Exploring marital safety: three South African wives living with HIV in nonmutual monogamous marriage

Abstract

For wives who have been sexually monogamous, their being infected with HIV disrupts the cultural assumption of sexual safety in marriage. This phenomenological interview study shows how three married South African women, who were diagnosed with HIV and had reported being monogamous, experienced gendered distress while contemplating the failures of married coupledom in offering safety and familial stability. Constructionist thematic analysis showed three themes to represent changes in the marital unit. The first theme, HIV as Demarcation of Enduring Disruption, pointed to infection as the harbinger of distressing relational dynamics. The second theme, Feeling Controlled, reflected domains in which the wives felt trapped: restricted freedoms and obligatory intimacy. The third theme, Relational Deterioration, showed meanings about infidelity, fights or arguments, and distress about partner disengagement. Highlighted in this analysis is that, for two women, male control and disempowerment after having been infected with HIV added to their experiences of feeling trapped because they felt pressured into regressing into subservient spousal roles. They were required to retreat into household, mothering, and child care duties. The study’s practice implication is that, to address the aftermath of the discovery of HIV infection in heterosexual married couples, wherein sexual monogamy remains the unquestioned norm, health psychology and clinical interventions should incorporate a gendered approach in counselling formulation.

Heterosexual marriage positions the wife as invulnerable to HIV infection (Ribeiro et al., 2021), but it can become a risk space when cultural intersections of gender and sexuality accord extradyadic ‘allowances’ to husbands. Even if partner infidelity is suspected, the wife cannot initiate condom use. In marriage, monogamy is idealised in the dominant social frame of sex and romance occurring within what has been termed ‘committed relationship ideology’ (Day, 2016, p. 349). However, these perceptions of safety can be gendered. As a Zimbabwean study (Chireshe & Chireshe, 2011) showed, more men, compared to women, perceived marriage to be safe from HIV. An Indian study supported this view, noting that monogamous wives’ perceptions of risk were embedded within social norms of gender roles (Newmann et al., 2000). In other words, the marriage ideology differentiates gender roles.

Wives may be aware of their partner’s extradyadic sex, as shown in a randomised clinical trial in Malawi where, in follow-up interviews, wives expressed worry about sexual fidelity because of married men’s concurrent relationships (Chapola et al., 2021). In south India, monogamous wives knew their husbands had multiple sex partners, but they could not negotiate condom use because this implied a lack of trust where the male head of an Indian household is considered blameless for sex outside of marriage (Varma et al., 2010). The danger is that HIV infection is not anticipated to be a risk, leading a husband’s primary monogamous sex partner to be left with delayed discovery of infection (Ribeiro et al., 2021). Such threats to sexual health get eclipsed by the ideology of commitment and trust. Sobo (1995) established that not using condoms is a social strategy that situates women within conjugal ideals. Mucosal sex is therefore symbolic of relationship stability, love, trust, and fidelity (Kyomugisha, 2006; Sobo, 1995) – investments that override the rational appeals of safe(r) sex campaigns.

Lack of knowledge of HIV transmission also puts wives in subordinated positions, a likely situation of marriage in the Global South. Interviews done with infected wives in Iran (Kalateh Sadati et al., 2019) and Indonesia (Ernawati et al., 2019) showed wives held incorrect or no health information. Investments in the roles of wife and mother took precedence over the impact of health information. Because of stigma in religious communities, infected wives in Ernawati et al.’s (2019) phenomenological study resorted to social avoidance, and those in Kalateh Sadati et al.’s (2019) focus group study became socially marginalised. So severe was the community branding for wives infected by husbands in Iran that they feared being given ‘the label of harlotry in the public’ (Kalateh Sadati et al., 2019, p. 3). Such stigma and wives’ (initial) lack of knowledge of HIV infection were also found in India in De Souza’s (2010) qualitative investigation of narratives of two widows infected by their late husbands. Standing out in these narratives was how, by assuming the roles of ‘moral agents, role models, and advocates’, they resisted their oppression as women, as widows, and as being HIV positive in Indian culture (De Souza, 2010, p. 251).

