Dyadic analyses of relational processes among Mozambique couples

Matthew A. Diemer, Ph.D., Professor of Psychology and Professor of Education at the University of Michigan received an MRI grant to examine relational processes more closely and deeply in couples (i.e., male partner processes impacting female partner processes, and vice versa) in Mozambique, via a dyadic structural equation modeling (SEM) approach. The crux of their HIV intervention in Mozambique, called HoPS+, is involving male partners in the treatment and testing process of their HIV-infected female partner, in order to foster adherence to antiretroviral medications as well as prenatal care. These efforts were undertaken to interrupt mother-to-child transmission of HIV, as well as to foster maternal health via adherence to antiretroviral medications.

To pursue these aims, Dr. Diemer repurposed existing measures of partner support, trust in medical professionals, and internalized HIV stigma – which were developed and validated in North America – to the Mozambican context. These measures were selected because Dr. Diemer hypothesized they, along with partner empathy, are likely important mediators of the relationships between the HoPS+ intervention (which emphasizes male partner involvement) and key child and maternal health outcomes. Because Mozambique has one of the highest rates of HIV infection in the world, this work holds the potential to address this critical problem.

The questions (measuring partner support, trust in medical professionals and internalized HIV-related stigma) were examined among a sample of 967 couples (1937 individuals) across 24 clinics in Mozambique.  The analyses were undertaken to best understand how these relational processes may mediate the impact of their HoPS+ field experiment upon maternal and child health outcomes (e.g., HIV status, viral load, antiretroviral therapy adherence). As of this writing, the project team is using the dyadic modeling strategy in order to most precisely model how the HoPS+ intervention impacts these mediators (e.g., partner support, trust in medical professionals, empathy and HIV stigma), which in turn are linked to these health outcomes. 

The project insights may inform clinical practice by (a) suggesting the importance of male partner involvement in HIV treatment and prenatal care, (b) provide analytic approaches to most precisely estimate how couples-based interventions impact downstream health outcomes, and (c) how negative or problematic male partners may disrupt HIV treatment and prenatal care for HIV-infected women.