed

Professor Nuala McGrath's primary research examines how sexual behaviour has changed with the availability of ART, how it continues to facilitate the onward transmission of HIV, and how sexual health practices contribute to HIV infection. Her research (prospective studies and secondary analyses) has shown that sexual risk behaviours in the general population have not increased as a result of treatment rollout; neither have they increased among people living with HIV.

Expanding treatment criteria

With the expanding treatment eligibility criteria for ART globally, repeated HIV testing and linkage to care has become ever more important if the HIV epidemic is to be eliminated. In this context, Professor McGrath currently contributes to three important HIV prevention trials.

The 3 HIV prevention trials:

  1. a 'Treatment as Prevention' (TasP) Trial, funded by a French national research agency on 'HIV and viral hepatitis' (ANRS) (mentioned above)
  2. 'Project Accept' (HPTN 043), which is a large cluster-randomised trial among 48 communities in Africa and Thailand, funded by a US National Institute of Mental Health
  3. The first couples-based intervention/randomised controlled trial to have couples HIV counselling and testing (CHCT) as its outcome (Uthando Lwethu), funded by the US National Institute of Health.
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