Thus, a woman’s adherence to coupledom, wherein she is in a subordinate position, shows the rigidity of the heterosexual couple configuration. The traditional script informing this social institution (Roseneil et al., 2020) is called into question when a husband transmits HIV to a monogamous wife, yet wives are blamed when husbands have sex with someone other than them. Women are rebuked for being unable to meet the sexual needs of their husbands.

Consequently, wives are the victims of stigma, whether they are widowed or whether they continue living with husbands who are infected with HIV (Ernawati et al., 2019; Kalateh Sadati et al., 2019; Subramoney, 2015). Research has therefore investigated women’s psychological experiences of being infected by male partners (Stevens & Hildebrandt, 2006) and their sociocultural and existential concerns when living with an HIV diagnosis (Subramoney, 2015). Subramoney’s (2015) phenomenological investigation stands out in South Africa for it demonstrated how impoverished minority Indian women living with HIV, after their intimate relationships had ended, needed to then contend with social isolation and fear of stigma. Gendered roles and their place in a relationship ideology shape wives’ psychological experiences after having been infected with HIV by their husbands. Studying these consequent interpersonal dynamics within the married couple after wives have discovered their being infected with HIV can inform sexual health interventions on individual and dyadic levels, for example. This health care problem needs situatedness within patriarchal constructions of the marital unit where wives’ needs and exposure to health risks may be sidelined by husband’s concurrent multiple sex partnering.

Method

Following HIV research findings that put into question the ideology of marriage as safe, this study aimed to describe, as conceived by the female spouse, the changes in married coupledom after she had tested positive for HIV. We pay attention to how married coupledom gets interrogated, putting into question the relational, rather than (already disrupted) sexual safety. The research question is:

• RQ. What are the relational dynamics in the marital unit for monogamous married women after they test positive for HIV?

Participants

Inclusion criteria for participation were: 18 years and older, legally married, self-reported sexual monogamy, and testing positive for HIV since the date of that marriage, and a self-report of having tested negative for HIV either prior to getting married or prior to sexual contact with husbands. The first author distributed a standardised information sheet containing study details via email or through personally delivered hard copies to health professionals at accessible public clinics and hospitals, private medical centres, and a wellness centre at a company, all located in two provinces in South Africa. The sites were preidentified as convenient locations to ask the health professionals there to give the information sheet to potential participants. Potential participants, if interested, contacted the first author telephonically, providing personal information about the criteria which, if met, was followed by them being invited to volunteer to be interviewed face-to-face. Three women agreed and were allocated identifiers (P1, P2, and P3).

Participants (mean age = 40 years) were married under civil union. According to South African race classification, they were Black. They were on antiretroviral therapy at the time of the interviews. P1, married for 7 years, had tested positive for HIV during an antenatal clinic visit, was living with HIV for 4 years, and resided with her husband and two young children. P2 was married for 14 years, and testing positive for HIV occurred after the first two of three children. Having tested positive for HIV 9 years prior to the interview, she reported receiving this result while pregnant with the third child and that the HIV-test results for first two pregnancies were ‘alright’, thereby inferring she was negative upon getting married. When asked for confirmation, her answer was in the affirmative that tests during the first two pregnancies were negative. P3 had been living with HIV for 4 years, was married for 4 years, and did not have children with her husband but reported that each of them had a child from previous relationships. P3 tested positive for HIV during routine screening in her workplace. She reported she regularly screened for HIV there and had exercised safe sexual practices before meeting her husband, thereby confirming she had received a negative HIV-test result before meeting him.

Procedure

Seidman’s (2006) in-depth sequential procedure of three interviews was used. This required that the first phase focus on personal history to contextualise the topic within the interviewee’s biography. Phase two focused on concrete aspects of the lived experience. In the third phase, participants reflected on the meanings of those lived experiences; that is, they described intellectual and emotional connections to their being diagnosed HIV positive in a reported nonmutually monogamous marriage. Seidman (2006) emphasises adhering to the three-interview structure but allows for variations. At two participants’ requests, because of their availability, we combined phases so they could be interviewed on fewer than three occasions. Interviews were audio recorded, transcribed verbatim, and translated from isiZulu to English.

