What the better half is thinking: A comparison of men’s and women’s responses and agreement between spouses regarding reported sexual and reproductive behaviors in Rwanda

• Authors: Kathy Marie Hageman, Emory University; Etienne Karita, Projet San Francisco; Kayitesi Kayitenkore, Projet San Francisco; Roger Bayingana, Projet San Francisco; Ariane van der Straten, RTI International; Robert Stephenson, Emory University; Martha Conkling, Zambia Emory HIV Research Project; Amanda Tichacek, Emory University; Lawrence Mwananyanda, Zambia Emory HIV Research Project; William Kilembe, Zambia Emory HIV Research Project; Alan Haworth, University Teaching Hospital; Elwyn Chomba, University Teaching Hospital; Susan A Allen, Emory University
• Journal Title: Psychology Research and Behavior Management
• Volume: Volume 2
• Publisher: Dove Medical Press | 2009-03-10, Pages 47-58
• Type of Work: Article | Post-print: After Peer Review
• Subjects: Psychology, Behavioral; Health Sciences, Public Health
• Keywords: HIV; couples; counseling and testing; agreement and disagreement; sexual behavior; condom use; pregnancy

Abstract

Objective: To compare responses to a sexual behavioral survey of spouses in cohabiting heterosexual relationships in Kigali, Rwanda. Design: Cross-sectional survey. Methods: Husbands and wives in 779 cohabiting couples were interviewed separately with parallel questionnaires. Participants were recruited from a three-year old cohort of 1458 antenatal clinic attendees enrolled in a prospective study in 1988. Analyses compared responses at the gender- and couple-level for agreement and disagreement. Results: Couples were in disagreement more than agreement. Women reported occasionally refusing sex, suggesting condom use, and believing married men were unfaithful. Men reported being in a faithful relationship, greater condom use, and being understanding when wives refused sex. Agreement included relationship characteristics, safety of condoms, and whether condoms had ever been used in the relationship. Disagreement included the preferred timing of next pregnancy, desire for more children, and whether a birth control method was currently used and type of method. Conclusions: Rwandan husbands and wives differed in sexual behavior and reproductive-related topics. Couple-level reporting provides the most reliable measure for relationship aspects as couples’ agreement cannot be assumed among cohabiting partnerships. Furthermore, HIV prevention programs for couples should incorporate communication skills to encourage couple agreement of HIV-related issues.