Ethical considerations

Participants provided informed consent. The study received ethical clearance from the Faculty of Humanities Research Ethics Committee at the University of Johannesburg in South Africa (approval no. 02-028-2016). Data were deidentified.

Data analysis

Thematic analysis as a method, supplemented by a constructionist element in the interpretive process, was used (Braun & Clarke, 2006). Generic inductive and data-driven procedures included rereadings of each data item or interview, highlighting data extracts to address the research question in each data item, coding these segments by assigning brief labels to them, sorting the common codes, organising these codes into groups with workable labels, reviewing these as themes and subthemes to ensure they represented a compelling point about the women’s experiences, and labelling and defining the themes. Because thematic analysis is flexible, in that it does not restrict theoretical departure points and, given the social assumptions that were made about the research topic (marriage as a cultural structure), we adopted a constructionist interpretive perspective. Our assumption was that the women’s accounts were shaped within contexts, thus foregrounding meanings rather than motivations. We were intent on locating meanings within the contextual frame of monogamy and heterosexual marriage. The constructionist element allowed interpretation to occur within a gendered lens where marriage in South Africa is a patriarchal institution, at least for these volunteer participants. Following Braun and Clarke (2006), we were positioned, therefore, as commentators and members of a cultural reality who could offer an analysis that strives to go beyond the surface level towards constructionist-leaning interpretive ends informed by actively examining the meanings, implications, underlying assumptions, and modes of talk encapsulating the themes.

Results

Analysis of the data resulted in three themes. The first theme, HIV as Demarcation of Enduring Disruption, refers to HIV infection as the harbinger of distressing relational dynamics. The second theme, Feeling Controlled, reflects disempowerment under spousal control and was illustrated through two subthemes (viz., restricted freedoms and obligatory intimacy). The third theme, Relational Deterioration, described suspicion, fights, and partners’ disengagement.

HIV as demarcation of enduring disruption

HIV discovery destabilised marital commitment, providing contexts for how the women made sense of their relationships:

I know that there are problems in any marriage. Do you understand? They are always there, whether you are infected or not infected, they are always there. But I think problems were too many after. But for now, all I can say is that, how can I say things are? They are not hundred percent, do you understand? (P1)

I know all relationships have ups and downs but, generally, challenges. It was alright until we got married. Problems started when we were about to get our third child. (P2)

It [relationship] was very good, I don’t want to lie, I always say to him, ‘Maybe if I knew other things before we committed, I would not have agreed to you marrying me’. If I had known things before, I wouldn’t have agreed because you discover his true colours when you are already involved. (P3)

These remarks connote the taken-for-granted ideology that defines traditional marriage: P1 attested to knowing marital difficulties ‘are always there’ irrespective of being (or until) infected with HIV; P2 knew ‘all relationships have ups and downs’; and P3 remarkably commented on commitment as a defining marriage feature shown through sexual fidelity. P3’s reference to ‘true colours’ speaks to her disrupted trust and the expectation of sexual fidelity.

In contrast to P1 and P3, P2 notably mentioned that blaming her husband would have been unproductive because she had accepted her health status and instead, in a depressed stance, reflected on her disappointment in the support structure that marriage represents:

When you are married, you always have the expectations that your partner will support you. You will support each other. I did not get that. I wished, I wished, even though I knew that even for him [it] wasn’t easy; but I wished we were able to hold each other’s hands and not blame one another. (P2)

Feeling controlled

This theme reflects restrictions in freedom and intimacy.

Restricted freedoms

Two participants reported social restrictions after testing positive:

I need to get out of the house. It means he wants me here, and he is not comfortable for his kids to return from school and finds that there is no one at home. (P1)

I think he is cruel. I get irritated because he infected me with this illness and, when he is done, he accuse me of cheating. And when he is done, he wants to put me in a cage. I am not able to be with my friends and other women and socialise with them. (P3)

You wish you can visit your family who are close by . . . you just tell them that you will see them tomorrow. When you do manage to go, you only spend 10 or 15 minutes. So, if he doesn’t want you to have friends, why doesn’t he allow you to go visit them because you also get bored? You have cleaned, and you have cooked; and now you are sitting feeling bored. You can’t even go there and visit them. (P3)

These two wives were not only trapped physically in their homes by couple dynamics; they were trapped in a chronic illness and in the wife role. P3 considered that being dissuaded from having a friendship circle was unjust because she had already fulfilled her traditional homemaking duties – tasks associated with being a successful and dutiful wife – but which her husband did not even acknowledge by allowing her to go out. In her estimation, P3 deserved a reward for having lived up to her positioning as a good wife, yet in the context of HIV infection, male control became exaggerated. Similarly, P1 was required to remain at home for child care. Considered convenient for the sexual division of labour in traditional gender roles, the marital discord frames her remaining at home within homemaking and mothering duties.

Unintentionally, the theme of Feeling Controlled was noted in P1’s commentary about the interview situation, which showed how the research participation itself gave shape to this theme. P1 was compliant with the three-interview structure: This might have been so because she was aware the interviewer was a psychologist, thereby constructing the interview as an emphatic means to send the husband the message that she needed help with the marital discord. Expressing this, she implied shame and secrecy as being dynamics, pointing to fears about masculinised anger, further locating her disempowerment in the conjugal unit:

I will tell him that I am seeing someone. I am not going to hide it from him. If he gets cross about it, it doesn’t matter because he doesn’t have any say anyway. Because I told him that, for me, it feels like I am losing myself. I told him that I need help, and I told him about 2 months ago. It’s a long time though. It is something I always mention to him . . . I am going to tell him that I am seeing a psychologist.

Obligatory intimacy

This theme applies to two wives who commented on altered meanings about physical or sexual intimacy:

He is making my love to diminish . . . [W]hen you are sharing a bed with someone, and it feels as though you are sharing it with your brother, you are no longer feeling anything? (P1)

I did not want this marriage anymore. I was intending to put divorce. I was fed up. To live with somebody, and he has infected you with this virus; and now he does not even trust you. He swears at you, and he doesn’t even know whether you have healed. When, on that day, he feels like sleeping with you, you must agree to it. It’s like you have no rights. It’s like you can’t even say you are not in the mood for it; then, it will be: ‘Yes. You are having an affair’. Do you understand? We are women; our feelings and your feelings will never be the same. When you feel like being intimate with your wife, you want your wife to also be in the mood. (P3)

You expect that because you want it [sex], I must give it to you. And you don’t even know how affected I feel when I first got my status, which is because of you. And now, you want me to do this thing just to satisfy you. (P3)

My marriage, I did not enjoy because since that day I had to use a condom. Do you get me? When he touches me, it feels as though he wants to finish me off. (P3)

P3 suggests that, since testing positive, sexual intimacy took on meanings of violation and fear. P1’s ‘sharing a bed’ is an unquestioned obligation in traditional marital relationships, hinting at continuation of conjugal sexual relations but without sexual desire. Although P3 appealed briefly to a women’s rights discourse, emphasis was on emotional readiness by expecting her husband to consider her feelings so that his sexual urges could be matched by her desires. Without sexual desire (‘in the mood’), sexual intimacy was unenjoyable. Interpersonally, the blaming sentiments recall the husband being unsupportive when she was diagnosed and for which he had not accepted blame. With emphatic indignation at his expectation for sexual activity to continue, the comment, ‘You expect that because you want it, I must give it to you’, positions the husband as having ready sexual access because of her role as wife.

P3’s reflections suggest that mucosal sex within marriage was supposed to be safe and enjoyable; however, after testing HIV positive, she become aware of its risks. This awareness removed her expectations of pleasure, making her hyperconscious of the risk of (re)infection, which conflicted with conjugal obligations. For P1, the comparison to sharing a bed with a brother suggests the dissolution of romantic feelings. For both women, this dynamic was an effect of the conjugal roles and setups.

Spotlighted was P3’s interpretation of husband’s sexual advances as attempts to ‘finish [her] off’. Rather than suggesting anxiety about getting reinfected with HIV, she positions herself as being a victim and the husband as a killer.

Relational deterioration

This theme has three subthemes: suspicions of infidelity, fights, and partner disengagement.

Suspicions of infidelity

After testing HIV positive, the marital relationship was fraught with arguments and fights:

Sometimes, I would even imagine things that are not there . . . I was going to a funeral and left him with the kids, and I think the kids were sharing a room with him when I was away. So, I see hair like this one [pointing to her braids] but if I had my hair done, I would get it done at a saloon [salon] and not here at home. So, I see this piece of hair, and we start fighting over this hair. I start asking him who was here, and only to find out that this was a doll’s hair. (P1)

Mistrust led P1 to question her husband’s faithfulness when she was not at home. She suspected her husband had brought a female sex partner to their home. The mistrust was enough to doubt her reality testing (‘I would imagine things’). P3, unlike P1, reported her husband had insinuated that the sexual infidelity was on wife’s side:

He would abuse me emotionally, accuses me of cheating, not trusting me, you see. You can’t even meet other women. You know, maybe if he was treating me like this [and] if it was me who brought this, this sickness or I was gallivanting. (P3)

Fights

The marriage changed because of arguments or physical fights:

So, as I was getting dressed, a message came through his phone. The message was from a certain lady. When the message arrived, I asked him then who is she? He then responded by telling me that he works with her. I asked, ‘What did she want?’ And he said, ‘She is a colleague from work, and she was just checking me’. And what made me to get suspicious is that I asked him to unlock his phone . . . I think he deleted the message, so that is why I ended up strangling him. I don’t want to lie; I was strangling him because I was angry with him, and my anger was because here in our home, we have this sickness, but there are still other women. (P1)

That’s when [HIV disclosure] arguments started, and things were never right from there, even though I would never say things were never fine immediately after telling him; but from there things were never the same like before. (P2)

To have your husband rape you and, at that time, he rapes you when your uncle is here. Your uncle is like your own father. Just because you went and assisted other women to peel, the people who were also assisting you. When you arrive here at home, you see, how this house is designed, you get pushed into the other side and asked to undress and, as you are asking [thinking], ‘Why you must get undressed? Undress, undress, undress. What?’ I am in my period! At the time you even wet yourself while you are in your period. There are many things that have traumatised me in this house. (P3)

Underlying the conflict that followed HIV diagnosis was broken trust. P1 expressed anger when she suspected that her husband had continued with extramarital relationships despite him knowing they were HIV positive. Her anger escalated into physical attacks. P3’s violation extended to being raped; however, prefiguring this point in her story is the description of her gendered responsibility in her South African Black community to assist in funeral preparations: She had returned home after fulfilling a duty as a woman by assisting the community to ‘peel’ – this refers to catering (peeling vegetables) as a communal activity that occurs before a large gathering, such as funerals. Communicated here discursively is her fulfilling of duties in the sexual division of labour that amounted to a community obligation (‘you went and assisted other women to peel’). This fortifies her gendered innocence: She did not interact with men. On returning home after having performed women’s duties, she became a victim of partner rape.

Noticeable is the anger for P1 and P3, expressed within allusions to HIV infection: ‘[M]y anger was because here in our home, we have this sickness, but there are still other women’ (P1) and ‘[M]any things that have traumatised me in this house’ (P3). The quotes indicate the women’s anger at their husbands for bringing HIV into a secure space – repeated through in ‘house’ and ‘home’ – both symbolic of the sanctity of marriage. The violation is not one of physical health and the body, but of the domestic space that represents the monogamous commitment in heteronormative marriage. Conflict was also expressed nonverbally. It was symbolised by spatial reorientation in P2’s marriage after her HIV discovery: ‘That’s when things started changing: We no longer sit together in the lounge; when he does get home, he goes straight to the bedroom even if he is not sleeping’. P2’s recollection here is connected to the next theme.

Related to the theme of the virus discovery demarcating the marital break, P2, after having disclosed to her husband while pregnant with their third child, recalled, ‘He had difficulty accepting but on my side I accepted’. P2 did not report anger as with the other two participants as she felt supported by her mother and her faith in religion.

Partner disengagement

This subtheme reflects the partner’s decreasing communication or physical distancing. First, the reduced communication was interpreted as husbands’ suppressing of emotions:

When you are talking to someone and you feel like you are talking to a brick wall, I don’t know, you know, and I won’t say I know how he feels. He keeps quiet and, for me, keeping quiet is like the one thing that annoys me the most. (P1)

You are able to stay 3 to 4 months without speaking to each other. (P3)

No, we do speak but not that topic. We do not even touch it. We do speak about other things, but that one we do not touch it. (P3)

The final extract in the preceding set of quotes is striking in reference to ‘that topic’, revealing husband’s avoidance of talk about HIV and sexual health.

Next, the disengagement, recalled by P2, was noticed after her disclosure of being infected, and this pattern seemed to have continued until the husband had moved out of their house to live with another woman:

That’s when the situation started, even touching one another when we are in the bedroom. There was a distance between us, which I noticed, you see. Even when he said everything was fine, I could see that things were no longer the same

We have a child who was in boarding school; he [husband] was using his room at the time, and I was left alone in our room.

Discussion

Whereas Chireshe and Chireshe’s (2011) study merely illustrated perceptions that marriage is not a haven for protection from HIV infection, our analysis provides a glimpse, offered by three women of the experiences of marriage as not being a haven. Gendered vulnerabilities that shaped marital conflict for two women and their views of male control were framed as husband deceit. This carries implications for husbands’ responsibilities for disclosure and making transparent less safe sexual activities carried out outside of the primary unit. In other words, aligned with perceptions of harm, men – more than women – cherish monogamous marriage as an institution that protects them from HIV infection (Chireshe & Chireshe, 2011).

Control over a wife is a control of sexuality and relegation to domesticity. Women, in their position in a married couple, take on patriarchal notions of being a wife. The subtheme of obligatory intimacy shows how, from a monogamous wife’s perspective, this role brings problems in retaining physical or sexual intimacy (P1 and P3). Similarly, in Varma et al.’s (2010) study, submitting to sexual demands was a means of averting sexual violence, which was demonstrated by one woman reporting partner rape in our study. Sexual violence, which upholds masculinity, is part of the cultural script of forgiving and respecting male partners (Leclerc-Madlala, 2009).

From wives’ experiential perspectives of marriage, which was the focus of this study, husbands’ accusations of infidelity characterise the marital conflict in the context of HIV infection. As with the instances in our study when husbands questioned fidelity, monogamous south Indian women whose husbands had abused alcohol were also considered to suspect their wives to be unfaithful if they were to suggest condom use (Varma et al., 2010). Husbands’ jealousy, reported in our subthemes, implied spousal control aimed at limiting a woman’s social circle. In the context of an inquiry about women who do not use condoms, decreased extraconjugal social support led to emotional and social dependency on the primary partner, which represented the idealisation of the conjugal unit (Sobo, 1995).

The two women who expressed anger in this study were similar to women in the same position in Stevens and Hildebrandt’s (2006) study who were outraged at what was considered to be partner treachery. Thus, in the position of being a faithful wife, women consider themselves rightfully angry (Stevens & Hildebrandt, 2006). In South Africa, Subramoney (2015), referring to Indian women who had contracted HIV in relationships with single partners, considered the betrayal from partners and HIV infection as compounding their suffering while they, in the social status of outcast, ended up struggling in lives already located in the structural violence of poor housing, gender inequalities, and poverty. However, Subramoney’s (2015) participants, unlike the women in our study, were not in intimate relationships with their (infected) partners at the time of their interviews because most of them had become single widows. Our analysis shows, instead, that being an HIV-infected wife, rather than a widow, can expose male control and continued female disempowerment.

Our analysis also shows how the discovery of HIV in a nonmutual monogamous marriage interrupts cultural scripts about hidden concurrent sexual relations (Leclerc-Madlala, 2009), making this narrative about husband deception for two women in our study.

One wife (P2), although, was left disillusioned with marital coupledom because her expectation of spousal support became shattered. Her meanings implied she had idealised the institution of marriage because, from the moment of the HIV intrusion, she considered her husband unresponsive to her crisis, and this loss became pronounced when he moved out to live with another woman. For another woman, the positioning of a husband as a killer was not unexpected, given the early associations of HIV infection with death. As a woman exclaimed in Stevens and Hildebrandt’s (2006, p. 25) study: ‘I felt as though my husband may as well have just taken a gun and shot me’.

It is not the community representation of HIV that is at play in our study. Our findings show the introjection of representations of the trust/sexual fidelity dynamic at play; that is, ‘the naturalization of unprotected sex in a stable or lasting relationship’ within the bigger social representation of unquestioned trust in the security of the relationship and denial of vulnerability to sexually transmitted infections (Ribeiro et al., 2021, p. 6).

Conclusion

Two wives’ reflections on marital discord after having been infected with HIV show that the infection added to their experiences of feeling trapped because they needed to regress into subservient female roles. They were required to retreat into household, mothering, and child care duties. HIV infection of a monogamous wife can thus serve as a case example within Roseneil et al.’s (2020) broader sociological project that draws on the very construction of the conventional couple as an oppressive androcentric institution. The traditional couple is located within monogamy as a defining feature of ‘committed relationship ideology’ (Day, 2016, p. 349) but, as the wives’ experiences in our study show, this is an ideal that gets shattered and ejected when HIV disrupts stability. The romantic love script represents sexual exclusivity, but the complication is that partner trust in fixed relationships has been shown to lead to late or delayed serological status discovery when CD4 counts get low (Ribeiro et al., 2021).

Because research was sparse in including or aiming at exploration of spousal dynamics in nonmutually monogamous heterosexual marriages, specifically when the monogamous wife tests positive for HIV during (conventional) marriage, this study aimed to access and describe that wife’s experiences and meanings of those interpersonal marital relations. The phenomenological interviewing allowed for empathic care to examine a sensitive topic because of wives’ disclosures touching on unresolved or painful emotional content. The interviewing style was therefore focused on women’s lifeworlds rather than probing for their speculations of husband’s individual motivations and behaviours. Interpretation, from a constructionist perspective, illuminated those meanings within gendered, heteronormative, and patriarchal institutions. Accordingly, the study could only, via the constructionist analysis, illustrate how the women positioned themselves and how they positioned their husbands. Given this, this picture remains incomplete because husband’s perspectives remain absent. To address this, further research could use conjoint interviewing or individual interviews with husbands.

In this study, husbands’ reactions cannot therefore be verified. Two wives’ tones of anger, although, point to the need for sexual health promotion interventions to be attuned to this emotion which is communicated within frames of injustice. Furthermore, couple intervention should be initiated soon after the sexually nonmonogamous spouse receives an HIV-positive test result. That is, although immunological safety is addressed by taking antiretrovirals, as was the case for our participants, altered couple dynamics require psychological therapies to address not only the HIV infection in the nonmonogamous partner but also individual and couple wellbeing that could be disrupted long term by the concomitant shattering of investments in traditional relationship ideology as experienced by the (female) partner. These complications, although, could be lessened, if the partner who tests positive, discloses that positive test result so that, as done in serodiscordant relationships, the HIV-negative partner begins HIV pre-exposure prophylaxis. Still, the disruption of investments in traditional marriage ideology would remain the couple-intervention focus.

Procedure modification was a study limitation: Each woman did not have three interviews as planned, but these were still delineated in three phases, as proposed by Seidman’s (2006) phenomenological interviewing structure. Reflecting on interviewer positionality, the first author, a clinical psychologist, needed to navigate the blurring of boundaries with P1, who initially associated being interviewed by a psychologist as being akin to ventilating during psychotherapy. In response, the research frame was clarified, and P1 was subsequently referred to a mental health practitioner. This instance, as well as the study, suggests that, to address the aftermath of HIV infection in those married couples where sexual monogamy is the unquestioned norm, interventions incorporate a gendered and critical (social) formulation in counselling applications.